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Drospirenone POP missed pill — DFSRH MCQ

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HardProgestogen-only methodsDrospirenone POP missed pillDFSRH

A drospirenone POP user missed the first two active tablets after the placebo interval, had diarrhoea for 24 hours and had UPSI yesterday. She restarts today. Which plan best manages the compounded risk?

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Correct answer: C — Assess EC and use condoms until 7 active pills are taken

The best answer is “Assess EC and use condoms until 7 active pills are taken”. Missed active drospirenone pills immediately after the placebo interval extend the hormone-free period; diarrhoea may compound failed absorption. EC must be assessed for the recent UPSI, the POP restarted, and additional precautions used until seven consecutive active pills have been taken. Switching product or taking extra tablets does not retrospectively cover UPSI.

Reference: CoSRH/FSRH, Progestogen-only Pills (August 2022, amended April 2026): https://www.cosrh.org/Public/Public/Documents/ceu-guideline-progestogen-only-pills.aspx