Eur J Contracept Reprod Health Care. 2017 Mar 9:1-5.

Missed pills: frequency, reasons, consequences and solutions

Chabbert-Buffet N, Jamin C, Lete I, Lobo P, Nappi RE, Pintiaux A, Häusler G and Fiala C


Objectives: Oral hormonal contraception is an effective contraceptive method as long as regular daily intake is maintained. However, a daily routine is a constraint for many women and can lead to missed pills, pill discontinuation and/or unintended pregnancy. This article describes the frequency of inconsistent use, the consequences, the risk factors and the possible solutions.

Methods: The article comprises a narrative review of the literature.

Results: Forgetting one to three pills per cycle is a frequent problem among 15-51% of users, generally adolescents. The reasons for this are age, inability to establish a routine, pill unavailability, side effects, loss of motivation and lack of involvement in the initial decision to use oral contraceptives. The consequences are 'escape ovulations' and, possibly, unintended pregnancy. Solutions are either to use a long-acting method or, for women who prefer to take oral contraceptives, use a continuous or long-cycle regimen to reduce the risks of follicular development and thus the likelihood of ovulation and unintended pregnancy. A progestogen with a long half-life can increase ovarian suppression.

Conclusions: For women deciding to use oral contraceptives, a shortened or eliminated hormone-free interval and a progestogen with a long half-life may be an option to reduce the negative consequences of missed oral contraceptive pills.

Comment: Often we are confronted with women who come with a question about forgotten pill(s). While many users think that forgetting a pill mid-"cycle" is a risk, it is actually the lengthening of the pill-free interval that causes an escape ovulation. So if two or more pills at the beginning or the end of as strip are forgotten, then additional contraception is needed. These authors give advice for women in whom this happens often: shortening routinely the pill-free interval to five or six days. (HMV)