OSCE: Contraceptive Counselling Flashcards
Generic format of contraceptive counselling station
Introduction
Brief History
ICE
What?
How to take?
How does it work?
Effectiveness
Screen for contraindications (if relevant)
Pros & cons
Additional information about specific type e.g. missed pills, procedures, safetynetting
Closing
What are the 3 main types of COCP?
1) Monophasic 21 day pill
2) Phasic 21 day pill
3) Everyday pill
Which type of COCP is most common?
Monophasic 21 day pill
How does the monophasic 21 day COCP pill work?
Each pill has same amount of hormone in it.
Taken for 21 days followed by a 7-day break.
How does the phasic 21 day COCP work?
- Each pill contains a different amount of hormone
- Pills must be taken in correct order
- Taken for 21 days followed by a 7-day break
How does the everyday COCP work?
- 21 pills containing hormones and 7 placebo pills
- Pills taken for 28 days with NO break in-between
3 ways that the COCP prevents pregnancy?
1) Prevents ovulation i.e. stops ovaries from producing an egg every month (main mechanism)
2) Thickens mucus around cervix: stops sperm entering
3) Thins lining of womb (endometrium): less likely that a fertilised egg would be able to implant in the womb
How effective is COCP?
If taken correctly, is around 99% effective.
What is important to stress about COCP effectiveness?
Emphasise that effectiveness depends on compliance.
Give some advantages of the COCP
- Non-invasive
- Effective (up to 99%)
- Problems associated with periods improve e.g. periods may become more regular, lighter, and less painful
- Controls timing of periods - you can run the pill packets back-to-back e.g. for holidays, certain events
- Improves acne in some people
- Reduces symptoms of PMS
- Reduces risk of ovarian, uterine & colon
Give some disadvantages of the COCP
- Side effects - headaches, nausea, mood changes, breast tenderness
- Breakthrough bleeding - especially in first few months (this is bleeding on the days you are taking the pill)
- No protection from STIs
- User dependent
What information can be given for helping woman to remember to take pill?
useful to set a reminder on phone or in diary
Risks of COCP?
1) Small VTE risk:
- Small increase in risk of developing clots in legs or lungs
- Small increase in risk of heart attack or stroke
- The risk is increased if you smoke regularly, have a high BMI or are immobile for a long period of time
2) Small increased risk of breast cancer –> risk reduces with time after stopping pill
3) Small increased risk of cervical cancer
Give some contraindications for COCP
1) Pregnancy
2) Age >35 y/o and smoking >15 cigarettes per day
3) >35 y/o and stopped smoking <1 year ago
4) BMI >35
5) Suffer from migraine with aura
6) Breastfeeding up to 6 weeks
7) FH of breast cancer
8) Active breast cancer
9) CVS and VTE risk factors
When is the COCP contraindicated in pregnancy?
Up to 6 weeks
What is the main mechanism action of COCP?
stops ovulation
When can the COCP be started?
Can start at any time if you are sure you are not pregnant
Important information regarding starting the COCP?
Need to use condoms for the first 7 days of taking the pill (unless started on day 1-5 of menstrual cycle).
What advice is given regarding ONE missed COCP (or a new pack is started one day late)?
Take the missed pill straight away and continue taking the rest of the pack as normal.
Emergency contraception is NOT required.
What advice is given regarding TWO missed COCP (or a new pack is started two days late)?
Take the most recent pill you missed straight away.
Leave any of the pills you missed before then.
Use condoms or abstain from sex for the next 7 days.
If you have had sex in the previous 7 days –> seek advice for emergency contraception
What should you do with the rest of the pack after a missed COCP?
If 7 or more pills left in the pack –> finish the pack and have the usual 7-day break.
If <7 pills in the pack –> finish the pack and start the new pack the next day (i.e. no break).
Some common patient questions during pill counselling:
1) What happens if I’m sick or have diarrhoea?
2) Which common medicines affect the efficacy of the pill?
3) Is it harmful to miss a withdrawal bleed?
4) What should the patient do if they want to try and become pregnant?
5) What should the patient do if they want to stop taking the pill?
6) Is it dangerous to take the pill for a long time?
How to counsel patient about COCP/POP if they ask: What happens if I’m sick or have diarrhoea?
If the patient is sick within 2 hours of taking the pill then they will need to take another one if they are feeling better.
If a patient has severe diarrhoea for more than 24 hours, they will need to take the pill as if they missed a pill and follow the instructions discussed above. This should continue until the diarrhoea is no longer severe.
How to counsel patient about COCP if they ask: Which common medicines affect the efficacy of the pill?
Explain to the patient that they should tell you what medicines they are currently taking.
Some medicatiosn that can affect the COCP (and reduce efficacy):
- antiepileptics
- HIV medication
- St Johns Wort
