COMBINED ORAL CONTRACEPTIVES

Question 1

COC

Answer 1

Contains oestrogen + progesterone
Inhibits ovulation

Question 2

Monophasic preparation

Answer 2

Fixed amount of oestrogen + progesterone

Question 3

Phasic preparation

Answer 3

Varying amounts of oestrogen + progesterone
- For women who do not have withdrawal bleeding OR
- Have breakthrough bleeding with monophasic preparations

Question 4

How to take pill

Answer 4

OD for 3 weeks
1 week pill free interval (withdrawal bleeding)
Start anytime in cycle
Started on day 6 or later = protection for 7 days

Question 5

Low strength-oestrogen preparation

Answer 5

Suitable for those with a risk factor for circulatory disease
Contains 20 mg Ethinylestradiol

Question 6

Side effects of hormonal contraceptives

Answer 6

headaches
unschedule bleeding
mood change
weight gain
libido change

Question 7

Oestrogen - increases risk of?

Answer 7

VTE
ATE (arterial thromboembolism)

Question 8

Risk factors that C/I treatment

Answer 8

Smoker (40+)
Personal history of VTE or ATE
Migraine with aura
Migraine 72 hours
Migraine treated with ergot derivatives
Diabetes with complications
Heart disease with pulmonary hypertension/risk of embolus
Valvular heart disease
BMI >35
50+
TIA
BP >160/95 mmHg
2 or more risk factors for VTE/ATE

Question 9

What age cannot use?

Answer 9

50+

Question 10

What is VTE?

Answer 10

PE = chest pain, breathlessness, cough with blood sputum
DVT = unexplained swelling or severe pain in calf of one leg

Question 11

VTE risk factors

Answer 11

Avoid COC if 2 or more are present
- Obesity BM1 >30
- Smoking
- First degree relative under 45 with VTE
- Superficial thrombophlebitis
- Long-term immobilisation
- Age >35
- Type of progesterone (Desogestrel, gestodene, drosperinone)

Question 12

ATE risk factors

Answer 12

Avoid COC if 2 or more present
- Diabetes
- Hypertension
- Migraine without aura

Question 13

Surgery

Answer 13

-Stop 4 weeks before (major surgery/surgery to legs/surgery that causes immobilisation)
- POP is alternative
- Restart usual contraception on 1st period at least 2 weeks after full mobilisation.

Question 14

Emergency surgery/COC not stopped

Answer 14

Thormboprophylaxis

Question 15

Travel

Answer 15

3+ hour journeys = compression stocking and leg exercises

Question 16

Reasons to stop

Answer 16

• calf pain, swelling and or redness (DVT)
• chest pain/ breathlessness and/or coughing up blood (PE)
• loss of motor of sensory function (stroke)
• severe stomach pain (hepatotoxicity)
• very high bp (haemorrhagic stroke)

Question 17

Benefits of COC

Answer 17

Reduced risk of ovarian + endometrial cancer
Reduces:
- Dysmenorrhea
- Menorrhagia
- PMS
Less risk of PID
Less symptomatic fibroids or functional ovarian cystSs

Question 18

Switching to a CHC

Answer 18

From CHC - no additional contraception needed
From POP - 7 days extra precaution
From LNG-IUD - 7 days extra precaution needed

From Copper IUD -
if CHC started up to day 5 of menstrual cycle - no additional needed
If started after day 5 - 7 days extra

Question 19

Switching from CHC to others

Answer 19

Week 1 (or day 3-7 of hormone free interval) + No UPSI since start of HFI
* Cu-lUD - no extra precaution
* POP - 2 days precautions
Others - 7 days precaution

Week 1 (or day 3-7 of hormone free interval) + UPSI since start of HFI
* Carry on with CHC until 7 consecutives days taken
Then act as week 2 or 3

Week 2 or 3 - no extra precaution needed

Question 20

Missed CHC
Late start after HFI (> 9 days since last active pill)

Answer 20

• emergency contraception if UPSI occurred
• take immediately and use condom till 7 consecutive days taken

Question 21

1 missed pill (48-72 hrs since last active pill)

Answer 21

• Take ASAP - no further action needed (if previous 7 active pills consistent)

Question 22

2 + missed pills (72 hours since last active pill)

Answer 22

• Week 1 of cycle: consider emergency contraception if UPSI happened within HFI and week 1. Take ASAP and use condom till 7 consecutive dose taken
• Week 2-3 of cycle: no emergency contraception needed - take ASAP. 7 days condom
• If 2+ pills missed in 7 days before HFI carry on taking pill throughout HFI

Question 23

Evra

Answer 23

Ethinylestradiol
Norelgestromin

Question 24

How to use evra

Answer 24

1 cycle =
- Weekly patch for 3 weeks
- 1 week patch-free

Question 25

Missed patch

Answer 25

Detachment or delayed application

Question 26

Missed patch - type 1

Answer 26

Detached for > 24 hours
Delayed application at BEGINNING of cycle
- Apply new patch ASAP
- Start new “day 1 cycle”
- Condom for 7 days

Question 27

Missed patch - type 2

Answer 27

Delayed application in middle of cycle (week 2 or 3)
< 48 hours = apply new patch, continue as normal
> 48 hours = start a new day 1 cycle + condom for 7 days

Question 28

Ring

Answer 28

1 ring per cycle (leave in for 3 weeks)
Can be removed for up to 3 hours during sex (if it is painful to keep in)
Not affected by vomiting/diarrhoea

Question 29

If ring is expelled, delayed insertion or broken

Answer 29

• After day 7 = new ring and use additional contraception for 7 days after.
• Broken = new ring + EHC if UPSI occurred in the last 5 days