lisa coulter contraceptive pills. combined oral contraceptive pill
TRANSCRIPT
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Lisa Coulter
Contraceptive Pills
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Combined Oral Contraceptive Pill
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Mode Of ActionAffect negative feedback suppressing FSH
and LH
No follicles develop
No ovulation
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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
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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
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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
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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
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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)
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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
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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
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Progestogen Only Contraceptive Pill
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Generations of POP1st: norethindrone
2nd: norethisterone (micronor), levenorgesterol (microval)
3rd: desorgestrel (cerazette), gestodene
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Mode of ActionCervical mucus changes
Endometrial changes
Variable effect on ovulation
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Who is Eligible for POP?Lactation
Older women and smokers
Diabetes/obesity
Hypertension
Women’s choice
Oestrogen related contraindications
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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
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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
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Emergency Contraception
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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
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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
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MethodsIUD
Copper IUD within 5d of UPSI
Inhibits implantation
Failures <1:1000
CI: possible implanted pregnancy, Recent PID
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ReferencesFaculty of family planningNICE guidance October 2005