Taking Yaz: Tablets must be taken in the order directed on the package every day at about the same time with some liquid as needed. Tablet taking is continuous. One tablet is to be taken daily for 28 consecutive days. Each subsequent pack is started the day after the last tablet of the previous pack.
Starting on Yaz: No Preceding Hormonal Contraceptive Use (In the Past Month): Tablet-taking has to start on day 1 of the woman's natural cycle (ie, the 1st day of her menstrual bleeding). Starting on days 2-5 is allowed, but during the 1st cycle a barrier method is recommended in addition for the first 7 days of tablet-taking.
Changing from a Combined Hormonal Contraceptive (Combined Oral Contraceptive/COC), Vaginal Ring or Transdermal Patch: The woman should start with Yaz preferably on the day after the last hormone-containing tablet of her previous COC, but at the latest on the day following the usual tablet-free or hormone-free tablet interval of her previous COC. In case a vaginal ring or transdermal patch has been used, the woman should start using Yaz preferably on the day of removal, but at the latest when the next application would have been due.
Changing from a Progestogen-Only Method (Minipill, Injection, Implant) or from a Progestogen-Releasing Intrauterine System (IUS): The woman may switch any day from the minipill (from an implant or the IUS on the day of its removal, from an injectable when the next injection would be due), but should in all of these cases be advised to additionally use a barrier method for the first 7 days of tablet-taking.
Management of Missed Tablets: Missed hormone-free white film-coated tablets can be disregarded. However, they should be discarded to avoid unintentionally prolonging the hormone-free white tablet phase. The following advice only refers to missed hormone-containing light pink film-coated tablets: If the user is <12 hrs late in taking any tablet, contraceptive protection is not reduced. The woman should take the tablet as soon as she remembers and should take further tablets at the usual time.
If the user is >12 hrs late in taking any tablet, contraceptive protection may be reduced. The management of missed tablets can be guided by the following 2 basic rules: 1. Tablet-taking must never be discontinued for longer than 4 days and 2. Seven days of uninterrupted tablet-taking are required to attain adequate suppression of the hypothalamic-pituitary-ovarian-axis.
Accordingly the following advice can be given in daily practice: Day 1-7: The user should take the last missed tablet as soon as she remembers, even if this means taking 2 tablets at the same time. She then continues to take tablets at her usual time. In addition, a barrier method eg, a condom should be used for the next 7 days. If intercourse took place in the preceding 7 days, the possibility of a pregnancy should be considered. The more tablets are missed and the closer they are to the hormone-free white film-coated tablet phase, the higher the risk of a pregnancy.
Day 8-14: The user should take the last missed tablet as soon as she remembers, even if this means taking 2 tablets at the same time. She then continues to take tablets at her usual time. Provided that the woman has taken her tablets correctly in the 7 days preceding the 1st missed tablet, there is no need to use extra contraceptive precautions. However, if this is not the case, or if she missed >1 tablet, the woman should be advised to use extra precautions for 7 days.
Day 15-24: The risk of reduced reliability is imminent because of the forthcoming hormone-free white film-coated tablet phase. However, by adjusting the tablet-intake schedule, reduced contraceptive protection can still be prevented. By adhering to either of the following 2 options, there is therefore no need to use extra contraceptive precautions, provided that in the 7 days preceding the 1st missed tablet the woman has taken all tablets correctly. If this is not the case, the woman should be advised to follow the 1st of these 2 options and to use extra precautions for the next 7 days as well.
1. The user should take the last missed tablet as soon as she remembers, even if this means taking 2 tablets at the same time. She then continues to take tablets at her usual time until the light pink film-coated tablets are used up. The 4 white hormone-free film-coated tablets must be discarded. The next pack must be started right away. The user is unlikely to have a withdrawal bleed until the end of the hormone-containing light pink film-coated tablets section of the second pack, but she may experience spotting or breakthrough bleeding.
2. The woman may also be advised to discontinue taking the light pink film-coated tablets from the current pack. She should then have a tablet-free interval of up to 4 days, including the days she missed tablets, and subsequently continue with the next pack.
If the woman missed tablets and subsequently has no withdrawal bleed in the hormone-free white film-coated tablet phase, the possibility of a pregnancy should be considered.
