COCP

Question 1

COCP - Indications

Answer 1

1. Reversible hormonal contraception

2. Second-line treatment of dysmenorrhoea

Question 2

Explaining to a patient how the COCP will provide them with contraception

Answer 2

o The pill is composed of 2 hormones called oestrogen and progesterone

o Usually what happens is if the sperm reaches the egg then pregnancy can occur – what the pill does is it prevents this by keeping the sperm and the egg apart and by preventing the release of the egg

o When taken correctly the pill is >99% effective at preventing pregnancy

Question 3

Other than contraception, what are the benefits of COCP?

Answer 3

• lighter/less painful/more regular periods
• reduce risk of cancers (e.g.- ovarian)
• reduce PMS symptoms

Question 4

COCP - side effects

Answer 4

o headaches
o nausea
o breast tenderness
o mood swings

temporary – if does not go away after a few months, come back

Question 5

COCP - rare side effect and what to safety net patient about

Answer 5

small risk of blood clots – if you noticed any severe new leg pain or SOB contact GP/go A&E

Question 6

COCP - patient communication on how to take the medication

Answer 6

take 1 tablet at the same time every day for 21 days then have a 7-day break (this is when you will have your bleed) then you start taking the pill again after the 7 days – take the first pill on the first day of your period (if started any other day then need to use protection for first 7 days)

HOWEVER, IF PREFERRED
You can run the packs back to pack (no break) to prevent you from having periods

Question 7

What should you wanr patients about with regards to if they experience diarrhoea or vomiting

Answer 7

if you experience vomiting or diarrhoea – use protection during sex because it could mean the pill is not working as effectively

if you vomit within 3hrs of taking the pill – you need to take another dose

Each day a woman experiences severe diarrhoea = missed pill

Question 8

COCP - patient has missed one dose within <12hrs of usual time - what should they do?

Answer 8

if you miss a pill and remember <12hrs of usual time – take missed pill and next dose

Question 9

COCP - patient has missed one dose >12hrs of usual time - what should they do?

Answer 9

if you miss a pill and remember >12hrs of usual time – do not take 2 pills – take next dose

Question 10

COCP - contraindications

Answer 10

• migraine with aura
• current or recent breast cancer
• > 35 who smoke
• BMI >35
• Multiple risk factors for CVD
• History of VTE

Question 11

What advise can you give patients regarding the use of COCP to protect against STIs?

Answer 11

Does NOT protect against STIs – still advised to use protection during sex

Question 12

COCP - interactions

Answer 12

Enzyme inducers - because reduced efficacy of COCP

• Antibiotics - rifampicin and rifabutin
• Anti-epileptic drugs - for example, carbamazepin
• Anti-retrovirals
• St John’s wort (herbal product)

Question 13

COCP - mechanism of action

Answer 13

Inhibits ovulation - MAIN ACTION - how?

• suppresses release of LH/FSH
• this prevents the release of the egg (prevents ovulation)
• this prevents the sperm from fertilising the egg = preventing pregnancy

But also does the below

Thickens the mucus - this makes it more difficult for sperm to move through the uterus to the egg

Thins the lining of the womb - this reduces chance of implantation