Combined Oral Contraceptive Pill Flashcards
What is the mechanism of action of the COCP?
Inhibits ovulation
What is the regime for the COCP?
Single tablet containing oestrogen and progesterone taken every day for 3 weeks then stopped for 1 week, vaginal bleeding occurs at the end of each packet.
What is the efficacy of the COCP?
99% with perfect use, 92% with typical use.
What is the difference between starting the COCP between day 1-5 of cycle and starting it after this?
- 1-5 days - cover is immediate
2. Later start - use condoms for 1 week
What are the reasons to stop the COCP?
- Sudden chest pain/breathlessness
- Severe calf pain/unexplained leg swelling
- Unusual severe prolonged headache
- Hemi-motor/sensory loss, dysphasia, sudden vision loss
- Hepatitis, jaundice
- Any contraindication
What is the guidance for missing one COCP for these doses?
- 30-35ug
- 20ug
Forgotten pill should be taken ASAP
- Missing 1 or 2 pills is fine, continue as normal
- Missing 1 pill is fine, continue as normal
What is the guidance for missing more than 2 COCP?
Condoms for 7 days
What is the guidance if there are <7 COCPs left in the packet?
Skip pill-free interval and start new pack immediately
What is the guidance if there are >7 COCPs left in the packet?
Continue pills as usual and observe pill-free interval
What is the guidance if 3 COCPs of the first 7 days of a cycle are missed?
Use emergency contraception if unprotected sex since end of last pack.
What is the advice about using COCP with enzyme-induced antibiotics?
Condoms during first week after course finishes. Broad spectrum are fine.
What is the advice about using COCP with P450 inducers?
Oestrogen dose may need to increase, and shorten pill-free interval to 4 days.
What is the advise on vomiting and diarrhoea around the time of taking a COCP?
- Vomited within 2 hours - take another
2. Diarrhoea - keep taking but manage as if a pill was missed
What is the recommendation for travelling and immobile for >3 hours if on the COCP?
Exercise, hydration, and stockings.
What are the advantages of the COCP?
- Very effective and very safe
- Regular, less painful and lighter periods
- Reduced ovarian cysts, breast cysts, fibroids, and endometriosis.
- Reduced pelvic inflammatory disease
- Hirsutism and acne improves
- Reduced ovarian, endometrial, and bowel cancer.
What are the side effects of the COCP?
- Nausea, headaches, breast tenderness
2. Breakthrough bleeding in first few months
What should you do if COCP breakthrough bleeding persists for more than 3 months?
- Screen STI, exclude pregnancy, check cervix.
2. Increase oestrogen dose if on low dose, or change progestogen.
What are the risks associated with COCP?
- VTE - doubles relative risk
- Stroke
- Breast and cervical cancer
- Mood changes
What are the absolute contraindications to the COCP?
- History of VTE/CVA/IHD/severe HTN
- Migraine and aura
- Active breast/cervical cancer
- Thrombophilia
- Pregnancy
- Breastfeeding <6 weeks post-partum
- Smokers >35 years smoking >15/day
- BMI >40
- Diabetes with vascular complications
- Active/chronic liver disease
What are the relative contraindications to the COCP?
- Smokers
- Renal impairment, diabetes mellitus
- Age >40
- BMI 35-40
- Breastfeeding up to 6 months post-partum
What are the important points to raise in counselling patients on the COCP (OSCE station)?
- Advise of major complications and benefits
- Advise to stop smoking
- Advise to seek help if symptoms suggestive of major complications
- Advise about antibiotics, sickness, and missed pills.
- Stress importance of BP check at 3 months then yearly afterwards.
