Missed pills: frequency, reasons, consequences and solutions

Abstract

Objectives: Oral hormonal contraception is an effective contraceptive method as long as regular daily intake is maintained. However, a daily routine is a constraint for many women and can lead to missed pills, pill discontinuation and/or unintended pregnancy. This article describes the frequency of inconsistent use, the consequences, the risk factors and the possible solutions.

Methods: The article comprises a narrative review of the literature.

Results: Forgetting one to three pills per cycle is a frequent problem among 15–51% of users, generally adolescents. The reasons for this are age, inability to establish a routine, pill unavailability, side effects, loss of motivation and lack of involvement in the initial decision to use oral contraceptives. The consequences are ‘escape ovulations’ and, possibly, unintended pregnancy. Solutions are either to use a long-acting method or, for women who prefer to take oral contraceptives, use a continuous or long-cycle regimen to reduce the risks of follicular development and thus the likelihood of ovulation and unintended pregnancy. A progestogen with a long half-life can increase ovarian suppression.

Conclusions: For women deciding to use oral contraceptives, a shortened or eliminated hormone-free interval and a progestogen with a long half-life may be an option to reduce the negative consequences of missed oral contraceptive pills.

Chinese abstract

目标：口服激素避孕是一种有效的避孕方式, 只要定期维持每日摄入量即可。然而, 日常生活是许多妇女的制约因素, 可能导致漏服药、停药和/或意外怀孕。本文介绍了不连续用药的频率、后果、风险因素和可能的解决方案。

方法：本文对文献进行了叙述性综述。

结果：对于15%∼51%的口服避孕药服用者, 通常是青少年, 每个周期漏服1 ∼ 3粒药是一个常见问题。其原因有年龄、无法建立常规、无法得到药物、副作用、失去动力和缺乏对服用口服避孕药最初决策的参与, 后果是避开排卵, 也有可能意外怀孕。对于喜欢服用口服避孕药的妇女, 可以选择服用长效口服避孕药, 采用连续或长周期方案来降低卵泡发育的风险, 从而降低排卵和意外怀孕的可能性。具有长半衰期的孕激素可促进卵巢抑制。

结论：对于决定服用口服避孕药的女性而言, 缩短或消除无激素间隔及服用具有长半衰期的孕激素可能是减少漏服口服避孕药所致负面后果的选择

Keywords:

• Compliance
• efficacy
• half-life
• hormone-free interval
• missed pill
• nomegestrol acetate
• non-compliance
• progestogen
• regimen

Acknowledgements

The manuscript was prepared with writing and editorial assistance from Jean-Louis Carsol, Daniel Loniewski and Tristan Blundell (Publicis Life Brands).

Disclosure statement

N. C.-B. is a member of the European board of Teva Pharmaceutical Industries/Theramex and of the French board of Gedeon Richter. C. J. is a consultant for MSD, Teva Pharmaceutical Industries and HRA Pharma. I. L. has a financial relationship (lecturer, member of advisory boards and/or consultant) with MSD, Teva Pharmaceutical Industries, Gedeon Richter, HRA Pharma and Nordic Pharma. P. L. has received lecture fees, is a member of advisory boards and/or is a consultant with Bayer HealthCare Pharmaceuticals, Effik, MSD and Teva Pharmaceutical Industries/Theramex. R. E. N. has a financial relationship (lecturer, member of advisory boards and/or consultant) with Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim, Eli Lilly, Gedeon Richter, HRA Pharma, MSD, Novo Nordisk, Pfizer, Procter & Gamble, Shionogi and Teva Pharmaceutical Industries. A. P. is a member of the European Board of Teva Pharmaceutical Industries, without personal gain. C. F. has been a lecturer for Teva Pharmaceutical Industries and Bayer HealthCare Pharmaceuticals, and is a member of the European scientific advisory board of Teva Pharmaceutical Industries and Exelgyn.

Additional information

Funding

This study was supported by Teva Pharmaceutical Industries.