1. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 1 Birth Control Pill Problems CAPT Mike Hughey, MC USNR

2. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 2 Which Pill Should I Start? It doesn’t usually matter. 90% will do well on any pill. 9% will do well on some pills but not others. 1% won’t do well, no matter what pill you use.

3. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 3 When to Start the Pills SUN TUEMONWEDTHUFRISAT 123456 78910111213 14151617181920 21222324252627 28293031 1st Sunday after flow begins 1st day of flow 5 days after onset

4. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 4 When are They Effective? About 98% effective after the first pill About 99.9% effective after the 1st cycle

5. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 5 What if the pill she normally takes is not available? Give her one that is available. 90% will do well on any pill. Switch at the normal break.

6. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 6 What if she skips some pills? Stop pills, wait 5 days for menses Resume a fresh pack Use backup contraception. Take as soon as remembered Continue the rest normally 1 pill 2 pills

7. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 7 Light Period or No Period Rule out pregnancy with an HCG Physiologic with low-dose pills Stop pills Change pills Add estrogen (Premarin.625 QD) Live with it

8. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 8 Menses at the wrong time Usually due to ovulation Rx: Keep taking the pills Rx: Restart a new pack If it persists, refer to GYN Don't forget to rule out pregnancy

9. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 9 Painful Menses Unusual (BCPs usually improve cramps) HCG Fibroids, PID, endometriosis, ovarian cyst, etc. Monophasic pills Continuous OCPs If symptoms persist, refer to gynecologist within weeks to months

10. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 10 How can I postpone a period using BCPs? Go directly from one pack into the next. Monophasic works best. May not postpone it. Spotting is common.

11. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 11 Side Effects 80% have no side effects at all. Among the 20% who do: –Nausea –Breast Tenderness –Spotting –Headaches –Depression –Decreased Libido

12. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 12 Headaches, Depression, Decreased Libido Nuisances Usually disappear after 1st month If they persist, change OCPs If symptoms severe, discontinue OCPs

13. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 13 Nausea Nuisance Usually disappears after 1st month If it persists... change OCPs If symptoms severe...discontinue OCPs Rule out pregnancy

14. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 14 Breast Pain Common in 1st month Usually disappears after 1st month If it persists... change OCPs Exam to rule out malignancy Rule out pregnancy

15. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 15 Spotting Between Periods Common in 1st month Try monophasic pills Rule out: – Pregnancy (HCG) – Cervical Disease (Pap) – Ovarian neoplasm (Exam)

16. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 16 Does the pill cause weight gain? Yes and no Generally, people gain weight as they age. Average weight gain due to BCPs is 1 pound in 5 years.

17. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 17 Emergency Contraception 2 Ovrals 12 Hours Later No abnormal bleeding. 50% have nausea and vomiting. Reduces pregnancy risk by 75%. (8% to 2%) Theoretical concern over exposure. We don't know how it works. May use 4/4 LoOvral, 4/4 Nordette, 4/4 Levelen Within 72 hours:

18. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 18 Thinks She May Be Pregnant She may be Better find out!

19. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 19