Starting contraception Flashcards
UKMEC4 criteria for COCP - do not prescribe
Current breast cancer
Migraine with aura
Current or history of VTE (clots)
Given birth less than 6w ago and breastfeeding
Age over 35 and smoking over 15 cigarettes per day
Uncontrolled hypertension
Obesity (BMI >35)
Previous stroke/coronary artery disease
Atrial fibrillation
Clotting disorders e.g. Factor V leiden
History questions to ask before counselling bit for COCP
Why are you looking to start the pill?
Taken any contraception before? What contraception do you usually use?
Which contraception option would you like? Have they considered a LARC (implant, IUS?)
PMH - breast cancer, VTE
DH -
FH - any VTE? breast cancer? etc…
SH - smoker? (also alcohol?, safe in relationship?)
Gynae - Menstrual cycle - when was last menstrual period, where in cycle are you now and length of cycles etc.., abnormal discharge, smears and results
Obs - been pregnant before? is there a chance you may be pregnant now?
How to take the pill guidance on starting the pill
Offer a leaflet
21 days followed by 7 pill-free days
Take the pill at the same time every day
If start in first 5 days of cycle then cover starts straight away, if not need to use condoms for protection for 7 days until full cover is achieved
Missed pill rules
If miss one pill - take the missed pill asap and take the remaining pills as normal from then on, don’t need Emergency contraception
If miss two or more:
- Most recent missed pill should be taken asap and further ones as normal
- and use condoms until 7 consecutive active pills taken
- First week of pills - consider EC if had UPSI
- Second week - no EC needed if week 1 pills taken correctly (or 7d before the UPSI)
- Third week - omit the pill free interval
Other guidance to give for COCP
If vomit within 3 hours of taking the pill then take another one straight away and continue next pill at usual time
Pill doesn’t protect against STIs - condoms are the only method of this
Let Dr/pharmacist know that on COCP when starting new medications
99% effective if taken correctly
Potential side effects and risks of the COCP
Small increased risk of breast cancer, cervical cancer and stroke/ blood clots
Side effects include - headache, nausea, mood changes, breast tenderness, reduced libido
Other advantages of COCP
Periods may become more regular, lighter and less painful.
May improve acne
How does the COCP work?
Stops the ovaries releasing an egg each month and thickens mucous from the cervix making it more difficult for sperm to move through.
Safety net and follow up
Stop pill and see doctor if develops migraines, calf pain and swelling, or bleeding after intercourse breast lumps
severe chest pain/SOB - dial 999
Follow up in 3 months
Examination
BMI, BP
