Combined Hormonal Contraception (CHC)

Question 1

Types of CHC

Answer 1

1. Oral - EE 20, 35, 50mcg available
   ●35mcg ideal
   ●20mcg - breakthrough bleeding
   ●50mcg - higher side effects
2. Vaginal ring

Question 2

Anti androgenic progesterone

Answer 2

Drospirinone

Question 3

OCP in different patient groups

Answer 3

1. Acne, hirsutism (dorspirinone)
   2.<35yrs - can use
2. <50yrs, non smoker - can use
   avoid in >35yrs with smoking, DM, HTN, CVS, Obesity problems
3. Liver enzyme inducing drugs -
   better avoid (can use IUCD, Implanon)
   Can use 50mcg EE (only case used) if necessary

Question 4

*Absolute C/I of OCP

Answer 4

1. 2wks postpartum, 6wks if breast feeding
2. > 35yrs and smoking
3. DVT, PE
4. Stroke, Ischemic HD, Valvular HD, cardiovascular problems, cardiomyopathy
5. Uncontrolled HTN
6. Migraine with aura
7. Breast/genital carcinoma

Question 5

*Relative C/I of OCP

Answer 5

1. > 35 BMI
2. R/f for CVS problems
3. 1deg relative, <45yrs, DVT+
4. AUB
5. H/o migraine with aura (not in past 5yrs)
6. Gene mutation for breast cancer
7. Gall bladder disease
8. Controlled HTN

Question 6

*Non contraceptive advantages of OCP

Answer 6

1. Heavy bleeding
2. Dysmenorrhoea
3. Endometriosis symptoms
4. ↓Incidence of functional ovarian cyst/tumours/cancer, endometrial cancer
5. PCOS
6. ↓Bowel cancer
7. PMS, PMMD

Question 7

S/E of OCP

Answer 7

1. Recurrent thrombosis- DVT, retinal
2. Stroke, cvs prob, IHD,
3. Breast/cervical cancer
4. Acne - give drospirinone, ciprotenone acetate
5. Breast tender - ↓estrogen dose
6. Chloasma - avoid sun, non-estrogenic OCP
7. Headache - ↓estrogen dose
   *Wt gain is not a s/e of OCP

Question 8

OCP and cancers

Answer 8

Protective in:
1. Ovarian CA
2. Endometrial CA
3. Bowel CA

↑Incidence of :
1. Cervical CA
2. Breast CA

Question 9

Missed pill

Answer 9

If last dose >48hrs
Take asap even if 2 pills/day
Abstinence/condoms for 1wk

If pill missed in first week after placebo
Levenorgestrel emergency contraception

If pill missed in 3rd wk
Skip placebo