Combined hormonal contraception Flashcards
How is the normal COCP course taken?
- 21 days of pills followed by 7 day pill - free interval
What happens during the pill free interval and is it necessary?
- Withdrawl bleed during the pill free interval
2. Pill free interval is not neccessary and can be substituted for pills in cases of headaches/dysmennorhea
How does the COCP effect fertility?
No effects on fertility as contraceptive efforts are immediately reversible upon stopping.
Advantages of combined oral contraceptive pill?
- Very effective
- Doesn’t intefere with sex
- Contraceptive efforts reversible upon stopping
How does the COCP effect period?
- Makes them regular, lighter and less painful
What are the health benefits of COCP?
- Reduces the risk of ovarian and endometrial cancer for several years after stopping the pill
- Reduces the risk of colorectal cancer
- May protect against pelvic inflammatory disease
What are some disadvantages of taking the COCP?
- Compliance
- No protection against STIs
- Increases risk of venous thromboembolism
- Increases risk of breast and cervical cancer
What are some side effects of taking the COCP?
- Head ache
- Nausea
- Mood swings
- Breast tenderness
What are cancer risks among users of COCP?
- Reduced risk of ;
- Colorectal cancer
- Endometrial cancer
- Ovarian cancer - Increased risk of ;
- Breast cancer
- Cervical cancer
UK Medical Eligibility Criteria (UKMEC)
UKMEC 1: a condition for which there is no restriction for the use of the contraceptive method
UKMEC 2: advantages generally outweigh the disadvantages
UKMEC 3: disadvantages generally outweigh the advantages
UKMEC 4: represents an unacceptable health risk
Examples of UKMEC 3 conditions include (6)
- more than 35 years old and smoking less than 15 cigarettes/day
- BMI > 35 kg/m^2*
- family history of thromboembolic disease in first degree relatives < 45 years
- controlled hypertension
- immobility e.g. wheel chair use
- carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
Examples of UKMEC 4 conditions include (6)
- more than 35 years old and smoking more than 15 cigarettes/day
- migraine with aura
- history of thromboembolic disease or thrombogenic mutation
- history of stroke or ischaemic heart disease
- breast feeding < 6 weeks post-partum
- uncontrolled hypertension
- current breast cancer
- major surgery with prolonged immobilisation
How is Diabetes mellitus classified on the UKMEC scale?
Diabetes mellitus diagnosed > 20 years ago is classified as UKMEC 3 or 4 depending on severity
What should be done if 1 pill has been missed? (more than 24 hours and upto 48)
- Continue contraceptive cover
- Take the missed pill as soon as you remember
- Continue with the rest of the course of medication
- Emergency cover is not required
If 2 or more pills have been missed and more than 48 hours late
- Take the most recent missed pill
- Continue with the rest of the course as normal
- Avoid intercourse or use condoms until 7 consecutive pills have been taken
