COMBINED ORAL CONTRACEPTIVES Flashcards
COC
Contains oestrogen + progesterone
Inhibits ovulation
Monophasic preparation
Fixed amount of oestrogen + progesterone
Phasic preparation
Varying amounts of oestrogen + progesterone
- For women who do not have withdrawal bleeding OR
- Have breakthrough bleeding with monophasic preparations
How to take pill
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
Low strength-oestrogen preparation
Suitable for those with a risk factor for circulatory disease
Contains 20 mg Ethinylestradiol
Side effects of hormonal contraceptives
headaches
unschedule bleeding
mood change
weight gain
libido change
Oestrogen - increases risk of?
VTE
ATE (arterial thromboembolism)
Risk factors that C/I treatment
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
What age cannot use?
50+
What is VTE?
PE = chest pain, breathlessness, cough with blood sputum
DVT = unexplained swelling or severe pain in calf of one leg
VTE risk factors
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)
ATE risk factors
Avoid COC if 2 or more present
- Diabetes
- Hypertension
- Migraine without aura
Surgery
-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.
Emergency surgery/COC not stopped
Thormboprophylaxis
Travel
3+ hour journeys = compression stocking and leg exercises
Reasons to stop
- 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)
Benefits of COC
Reduced risk of ovarian + endometrial cancer
Reduces:
- Dysmenorrhea
- Menorrhagia
- PMS
Less risk of PID
Less symptomatic fibroids or functional ovarian cystSs
Switching to a CHC
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
Switching from CHC to others
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
Missed CHC
Late start after HFI (> 9 days since last active pill)
- emergency contraception if UPSI occurred
- take immediately and use condom till 7 consecutive days taken
1 missed pill (48-72 hrs since last active pill)
- Take ASAP - no further action needed (if previous 7 active pills consistent)
2 + missed pills (72 hours since last active pill)
- 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
Evra
Ethinylestradiol
Norelgestromin
How to use evra
1 cycle =
- Weekly patch for 3 weeks
- 1 week patch-free
