contraception 2

Question 1

when should you start COC?

Answer 1

• Day 1 of natural cycle, effective immediately and don’t need additional precautions
• Day 1-5, no additional precautions
• Quick-starting (day 6 or later) - additional precautions for 7 days – this is how long it takes to make the eggs dormant

Question 2

when should you start POP?

Answer 2

• Day 1-5, no additional precautions
• Quick-starting (day 6 or later) - additional precautions for 2 days
• Starting a POP (Cerazette, Micronor or Noriday) start within days 1-5 & no additional precautions needed (day 6 onwards, use additional precautions for 2/7

Question 3

what should you do if you change from COC to POP/

Answer 3

precautions for 2/7, if pill-free period
• COC(ED) to POP – use addition precaution for 2/7, if ED/placebo pills taken
• COC(non-ED) to POP – for immediate cover, omit pill-free period, start POP immediately
• COC to Cerazette (POP) – for immediate cover, omit pill-free period.

Question 4

what should you do if you swap from POP to COC?

Answer 4

• POP – Qlaira (COC) (additional precautions for 9 days)
• POP – Zoely (additional precautions for 7 days)
• POP-COC (add precautions for 7/7)

Question 5

what is the missed pill advice for COC?

Answer 5

• > 24 hrs LATE
• If starting on day 6 or later, add precautions for 7 days
• Critical at end or start of cycles as PF period elongated
• EHC indicated if 2 or more missed (>24 hrs)*
• except Zoely24+4 and Qlaira26+2 – where EHC indicated if 1 or more missed (>12 hrs)*
• COC Zoely and Qlaira missed pill = 1> 12 hours late

Question 6

what is the missed pill advice for POP?

Answer 6

• > 3 hrs late [Micronor/Noriday]
• > 12hrs late [*Cerazette Cerrelle]
• Continue pills with 2 days extra precautions
• EHC indicated if 1 or more pills missed (>3/12hrs) [and UPSI before 2 more tablets taken correctly]
• POP – Cerazette/Cerelle missed pill = >12 hours

Question 7

what are the two types of hormonal emergency contraception?

Answer 7

• levonelle

- ellaone

Question 8

what is the type of non hormonal emergency contraception?

Answer 8

IUD

Question 9

which drugs can you NOT have with a patch, ring, tablet and implant?

Answer 9

- enzyme inducing drugs
	Antiepileptics: Carbamazepine, oxcarbazepine, phenytoin, phenobarbital, primidone, topiramate
	Antiretrovirals: Nevirapine, ritonavir
	Antibiotics: Rifabutin, rifampicin
	Other: St John’s Wort and griseofulvin
	INCLUDING 28 DAYS AFTER CESSATION

Question 10

what are the risks of hormonal contraception and antibiotics/

Answer 10

• neither efficacy will not be affected

- should seek advice from healthcare professional if they worry about the side effects

Question 11

what are the issues with sodium valporate?

Answer 11

• Serious risk from taking valproate in pregnancy
o Congenital malformation and neurodevelopmental disorders
• Specialist initiation
• Requires HIGHLY effective contraceptive option (LARC or any with failure rate of <1%), and if not, implement regular pregnancy testing
• ALL female patients of child-bearing age, regardless of sexual activity
• Give patient card, patient guide, and complete Annual risk Acknowledgement form