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WHO Empfehlungen für vergessene Pillen

13. Mai 2011 um 19:29 Letzte Antwort: 3. Dezember 2011 um 15:42

Quelle: World Health Organization, SELECTED PRACTICE RECOMMENDATIONS FOR CONTRACEPTIVE USE
Second edition, 2004

Leider nur in Englisch, klärt aber viele der hier gestellten Fragen!

17.What can a woman do if she misses combined oral contraceptives (COCs)?

For 3035 g ethinylestradiol pills:

Missed 1 or 2 active (hormonal) pills or if she starts a pack 1 or 2 days late
She should take an active (hormonal) pill as soon as possible* and then continue taking pills daily, 1 each day.
She does not need any additional contraceptive protection.

Missed 3 or more active (hormonal) pills or if she starts a pack 3 or more days late
She should take an active (hormonal) pill as soon as possible* and then continue taking pills daily, 1 each day.
She should also use condoms or abstain from sex until she has taken active (hormonal) pills for 7 days in a row.
If she missed the pills in the third week, she should finish the active (hormonal) pills in her current pack and start a new pack the next day. She should not take the 7 inactive pills.
If she missed the pills in the first week and had unprotected sex, she may wish to consider the use of emergency contraception.

For 20 g or less ethinylestradiol pills:

If the woman misses 1 active (hormonal) pill or starts a pack 1 day late, she should follow the guidance above for Missed 1 or 2 active (hormonal) pills or if she starts a pack 1 or 2 days late.
If the woman misses 2 or more active (hormonal) pills or if she starts a pack 2 or more days late, she should follow the guidance above for Missed 3 or more active (hormonal) pills or if she starts a pack 3 or more days late.

For both 3035 g and 20 g or less ethinylestradiol pills:
Missed any inactive (nonhormonal) pills
She should discard the missed inactive (nonhormonal) pill(s) and then continue taking pills daily, 1 each day.

* If a woman misses more than 1 active (hormonal) pill, she can take the first missed pill and then either continue taking the rest of the missed pills or discard them to stay on schedule.
Depending on when she remembers that she missed a pill(s), she may take 2 pills on the same day (one at the moment of remembering, and the other at the regular time) or even at the same time.

Comments
The expert Working Group considered the inconsistent or incorrect use of pills to be a major reason for unintended pregnancy. Seven days of continuous COC use was deemed necessary to reliably prevent ovulation. Women who frequently miss pills should consider an alternative contraceptive method.
The expert Working Group noted that the evidence for "missed pill" recommendations is primarily derived from studies of women using 3035 g ethinylestradiol pills.
Many women (including those whose pill packs are marked with the days of the week) follow a pill-taking schedule that involves starting on a certain day of the week. When such a woman misses pills, it is necessary to discard the missed pills if she is to maintain her schedule. Other women may prefer not to discard missed pills, but they may have menses at other than expected intervals.
The following four principles underlie the expert Working Groups recommendations:
It is important to take an active (hormonal) pill as soon as possible when pills have been missed.
If pills are missed, the chance that pregnancy will occur depends not only on how many pills were missed, but also on when those pills were missed. Based on data regarding ovulation, the expert Working Group determined that missing 3 or more active (hormonal) pills (2 or more for 20 g or less ethinylestradiol pills) at any time during the cycle warrants additional precautions. The risk of pregnancy is greatest when active (hormonal) pills are missed at the beginning or at the end of the active pills, i.e. when the hormone-free interval is extended.
Limited evidence on 20 g ethinylestradiol pills suggests that there may be a higher risk of pregnancy when missing 20 g ethinylestradiol pills than when missing 3035 g ethinylestradiol pills. Accordingly, the expert Working Group recommended a more cautious approach when missing 20 g or less ethinylestradiol pills.
Field experience from the first edition of the Selected practice recommendations for contraceptive use highlighted the need for simple "missed pill" recommendations.




18.What can a woman do if she misses progestogen-only pills (POPs)?


Having menstrual cycles (including those who are breastfeeding) AND missed 1 or more pills by more than 3 hours
She should:
Take 1 pill as soon as possible. Continue taking the pills daily, 1 each day.
Abstain from sex or use additional contraceptive protection for the next 2 days.
She may wish to consider the use of emergency contraception if appropriate. Breastfeeding and amenorrhoeic AND missed 1 or more pills by more than 3 hours
She should:
Take 1 pill as soon as possible.
Continue taking the pills daily, 1 each day.
If she is less than 6 months postpartum, no additional contraceptive protection is needed.

18.What can a woman do if she misses progestogen-only pills (POPs)?

Having menstrual cycles (including those who are breastfeeding) AND missed 1 or more pills by more than 3 hours
She should:
Take 1 pill as soon as possible. Continue taking the pills daily, 1 each day. Abstain from sex or use additional contraceptive protection for the next 2 days.
She may wish to consider the use of emergency contraception if appropriate.

Breastfeeding and amenorrhoeic AND missed 1 or more pills by more than 3 hours
She should:
Take 1 pill as soon as possible.
Continue taking the pills daily, 1 each day. If she is less than 6 months postpartum, no additional contraceptive protection is needed.

Comments
The expert Working Group considered the inconsistent or incorrect use of pills to be a major reason for unintended pregnancy and highlighted the importance of taking POPs at approximately the same time each day. An estimated 48 hours of POP use was deemed necessary to achieve the contraceptive effects on cervical mucus.




19.What can a woman do if she vomits and/or has severe diarrhoea while using combined oral contraceptives (COCs) or progestogen-only pills (POPs)?

Vomiting (for any reason) within 2 hours after taking an active (hormonal) pill
She should take another active pill. Severe vomiting or diarrhoea for more than 24 hours
She should continue taking pills (if she can) despite her discomfort.
If severe vomiting or diarrhoea continues for 2 or more days, she should follow the procedures for missed pills.

Comments
The expert Working Group found no direct evidence to address this question but considered the effects of vomiting or diarrhoea to be similar to those of missing pills.

Wobei die WHO unter Durchfall mindestens 3 vollkommen ungeformte (=dünnflüssige) Stuhlgänge an einem Tag versteht.

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3. Dezember 2011 um 14:32

Habe grad diesen Beitrag entdeckt...
... demnach wäre es ja egal, wenn ich nach der Pause die erste Pille vergesse, und ich müsste überhaupt keine zusätzlichen Maßnahmen einleiten??
Obwohl doch immer davor gewarnt wird, wie gefährlich das Vergessen in Woche 1 sei

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3. Dezember 2011 um 15:42

War nur grad etwas überrascht...
habe mich mit der who bisher noch nicht auseinandergesetzt, aber hat mich nur mal grundsätzlich interessiert.
ist bei mir ohnehin nicht so wichtig, da ich die pille in den letzten zehn jahren nur ein mal wirklich vergessen habe.

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