Lisa Coulter Contraceptive Pills. Combined Oral Contraceptive Pill.
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Transcript of Lisa Coulter Contraceptive Pills. Combined Oral Contraceptive Pill.
Lisa Coulter
Contraceptive Pills
Combined Oral Contraceptive Pill
Mode Of ActionAffect negative feedback suppressing FSH
and LH
No follicles develop
No ovulation
Absolute Contraindications to COCP Smoker 15 per day and >35
BMI >40
BP 160/95
VTE/IHD/CVA
Current breast ca
Viral hepatitis/cirrhosis
DM plus nephropathy/retinopathy/neuropathy
Starting COCP Day 1-5 menstrual cycle – no condoms
Post TOP/miscarriage – if start within 7d of TOP/miscarriage <24 gestation, no condoms
Post partum (not breast feeding) – start day 21of cycle, no condoms
Post partum (breast feeding) – not recommended; if >6m pp and menstruating, as for other cycling women
After other contraceptionDepo: start 12w and 5d after last depo, no condoms From POP: change anytime, no condomsFrom implanon: any time prior to removal, or on day of
removal, no condoms
Missed COCP Pills If <12h late and UPSI – take pill and continue as normal
If >12h late and UPSI:
In pill free wk/first 7 pills: (if miss 2x20mcg or 3x30mcg pills) need EC
Middle 7 pills: take missed pill, condoms for 7d, no EC
Last 7 pills: take missed pill, start next packet without break, condoms 7d, no EC
COCP and D&VIf vomit within 2h of taking pill, take another or
follow rules for missed pills
If severe diarrhoea >24h – keep taking pills but follow missed pill instructions for each day of diarrhoea
COCP and Broad Spectrum AbxPenicillins, ampicillin, tetracyclines and
cephalosporins may affect enterohepatic recirculation of ethinylestradiol
Continue pills, condoms during and for 7d after abx
Emergency contraceptive if UPSI during/7d after abx
Women established on non-enzyme inducing abx, i.e. >3w use do not require condoms (effects on bowel flora subside after 3w)
COCP and Enzyme InducersWomen should be offered regime containing
50mcg ethinylestradiol
Condoms should be used during use of enzyme inducers and for 4w after stopping
When to Discontinue COCPAt least 4w before major surgery
First onset of migraine with aura
Pain or swelling in legs
Chest pain with breathlessness or haemoptysis
Cigarette smoker >35y
Age 50y
Progestogen Only Contraceptive Pill
Generations of POP1st: norethindrone
2nd: norethisterone (micronor), levenorgesterol (microval)
3rd: desorgestrel (cerazette), gestodene
Mode of ActionCervical mucus changes
Endometrial changes
Variable effect on ovulation
Who is Eligible for POP?Lactation
Older women and smokers
Diabetes/obesity
Hypertension
Women’s choice
Oestrogen related contraindications
When to Start POPFirst Use: day 1-5 of cycle no condoms,
otherwise condoms required for 2d
Post partum and breast feeding: ideally on day 21 of cycle, no condoms
Post TOP: If started >7d after TOP, condoms for 2d
Missed POPTraditional POP (>3h late)
take missed pill, continue daily pill taking, condoms for 2d
Desorgestrel-only pill (>12h late)Take missed pill, continue daily pill taking,
condoms for 2d
Emergency Contraception
Specific indications Unprotected SI
Potential barrier failures
Potential COCP failure2x20mcg or 3x30mcg and UPSI in pill free wk/wk 1
Potential POP failure 1 or more missed and UPSI in next 2d
Potential IUD/IUS failure expelled/removed and UPSI in previous 7d
Potential injectable failure>14w depot and UPSI
Enzyme inducers and OCPs/implants during or within 28d of use and UPSI
Methods Levonelle 1500
Levonorgestrel 1500mcg within 72h of UPSI
Affects sperm migration/ function and endometrial receptivity
Variable effect on ovulation
Efficacy: 95%<24h, 85% 24-48h, 58% 48-72h
CI: pregnancy, hypersensitivity
SE: N&V, menstrual disturbance, breast tenderness
Double dose if taking enzyme inducers
MethodsIUD
Copper IUD within 5d of UPSI
Inhibits implantation
Failures <1:1000
CI: possible implanted pregnancy, Recent PID
ReferencesFaculty of family planningNICE guidance October 2005