Non-LARC Flashcards
What are some of the non-contraceptive benefits of the combined oral contraceptive?
COC can help with:
- heavy menstrual bleeding
- painful periods
- acne
- irregular periods
- premenstrual symptoms
- endometriosis
- menstrual migraine (no aura)
What is the primary mode of action of the combined oral contraceptive?
Inhibiting ovulation via action on hypothalmic-pituitary-ovarian axis to reduce luteinising and follicle-stimulating hormones
What is the standard regime for taking the combined oral contraceptive?
Take daily for 21 days then stop for 7 days during which a withdrawal bleed occurs due to shedding of the endometrium
Why are 21 COC pills taken?
The first 7 pills inhibit ovulation and the next 14 maintain anovulation
What is the standard regime for the combined transdermal patch?
One patch is applied and worn for 1 week to suppress ovulation
Thereafter the patch is reapplied weekly for a further 2 weeks
The fourth week is patch-free to allow a withdrawal bleed
What is the standard regime for the combined vaginal ring?
A ring is placed into the vagina and left continuously for 21 days
After a ring-free interval of 7 days to induce a withdrawal bleed, a new ring should be inserted
What factors may inhibit effectiveness of CHC?
Impaired absorbtion e.g. GI conditions
Impaired metabolism e.g. liver enzyme induction, drug interactions
What are some of the risks associated with taking CHC?
Venous thrombosis
Arterial thrombosis
Adverse effects on some cancers
Why should COC not be prescribed in those who have migraine with aura?
COC increases risk of stroke
Migraine with aura increases risk of stroke
Which cancer does combined pill put women at risk of?
Breast cancer
Small increased risk of cervical cancer if taken >5 years
What cancers does combined pill protect women from?
Ovarian cancer - 20% decrease if 5yrs use
Endometrial cancer - 50% reduction
What are the side effects of the combined pill?
Unscheduled bleeding – up to 20% experience, usually settles with time
Mood changes – can occur but no evidence it causes depression
Weight gain
When is the combined oral pill started?
COC’s can be started up to and including Day 5 of the cycle without the need for any additional contraception
Beyond Day 5 a woman can start the COC at any other time (off licence) provided she is ‘reasonably certain’ she is not pregnant and use condoms/abstinence for 7 days – ‘quick start’
What should a patient do if they miss one pill from COC packet?
Take the pill when remembered
Continue packet with no need for additional measures
What should a patient do if they miss two pills i.e. haven’t taken a pill for 48 hours?
Take the most recent missed pill
Take the remaining pills at the correct time
Use condoms or abstain until 7 pills have been taken consecutively
