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Contraceptive Pills Lisa Coulter.

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Presentation on theme: "Contraceptive Pills Lisa Coulter."— Presentation transcript:

1 Contraceptive Pills Lisa Coulter

2 Combined Oral Contraceptive Pill

3 Mode Of Action Affect negative feedback suppressing FSH and LH
No follicles develop No ovulation

4 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

5 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 contraception Depo: start 12w and 5d after last depo, no condoms From POP: change anytime, no condoms From implanon: any time prior to removal, or on day of removal, no condoms

6 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

7 COCP and D&V If 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

8 COCP and Broad Spectrum Abx
Penicillins, 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)

9 COCP and Enzyme Inducers
Women should be offered regime containing 50mcg ethinylestradiol Condoms should be used during use of enzyme inducers and for 4w after stopping

10 When to Discontinue COCP
At 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

11 Progestogen Only Contraceptive Pill

12 Generations of POP 1st: norethindrone
2nd: norethisterone (micronor), levenorgesterol (microval) 3rd: desorgestrel (cerazette), gestodene

13 Mode of Action Cervical mucus changes Endometrial changes
Variable effect on ovulation

14 Who is Eligible for POP? Lactation Older women and smokers
Diabetes/obesity Hypertension Women’s choice Oestrogen related contraindications

15 When to Start POP First 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

16 Missed POP Traditional 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

17 Emergency Contraception

18 Specific indications Unprotected SI Potential barrier failures
Potential COCP failure 2x20mcg 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

19 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

20 Methods IUD Copper IUD within 5d of UPSI Inhibits implantation
Failures <1:1000 CI: possible implanted pregnancy, Recent PID

21 References Faculty of family planning NICE guidance October 2005

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