A 22-year-old woman on a combined oral contraceptive forgets to take the last pill and is 14 hours late in the third week of her pack. What is the most appropriate advice?

• A. Take the missed pill now, continue the pack as usual, and take the 7-day break as normal
• B. Stop the current pack and start a new pack immediately
• C. Do not take any more pills this cycle and wait for next withdrawal bleed
• D. Use an additional barrier method for 7 days

Answer: (A)

When a combined oral contraceptive is missed by a small amount, the aim is to keep hormone levels as close to regular as possible. If the missed active pill is taken within 24 hours, you should take it as soon as you remember, continue taking the remaining pills on their usual schedule, and proceed with the normal seven-day pill-free interval.

Here, a single missed pill with only a 14-hour delay in the third week still falls within that short window. Taking the missed pill now restores the pill’s hormone coverage, so no change to the pack timing is needed and you can have the withdrawal bleed at the end of the pack as usual. This preserves contraceptive effectiveness without introducing a gap that could risk ovulation.

If more pills were missed or the delay extended beyond 24 hours, a backup method for a specified period or starting a new pack might be considered, but for this scenario the described course is appropriate.