Recommended Actions After Late or Missed Combined Oral Contraceptives

If one hormonal If one hormonal pill has been If two or more consecutive hormonal
pill is late: (<24 hours since a missed: (24 to <48 hours since pills have been missed: (≥48 hours
pill should have been taken) a pill should have been taken) since a pill should have been taken)

• Take the late or missed pill as • Take the most recent missed pill as soon as possible
soon as possible. (any other missed pills should be discarded).
• Continue taking the remaining • Continue taking the remaining pills at the usual time
pills at the usual time (even if it (even if it means taking two pills on the same day).
means taking two pills on the • Use back-up contraception (e.g., condoms) or avoid
same day). sexual intercourse until hormonal pills have been taken
• No additional contraceptive for 7 consecutive days.
protection is needed. • If pills were missed in the last week of hormonal pills
• Emergency contraception is (e.g., days 15-21 for 28-day pill packs):
not usually needed but can -- Omit the hormone-free interval by finishing the
be considered if hormonal hormonal pills in the current pack and starting a new
pills were missed earlier in the pack the next day.
cycle or in the last week of the
previous cycle. -- If unable to start a new pack immediately, use back-
up contraception (e.g., condoms) or avoid sexual
intercourse until hormonal pills from a new pack have
been taken for 7 consecutive days.
• Emergency contraception should be considered if
SUN MON TUES WED THUR FRI SAT hormonal pills were missed during the first week and
1
unprotected sexual intercourse occurred in the previous
5 days.
2
• Emergency contraception may also be considered at
3 other times as appropriate.
4

Source: For the full recommendations, see the US Selected Practice Recommendations for Contraceptive Use, 2013 (http://www.cdc.gov/mmwr/pdf/rr/rr6205.pdf).
 Recommended Actions After Delayed Application Recommended Actions After Delayed Insertion
or Detachment With Combined Hormonal Patch or Reinsertion With Combined Vaginal Ring
Delayed application or Delayed insertion of a new Delayed insertion of
Delayed application or
detachment* for <48 ring or delayed reinsertion* a new ring or delayed
detachment* for ≥48 hours
hours since a patch of a current ring for <48 reinsertion* for ≥48 hours
since a patch should have
should have been hours since a ring should since a ring should have
been applied or reattached
applied or reattached have been inserted been inserted

• Apply a new patch as • Apply a new patch as soon as possible. • Insert ring as • Insert ring as soon as possible.
soon as possible. • Keep the same patch change day. soon as possible. • Keep the ring in until the scheduled ring
(If detachment occurred • Keep the ring in until removal day.
<24 hours since the • Use back-up contraception
(e.g., condoms) or avoid sexual the scheduled ring • Use back-up contraception
patch was applied, removal day.
try to reapply the patch intercourse until a patch has been worn (e.g., condoms) or avoid sexual
or replace with for 7 consecutive days. • No additional intercourse until a ring has been worn
a new patch.) • If the delayed application or detachment contraceptive for 7 consecutive days.
occurred in the third patch week: protection is needed. • If the ring removal occurred in the third
• Keep the same patch
change day. -- Omit the hormone-free week by • Emergency week of ring use:
finishing the third week of patch use contraception is not -- Omit the hormone-free week by
• No additional usually needed but
contraceptive (keeping the same patch change day) finishing the third week of ring use
and starting a new patch immediately. can be considered if and starting a new ring immediately.
protection is needed. delayed insertion or
• Emergency -- If unable to start a new patch reinsertion occurred -- If unable to start a new ring
contraception is not immediately, use back-up earlier in the cycle or immediately, use back-up
usually needed but contraception (e.g., condoms) or in the last week of the contraception (e.g., condoms) or avoid
can be considered if avoid sexual intercourse until previous cycle. sexual intercourse until a new ring has
delayed application or a new patch has been worn for been worn for 7 consecutive days.
detachment occurred 7 consecutive days. • Emergency contraception should be
earlier in the cycle or • Emergency contraception should be considered if the delayed insertion or
in the last week of the considered if the delayed application reinsertion occurred within the first
previous cycle. or detachment occurred within the first week of ring use and unprotected
week of patch use and unprotected sexual intercourse occurred in the
*If detachment takes place but sexual intercourse occurred in the *If removal takes place but the previous 5 days.
the woman is unsure when previous 5 days. woman is unsure of how long the
detachment occurred, consider ring has been removed, consider • Emergency contraception may also be
the patch to have been detached • Emergency contraception may also be the ring to have been removed for considered at other times as appropriate.
for ≥48 hours since a patch should considered at other times as appropriate. ≥48 hours since a ring should
have been applied or reattached. have been inserted or reinserted.

Source: For the full recommendations, see the US Selected Practice Recommendations for Contraceptive Use, 2013 (http://www.cdc.gov/mmwr/pdf/rr/rr6205.pdf). CS248124