Missed CHC pills week 3 — DFSRH MCQ

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HardCombined hormonal contraceptionMissed CHC pills week 3DFSRH

A 25-year-old woman has missed three combined pills in week 3 of a 21-day pack. She had no unprotected sex in week 1 and wants to avoid pregnancy. What is the most appropriate management?

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Correct answer: E — Take the most recent missed pill and omit the hormone-free interval

The best answer is “Take the most recent missed pill and omit the hormone-free interval”. With multiple missed pills in week 3, the hormone-free interval should be omitted to prevent follicular escape. EC is not routinely required if week 1 was protected and prior pills were taken correctly. The trap is treating every missed-pill scenario the same. Combined hormonal contraception must be assessed by applying oestrogen-related arterial and venous risk, the exact timing of incorrect use, drug interactions and the need for emergency contraception. A non-oestrogen method may be acceptable even when CHC is not. Missed-use advice depends on whether the hormone-free interval was extended, rather than simply on the number of tablets mentioned.

Reference: CoSRH/FSRH, Recommended Actions after Incorrect Use of Combined Hormonal Contraception: https://www.cosrh.org/Common/Uploaded%20files/documents/fsrh-ceu-recommended-actions-after-incorrect-use-of-chc-march-2020-amended-jul-2021-.pdf