Combined oral contraceptive pill: counselling Flashcards
1
Q
Combined oral contraceptive pill: counselling
Women who are considering taking the combined oral contraceptive pill (COC) should be counselled in a number of areas:
Potential harms and benefits, including
A
- the COC is > 99% effective if taken correctly
- small risk of blood clots
- very small risk of heart attacks and strokes
- increased risk of breast cancer and cervical cancer
2
Q
Combined oral contraceptive pill: counselling
Advice on taking the pill, including
A
- if the COC is started within the first 5 days of the cycle then there is no need for additional contraception. If it is started at any other point in the cycle then alternative contraception should be used (e.g. condoms) for the first 7 days
- should be taken at the same time everyday
- taken for 21 days then stopped for 7 days - similar uterine bleeding to menstruation
- advice that intercourse during the pill-free period is only safe if the next pack is started on time
3
Q
Combined oral contraceptive pill: counselling
Discussion on situations where efficacy may be reduced*
A
- if vomiting within 2 hours of taking COC pill
- if taking liver enzyme inducing drugs
- discussion on STIs
4
Q
Combined oral contraceptive pill: counselling
Concurrent antibiotic use
A
- 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
5
Q
Combined oral contraceptive pill:
advantages
A
Advantages of combined oral contraceptive pill:
- highly effective (failure rate < 1 per 100 woman years)
- doesn’t interfere with sex
- contraceptive effects reversible upon stopping
- usually makes periods regular, lighter and less painful
- reduced risk of ovarian, endometrial and colorectal cancer
- may protect against pelvic inflammatory disease
- may reduce ovarian cysts, benign breast disease, acne vulgaris
6
Q
Combined oral contraceptive pill: disadvantages
A
Disadvantages of combined oral contraceptive pill:
- people may forget to take it
- offers no protection against sexually transmitted infections
- increased risk of venous thromboembolic disease
- increased risk of breast and cervical cancer
- increased risk of stroke and ischaemic heart disease (especially in smokers)
- temporary side-effects such as headache, nausea, breast tenderness may be seen
