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Matthew Dowling 10/9/14 CONTRACEPTION

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CONTENTS Oral Contraceptives: Types Method of action Contraindications (MEC) Emergency Contraception

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ORAL CONTRACEPTIVES 2 main types: Combined oral contraceptives (Progestogen and Oestrogen) Progestogen-only contraceptives (Mini-pill or POP)

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COMBINED ORAL CONTRACEPTIVES One of most commonly used methods of contraceptives Currently available CHCs contain a synthetic oestrogen (ethinylestradiol or mestranol) and a progestogen Eg: Microgynon (30microg ethinylestradiol and 150mg levonogestrol) Loestrin (20 microg ethinylestradiol and 1mg noresthisterone) Dianette (25mcg ethinylestrodiol and 2mg cyproterone acetate) Yasmin (30microg ethinylestradiol and 3mg drospironone) Logynon Binovum Brevinor Cilest

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HOW DO THEY WORK? Primarily by preventing ovulation through inhibition of hypothalamo-ovarian-pituitary axis Also cervical mucus Endometrial changes

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HOW ARE THEY TAKEN? 28 pills (21 active 7 placebo) First 7 inhibit ovulation Next 14 maintain anovulation

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WHEN TO START? Any time as long as sure not pregnant Immediate contraceptive cover if started on day 1-5 of cycle If starting after day 5, extra protection required for 7 days

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QUESTION A 25 yr old woman phones for advice. She has missed two pills in a row. Today she would be taking the 19 th pill of the packet. There have been no other missed pills during the packet. She has been having regular UPSI during the weekend. You have already told her to take two of her pills as soon as possible. What next? 1. Needs EC + use condoms for 7 days + skip the break 2. Use condoms for 7 days + skip the break 3. Needs EC + skip the 7 day break 4. Needs EC + use condoms for 7 days 5. Use condoms for next 7 days

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WHAT TO DO IF YOU MISS A PILL... 1 pill missed Take asap then carry on, no additional protection required 2 or more missed pills Take latest missed pill then use extra protection for next 7 days In week 1- consider EC if had UPSI in the last 7 days or pill free period In week 2- No need for EC (as long as has had 7 consecutive pills in 1 st week) In week 3- No need for EC. Finish the pills in her current pack, skip the break

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QUESTION A 25 yr old woman phones for advice. She has missed two pills in a row. Today she would be taking the 19 th pill of the packet. There have been no other missed pills during the packet. She has been having regular UPSI during the weekend. You have already told her to take two of her pills as soon as possible. What next? 1. Needs EC + use condoms for 7 days +skip the break 2. Use condoms for 7 days + skip the break 3. Needs EC +skip the 7 day break 4. Needs EC + use condoms for 7 days 5. Use condoms for next 7 days

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QUESTION A 25 yr old woman phones for advice. She has missed two pills in a row. Today she would be taking the 19 th pill of the packet. There have been no other missed pills during the packet. She has been having regular UPSI during the weekend. You have already told her to take two of her pills as soon as possible. What next? 1. Needs EC + use condoms for 7 days +skip the break 2. Use condoms for 7 days + skip the break