Progestogen-only Pill Flashcards
When may POP not be suitable for women?
- if taking liver enzyme inducing drugs
- had hormone-dependent tumour in the last 5 years
- have severe decompensating cirrhosis or liver tumours
- are sensitive to any of the components of the POP
- are currently taking a POP and develop ischaemic heart or CVD
In which circumstances is generic desogestrel POP contraindicated?
In those with peanut allergies
Contains soybean ooil
What is the MOA of the POP?
- All POPs alter cervical mucus to reduce sperm penetration
- Induce changes to the endometrium to prevent sperm survival and implantation of the blastocyst
- Sperm motility and function is affected, preventing fertilization
- Ovulation may be suppressed
What is the efficacy of the POP?
- Failure rate <1% with perfect use
- Typical failure rate is 7% in the first year of use
Which POP has a 12 rather than 3 hour safety window?
Desogestrel POP
What are the advantages of the POP?
- Unrelated to sexual intercourse
- Simple, convenient to use, and under the woman’s control
- Can be taken when breastfeeding
- May help to reduce dysmenorrhoea and also the severity of migraines
- Ideal for women who suffer from oestrogenic side-effects when using CHC
- Suitable for women over 35 years who smoke
- Can be used in overweight or obese women with no dose adjustment
- Can be taken by those with medical illnesses where CHCs are contraindicated
- No evidence of an increased risk of cardiovascular disease, thromboembolism or stroke
- Minimal alteration in carbohydrate and lipid metabolism, therefore a useful option for diabetics, even those with neuropathic or nephropathic complications
What are the disadvantages of the POP?
- Side-effects - breast tenderness, mood changes, headaches or acne
- Overall risk of pregnancy reduced but 1 in 10 of these pregnancies may be ectopic
- Increased breakthrough bleeding, spotting and amenorrhoea
- Functional ovarian cysts may develop
How should you take the POP?
Every day with no break
Needs to be taken within 3 hours window period (except desogestrel which has 12 hour period)
What to advise if diarrhoea or vomiting with POP use?
- If vomiting occurs within 2 hours of taking the POP, another pill is taken and no further action is required
- If vomiting continues and/or an individual is 3 or more hours later than normal taking the pill, then the missed pill guidance should be followed
What are some enzyme inducers that may affect POP use?
- Carbamazepine
- Phenobarbital
- Phenytoin
- Topiramate
- Rifabutin
- Rifampicin
- Ulipristal acetate
- Bosentan
- St John’s wort
- Lamotragine
What do you advise if enzyme inducers are used short term with POP?
Additional method such as condoms should be used during the time of drug administration and for 4 weeks after stopping the medication
What do you advise if enzyme inducers are used long term with POP?
An alternative method such as an injectable or IUC should be chosen
When are additional precautions not required for 2 days when starting the POP?
- Starting up to and including day 5 of the natural menstrual cycle
- Up to day 21 post-partum
- Day 1-5 following abortion, miscarriage, ectopic pregnancy or gestational trophoblastic disease
- Switching from another POP at any time
- Day 1-2 of HFI switching from CHC
- In week 2-3 of CHC when switching from CHC (providing method has been used consistently and correctly prior to switching)
- Switching from injectable any time up to when repeat injection is due
- Switching from the implant any time up to when the implant is due for removal
- Switching from LNG-IUS if LNG-IUS remains in-situ for 2 days until the POP becomes effective (NOTE if there has been any UPSI in the preceding 7 days the LNG-IUS should be left in situ for 7 days)
- Switching from IUD on D1-5 of cycle
- Switching from IUD if IUD remains in-situ for 2 days until the POP becomes in-situ (NOTE if there has been any UPSI in the preceding 7 days the LNG-IUS should be left in situ for 7 days)
What to advise if missed pill <3 hours?
The missed pill should be taken and the pack continued as normal. No additional cover is required.
What to advise if missed pill >3 hours?
The last missed pill should be taken and the pack continued as normal. Condoms should also be used as additional contraception for the next 48 hours.
