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Contraceptive Pills

Contraceptive Pills. Lisa Coulter. Combined Oral Contraceptive Pill. Mode Of Action. Affect 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

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Contraceptive Pills

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  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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