Combined OCP / patch / vaginal ring

Question 1

Action

Answer 1

Stops ovulation
Increased cervical mucus - barrier
Thins endothelium - reduces chance of implantation

Question 2

Treatment course

Answer 2

Pill: take daily (3 weeks on, 1 week pill free)
Patch: change weekly (one patch free week per month)
Ring: leave in for 3 weeks and then have 1 week ring free

Question 3

Side effects

Answer 3

Hormonal: weight gain, acne, mood changes, headache
Blood clots
Increased risk of breast / cervical cancer
Makes periods lighter
Local irritation from the patch
Pain during intercourse from the ring (can remove max 3 hours)

Question 4

Contraindications

Answer 4

Absolute: smoker > 35 years, <6/52 postpartum, breast feeding, HTN, VTE, migraine with aura, CVD, current breast ca, liver cirrhosis

Relative: adequately controlled HTN, migraine > 35, BMI > 35, enzyme inducing medications

Question 5

Comments

Answer 5

Start on day 1 of cycle
Reduced risk of endometrial / ovarian cancer
Missed pill: take ASAP (even if with next one). If next one is on time it’s fine. If two are missed take immediately but use condom for 7 days. If:
week 1: will need emergency contraception if had sex in pill free interval or 1st week of pill packet
week 2: no action
week 3: omit pill free week
- 7 day (condom) rule for D&V, enzyme inducing drugs

Question 6

Positives vs negatives

Answer 6

+ controls periods, bleeding and pain