COCP

Question 1

Advantages

Answer 1

highly effective (failure rate < 1 per 100 woman years)
doesn’t interfere with sex
contraceptive effects reversible upon stopping
usually makes periods regular, lighter and less painful
reduced risk of ovarian, endometrial - this effect may last for several decades after cessation
reduced risk of colorectal cancer
may protect against pelvic inflammatory disease
may reduce ovarian cysts, benign breast disease, acne vulgaris

Question 2

Disadvantages

Answer 2

people may forget to take it
offers no protection against sexually transmitted infections
increased risk of venous thromboembolic disease
increased risk of breast and cervical cancer
increased risk of stroke and ischaemic heart disease (especially in smokers)
temporary side-effects such as headache, nausea, breast tenderness may be seen

Question 3

how are contraindications to the COCP graded?

Answer 3

UKMEC 3: disadvantages generally outweigh the advantages

UKMEC 4: represents an unacceptable health risk

Question 4

Examples of UKMEC 3 conditions

Answer 4

• > 35 years old, smoking <15 cigarettes/day
• BMI > 35
• FHx VTE in first degree relatives < 45 years
• controlled hypertension
• immobility e.g. wheel chair
• carrier of mutations assoc. with breast cancer (e.g. BRCA1/BRCA2)
• gallbladder disease

Question 5

Examples of UKMEC 4 circumstances

Answer 5

• > 35 years old, smoking >15 cigarettes/day
• migraine with aura
• VTE/ thrombogenic mutation
• stroke/ IHD
• breast feeding < 6 weeks post-partum
• uncontrolled hypertension
• current breast cancer
• major surgery with prolonged immobilisation
• positive antiphospholipid antibodies (e.g. in SLE)

Question 6

Is diabetes diagnosed >20 years ago classified as a UKMEC 3 or 4 condition?

Answer 6

can be UKMEC 3 or 4 depending on severity

Question 7

If the COCP is started on Day 4 of a woman’s cycle, does she need to use additional contraception?

Answer 7

• Pill started within first 5 days of the cycle = no need for additional contraception.
• If started at any other point in the cycle then alternative contraception should be used (e.g. condoms) for the first 7 days

Question 8

When may efficacy of the pill be reduced?

Answer 8

• vomiting within 2 hrs of taking pill
• medications causing diarrhoea or vomiting may reduce effectiveness (e.g. orlistat)
• liver enzyme-inducing drugs

Question 9

Should extra precautions be taken when taking concurrent antibiotics?

Answer 9

Previous advice = concurrent Abx may interfere with the enterohepatic circulation of oestrogen
=> COCP ineffective and ‘extra-precautions’ were advised for the duration of antibiotic treatment and for 7 days afterwards.

Since 2011, recommendation is:
precautions should still be taken with enzyme inducing antibiotics such as rifampicin

Question 10

If a woman were to start her COCP on Day 14 of her cycle, should she use additional contraception?

Answer 10

YES
If started at any other point in the cycle then alternative contraception should be used (e.g. condoms) for the first 7 days

Question 11

How many days do women usually take the COCP for before having a week off for a withdrawal bleed?

Answer 11

Conventional method - 21 days then stopped for 7 days (withdrawal bleed)

Since 2019, options include:
- no pill free interval
- Tricycling (3 packs) then 4 or 7 day break for withdrawal bleed

Question 12

Sexual intercourse is safe during the pill-free period. TRUE/FALSE?

Answer 12

TRUE
as long as the next pack is started on time