Emergency Contraceptive Pills: What to Do After a Missed Dose? - Obstetrics and Gynecology

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When it comes to missed doses of oral contraceptive pills, especially in the context of emergency contraceptive measures, it is crucial to understand the implications and necessary actions to take. Based on the scenario you've provided, your girlfriend typically takes a 21-day oral contraceptive pill and missed the dose on February 21. She took two pills on February 23, which is a common approach to address a missed dose, but there are specific guidelines to follow to ensure continued contraceptive effectiveness.

First, it’s important to note that the effectiveness of oral contraceptives can be compromised if doses are missed, particularly if the missed dose is in the first or third week of the pill cycle. In your girlfriend's case, since she missed the dose on February 21, she should have taken the missed pill as soon as she remembered. Since she took two pills on February 23, she has effectively compensated for the missed dose, but there are additional considerations.

According to the guidelines for missed doses of combined oral contraceptives, if a single pill is missed (which is the case here), it should be taken as soon as remembered, and the next pill should be taken at the usual time. Since she took two pills on February 23, she should continue taking her pills as scheduled, meaning she should take her next pill on February 24 at the usual time (11:50 PM).
However, since she missed a dose and had unprotected intercourse during this time, there is a risk of unintended pregnancy. If the missed dose was more than 24 hours ago, it is advisable to use a backup method of contraception, such as condoms, for the next seven days to ensure protection against pregnancy. This is particularly important if she had unprotected sex after the missed dose.

In addition, if there is any concern about potential pregnancy due to unprotected intercourse after the missed dose, it may be prudent to consider emergency contraception (EC). Emergency contraceptive pills (like Plan B or Ella) can be taken within a certain time frame after unprotected intercourse to prevent pregnancy. The sooner they are taken, the more effective they are, ideally within 72 hours for Plan B and up to 120 hours for Ella.

Regarding the menstrual cycle, missing a dose can sometimes lead to irregular bleeding or changes in the timing of the next period. If your girlfriend experiences unusual bleeding or if her period is more than a week late after this incident, it would be wise for her to take a pregnancy test and consult with a healthcare provider.

In summary, after a missed dose of oral contraceptive pills, the following steps should be taken:
1. Take the missed pill as soon as remembered.

2. Continue taking the remaining pills as scheduled.

3. Use backup contraception for the next seven days if the missed pill was taken more than 24 hours late.

4. Consider emergency contraception if unprotected intercourse occurred after the missed dose.

5. Monitor for any irregularities in the menstrual cycle and consult a healthcare provider if necessary.

It's always best to consult with a healthcare professional for personalized advice and to address any specific concerns regarding contraceptive use and sexual health.