Incorrect Use of Combined Hormonal Contraception Flashcards
What constitutes as being late to restart a new pill packet after the HFI?
≥9 completed days since last active pill was taken
(I.e. if a woman took her last pill before the HFI at 9am on monday, as long as she restarts before 9am on wednesday the following week she’s okay)
A patient is 3 days late restarting her new pill packet after the HFI, what do you advise?
- Consider EC if UPSI has taken place during or after the HFI
- Take the most recent missed pill ASAP
- Continue the remaining at the usual time
- Condoms for 7 days
- Follow-up PT if applicable
A patient has missed 1 pill (48 to <72 hours since last pill) in week 1 after the HFI, what do you advise?
- Check the first pill after HFI was taken correctly
- If yes, EC not required if consistent, correct use earlier in week 1 and the 7 days prior to HFI
- Take missed pill ASAP
- Continue remaining pills as usual
- No additional precautions required if meets all the above critera
A patient has missed 1 pill in week 3 after HFI, what do you advise?
- EC not required if consistent, correct use in previous 7 days
- Take missed pill ASAP
- Continue remaining pills as usual
- No additional precautions required if meets the above criteria
A patient misses 2 pills (≥72 hours since last pill was taken) in week 1 after the HFI, what do you advise?
- Check the first pill after the HFI was taken correctly
- Consider EC if UPSI has taken place during the HFI or week 1
- Take most recent pill ASAP
- Continue remaining pills as usual
- Condoms for 7 days
- Consider follow-up PT
A patient has missed 2 pills in week 3 after HFI, what do you advise?
- EC not required if consistent, correct use in previous 7 days
- Take most recent missed pill ASAP
- Continue remaining pills as usual
- If in the week prior to scheduled HFI, omit the HFI
- Use condoms for 7 days (overcautious)
A patient realises she has missed 8 consecutive pills of COC, what do you advise?
- Treat as new start contraception
- Consider EC etc
What constitutes as being late restarting the combined vaginal ring after HFI?
- ≥ 8 completed days since ring was removed for HFI
(I.e. if a woman removed her ring at 9am on Monday, she needs to insert a new ring by 9am the following Tuesday)
A patient is late to insert her new ring post HFI by 3 days. What do you advise?
- Consider EC if UPSI has taken place during or after the HFI
- Insert new ring ASAP
- Keep ring in until scheduled removal day
- Condoms for 7 days
- Consider follow-up PT
A patient realises her ring fell out 36 hours ago in week 1 after HFI, what do you advise?
- EC not required in unscheduled ring removal for <48 hours, IF consistent use earlier in week 1 and in the 7 days prior to HFI
- Insert new ring ASAP
- Keep ring in until scheduled ring removal day
- No additional precautions required if the above criteria met
A patient realises her ring fell out 36 hours ago in week 3 after HFI, what do you advise?
- EC not required in unscheduled ring removal for <48 hours, IF consistent use in the previous 7 days
- Insert ring ASAP
- Keep ring in until scheduled removal day
- No additional precautions required if meets the above criteria
A patient realises her ring fell out 50 hours ago in week 1 after HFI, what do you advise?
- Consider EC if UPSI has taken place during the HFI or week 1
- Insert new ring ASAP
- Keep ring in until scheduled ring removal day
- Condoms for 7 days
- Consider follow-up PT
A patient realises her ring fell out 50 hours ago in week 3 after HFI, what do you advise?
- EC not required if correct use in previous 7 days
- Insert ring ASAP
- Keep in until scheduled removal day
- If in the week before HFI, omit the HFI
- Condoms for 7 days (over cautious)
A patient accidentally kept her ring in for 26 days, what do you advise?
- As long as ≤28 days, EC not required if ring was correctly used from day 21 to day 28
- Start HFI (if scheduled) and insert new ring at end of HFI, OR just insert a new ring (if not wanting HFI)
- No additional precautions necessary if correct use otherwise
A patient accidentally kept her ring in for 4 weeks and 2 days, what do you advise?
- EC not required with continued use of same ring for >4 weeks and ≤5 weeks (if correct use of the ring otherwise)
- Omit HFI
- Insert new ring ASAP
- Condoms for 7 days (over cautious)
A patient accidentally kept her ring in for 6 weeks, what do you advise?
- Consider EC if UPSI has taken place after 5 weeks or later
- PT
- Omit HFI
- Insert new ring ASAP
- Condoms for 7 days
- Follow-up PT
What constitutes as being late to restart a patch after the HFI?
- If ≥ 8 completed days since last patch was removed for scheduled HFI
(i.e. if woman removed her patch at 9am on Monday, she has until 9am the following Tuesday to apply a new one)
A patient is 72 hours late restarting her patch after the HFI, what do you advise?
- Consider EC if UPSI has taken place during or after the HFI
- Attach new patch ASAP
- Keep new patch on until scheduled removal day
- Condoms for 7 days
- Follow-up PT
A patient’s patch fell off but she’s certain it was for <48 hours, and she is in week 1 after HFI, what would you advise?
- EC not required if correct use earlier in week 1 and the 7 days prior to HFI
- Attach new patch ASAP
- Keep new patch on until scheduled removal day
- No additional precautions required if the above criteria met
These same rules apply if continued use of the same patch for up to 48 additional hours
A patient’s patch fell off but she’s certain it was for <48 hours, and she is in week 3 after HFI, what would you advise?
- EC not required if correct use in previous 7 days
- Attach new patch as soon as possible
- Keep new patch on until scheduled removal day
- No additional precautions required if the above criteria were met
These same rules apply if continued use of the same patch for up to 48 hours
A patient’s patch fell off but she thinks it may have fallen off 72 hours ago, and she is in week 1 after HFI, what would you advise?
- Consider EC if UPSI during the HFI or week 1
- Attach new patch as soon as possible
- Keep new patch on until scheduled removal day
- Condoms for 7 days
- Follow up PT
These same rules apply if continued use of the same patch for ≥48 additional hours
A patient’s patch fell off but she thinks it may have fallen off 72 hours ago, and she is in week 3 after HFI, what would you advise?
- EC not required if correct use in the previous 7 days
- Attach new patch ASAP
- Keep new patch on until scheduled removal day
- If the patch fell off in the week prior to HFI, omit the HFI
- Condoms for 7 days
