COCP_Special_Situations_Flashcards
How has the UK historically advised women using the combined oral contraceptive pill (COCP) regarding concurrent antibiotic use?
The UK historically advised that the concurrent use of antibiotics might interfere with the enterohepatic circulation of oestrogen, making the COCP ineffective, and recommended ‘extra-precautions’ for the duration of antibiotic treatment and for 7 days afterwards.
What was the rationale behind advising ‘extra-precautions’ with concurrent antibiotic use and the COCP?
The rationale was that antibiotics might interfere with the enterohepatic circulation of oestrogen, potentially reducing the effectiveness of the COCP.
How does the approach to concurrent antibiotic use with the COCP differ in the US and mainland Europe compared to the UK?
No such precautions are taken in the US or the majority of mainland Europe regarding concurrent antibiotic use with the COCP.
What guidelines were produced in 2011 by the Faculty of Sexual & Reproductive Healthcare regarding concurrent antibiotic use with the COCP?
In 2011, the Faculty of Sexual & Reproductive Healthcare produced new guidelines abandoning the approach of advising extra precautions with concurrent antibiotic use, except for enzyme-inducing antibiotics.
What is the current recommendation regarding enzyme-inducing antibiotics such as rifampicin and the COCP?
Precautions should still be taken with enzyme-inducing antibiotics such as rifampicin when using the COCP.
What is the apparent contradiction between the BNF and the Faculty of Sexual & Reproductive Healthcare (FSRH) regarding switching combined oral contraceptive pills?
The BNF advises omitting the pill-free interval if the progesterone component changes when switching COCPs, while the Clinical Effectiveness Unit of the FSRH states that the pill-free interval does not need to be omitted.
What does the Clinical Effectiveness Unit of the FSRH state about the pill-free interval when switching combined oral contraceptive pills?
The Clinical Effectiveness Unit of the FSRH states that the pill-free interval does not need to be omitted when switching combined oral contraceptive pills.
What does the BNF advise regarding the pill-free interval if the progesterone component changes when switching COCPs?
The BNF advises missing the pill-free interval if the progesterone component changes when switching combined oral contraceptive pills.
Given the uncertainty in guidelines, what is the best practice to follow when switching combined oral contraceptive pills?
Given the uncertainty, it is best to follow the BNF’s advice when switching combined oral contraceptive pills.
summarise cocp special situations
Combined oral contraceptive pill: special situations
Concurrent antibiotic use
for many years doctors in the UK have advised that the concurrent use of antibiotics may interfere with the enterohepatic circulation of oestrogen and thus make the combined oral contraceptive pill ineffective - ‘extra- precautions’ were advised for the duration of antibiotic treatment and for 7 days afterwards
no such precautions are taken in the US or the majority of mainland Europe
in 2011 the Faculty of Sexual & Reproductive Healthcare produced new guidelines abandoning this approach. The latest edition of the BNF has been updated in line with this guidance
precautions should still be taken with enzyme inducing antibiotics such as rifampicin
Switching combined oral contraceptive pills
the BNF and Faculty of Sexual & Reproductive Healthcare (FSRH) appear to give contradictory advice. The Clinical Effectiveness Unit of the FSRH have stated in the Combined Oral Contraception guidelines that the pill free interval does not need to be omitted (please see link). The BNF however advises missing the pill free interval if the progesterone changes. Given the uncertainty it is best to follow the BNF
A 23-year-old woman is requesting combined oral contraception. She has been taking the progesterone-only pill (norethisterone) due to concerns about blood clotting adverse effects. She is not satisfied with the irregular bleeding she gets with this medication and wants to change. There are no contraindications to the combined oral contraceptive pill.
What advice should be given to her regarding additional contraception when switching?
10-days of additional barrier contraception is needed
14-days of additional barrier contraception is needed
3-days of additional barrier contraception is needed
7-days of additional barrier contraception is needed
No additional barrier contraception is needed
7-days of additional barrier contraception is needed
When switching from a traditional POP to COCP (with correct prior use) 7 days of barrier contraception is needed
Important for meLess important
The safest option in this situation would be to recommend 7-days of barrier contraception while commencing the combined oral contraceptive to prevent unwanted pregnancy. This is the standard length of time that protection needs to be used when commencing this medication outside of menstruation.
10-days of additional barrier contraception is not required as the standard recommendation for the combined oral contraceptive pill is 7 days.
14-days of additional barrier contraception is not required as the standard recommendation for the combined oral contraceptive pill is 7 days.
3-days is too short for barrier contraception use. It is the length of time that would be used when commencing a traditional progesterone-only pill such as norethisterone.
It is incorrect that no additional barrier contraception is required. Although she may be protected, it would be safest to recommend 7-days of additional contraception to prevent unwanted pregnancy.
