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GPs able to reassure women over missed contraceptive pills

By Lilian Anekwe

GPs can reassure women that there is no need to take additional precautions if only one active contraceptive pill is missed, according to revised guidance from the Royal College of Obstetricians and Gynaecologists.

The guidance, produced jointly with the MHRA, also advises that if women have missed two or more pills – either consecutively or any two pills in the pack – additional precautions should be taken only for the next seven days.

The previous guidance was updated to include the new recommendations after the MHRA and the College's faculty of sexual and reproductive healthcare clinical effectiveness unit found 'anecdotal evidence that women and healthcare professionals found existing rules complicated and difficult to use.'

The guidance also states that if a GP is 'reasonably certain' that the woman is not pregnant, combined oral contraceptive pills can be initiated on any day of the menstrual cycle, not just the first day.

But additional contraceptive precautions are required for the first seven days if the pills are started after day five of the cycle.

These recommendations apply to all combined oral contraceptive pills, except Qlaira, 'in view of the limited clinical experience with this product to date'. Women taking this pill should seek advice from their GPs if they have missed a pill.

Dr Carolyn Sadler, a GP in Derby and associate specialist in sexual health said the guidance would bring welcome clarifications.

'The old guidelines weren't very user friendly. They were quite complex and difficult to explain to patients.'

'The guidance clarifies that the rules are the same for the different doses of pill and that if you missed one it's OK but if you missed two then you need to take additional precautions.'

'It reminds us to go into the history and check women haven't missed previous pills. I think it's good that they're now requesting that drug companies bring their data sheets into line with the guidance.'

What the guidance recommends

One missed pill:
- Take the last pill you missed now
- Continue taking the rest of the pack as usual
- No additional or emergency contraception necessary.

Two or more missed pills:
- Take the last pill you missed now
- Continue taking the rest of the pack as usual
- Leave any earlier missed pills
- Use an additional method of contraception for the next seven days
- If you have had unprotected sex in the previous seven days, you may need emergency contraception. Seek advice.
- If there are seven or more pills left in the pack, finish the pack and have the usual seven day break. If there are less than seven pills left, finish the pack and begin a new one next day.

Source: Faculty of sexual and reproductive healthcare clinical effectiveness unit, May 2011

GPs able to reassure women over missed contraceptive pills

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