What to do when oral contraceptive pills are missed?

What to do when oral contraceptive pills are missed?

Many women around the globe are using oral contraceptive pills and missing the pills are not rare as according to a study only 33% of women reported to have missed no pills in 1^st cycle and by 3^rd cycle about one-third of women missed 3 or more pills with many episodes of consecutive days of missed pills. Missed pills may lead to contraceptive failure so women must know what to do when pills are missed. If you want to know about correct use of pills then you can visit my earlier blog, the link of which is given at the end of this article.

I) If a woman misses one pill – She should take the pill as soon as she remembers and continue the rest of the schedule as usual. Suppose a women takes a pill daily at 8pm and forgets to take it on Tuesday but remembers it on Wednesday morning, she must take the pill on Wednesday morning and continue the schedule as usual, i.e., from Wednesday 8pm onwards. There is no need for any backup protection (condoms etc.).

II) If a woman misses two pills   (on consecutive days) in first two weeks-   She must take two pills daily on two consecutive days and then finish the pack according to schedule. In addition to this, she must take back-up protection (may be in the form of condoms) for 7 days. Suppose a woman forgets to take pills on Tuesday and Wednesday, then she must take two pills on Thursday and Friday and finish the pack as usual. She should also use a back-up protection (condoms) from Thursday to Wednesday of next week.

III) If a woman misses two pills   (on consecutive days) during 3^rd week or misses 3 or more pills (consecutively) at any point of cycle-

a)      Day 1 start user- She should start a new packet and also use a back-up (condoms or abstinence) immediately and for 7 days.

b)      Sunday start user-   She should take a pill daily until Sunday and then start a new packet. She must also use back-up immediately and for 7 days.

How  to use pills correctly-

 https://meddscience.blogspot.in/2018/03/how-to-use-oral-contraceptives-pills.html
 Please comment in comments section, I,ll be very happy to respond to those comments.

 

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How to use oral contraceptives pills correctly?

ORAL CONTRACEPTION

     Oral contraceptive pills (OCPs) are the one of the most common methods of contraception used nowadays. Though it is very effective but  because of its improper use it may lead to contraceptive failure or pregnancy. Unfortunately improper use is very much prevalent and there is a need to create proper awareness among users so that failure rates can be minimized.This article attempts to clear all those doubts and confusions regarding its use in the most simple way possible.

     Most commonly used oral contraceptive pills are combined oral contraceptive pills which has one estrogen component and one progesterone component. Estrogen and progesterone are the name of hormones which has many functions inside the body and ovulation is one of them which is necessary for attaining pregnancy. This pills prevent this ovulation by negative feedback inhibition mechanism, which I am not going into details as it is outside the scope of this article. So, I 'll be discussing correct use of combined oral contraceptive pills.

  HOW TO TAKE PILLS

There are commonly 2 choices of  starting the pills                    

1) Start on first day of menses. 

    Advantage- Assured immediate protection.      

    In this method , first pill is taken on the first day of menses and then  one pill is taken daily preferably at the same time, for eg. 8pm daily. Once 21 pills are finished , then you can wait for 7 days in which menses occur , in technical terms it is called withdrawal bleed.Sometimes 7 dummy pills of iron are provided in the packet for continuation after 21 pills of OCPs for maintaining continuity as shown in the figure above. You have to start next cycle immediately after this 7 days , i.e 29th day , which is the 1st day of your next cycle irrespective of your menses. In some packets this dummy pills are absent, in that case you have to simply wait for 7 days (pill free period) and then from 8th day start the next cycle of 21 pills.Its user's choice whether to take those 7 dummy pills or not.This  pill taking has nothing to do with calendar dates. Some companies like Mala-D/Mala-N also advise to start pills on 5th day of menstruation which also can be practiced.

2) Start on first Sunday after onset of menses.
    Advantage- Avoids weekend menses.
    Disadvantage- Backup protection ( may be in the form of condoms) is advised during first week.

       In this method , you have to start taking pills on first Sunday following the onset of menses and added backup protection (eg.condoms) is advised in the first week of use.Suppose, menses start on Wednesday, then  condoms may be used from Wednesday to next Wednesday and pills has to be started on Sunday following first Wednesday and then next cycle will be continued . There is no need for backup protection (eg.condoms) from 2nd cycle onwards if continued properly. 

       First day start is preferred and Sunday start  is no longer recommended.

     In my upcoming blogs I will be discussing about what to do in case of missing pills, who is the proper candidate of OCPs, Continuing pills without pill free period, and what are side effects of this pills.
   
Thanks for reading and please go through my upcoming blogs if  you found it relevant.

                                                                                           - Dr. Rohit Kr Sinha

  

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