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Birth Control Pill Problems

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Birth Control Pill Problems. CAPT Mike Hughey, MC USNR. 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. SUN. MON. TUE. WED. THU. FRI. SAT. 1. 2. 3. 4.

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slide1
Birth Control Pill Problems

CAPT Mike Hughey, MC USNR

which pill should i start
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.
when to start the pills

SUN

MON

TUE

WED

THU

FRI

SAT

1

2

3

4

5

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When to Start the Pills

• 1st Sunday after flow begins

• 1st day of flow

• 5 days after onset

when are they effective
When are They Effective?
  • About 98% effective after the first pill
  • About 99.9% effective after the 1st cycle
what if the pill she normally takes is not available
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.
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

What if she skips some pills?

2 pills

1 pill

light period or no period
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
menses at the wrong time
Menses at the wrong time

Don\'t forget to rule out pregnancy

  • Usually due to ovulation
  • Rx: Keep taking the pills
  • Rx: Restart a new pack
  • If it persists, refer to GYN
painful menses
Painful Menses

If symptoms persist, refer to gynecologist within weeks to months

  • Unusual (BCPs usually improve cramps)
  • HCG
  • Fibroids, PID, endometriosis,ovarian cyst, etc.
  • Monophasic pills
  • Continuous OCPs
how can i postpone a period using bcps
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.
side effects
Side Effects
  • 80% have no side effects at all.
  • Among the 20% who do:
    • Nausea
    • Breast Tenderness
    • Spotting
    • Headaches
    • Depression
    • Decreased Libido
headaches depression decreased libido
Headaches, Depression, Decreased Libido
  • Nuisances
  • Usually disappear after 1st month
  • If they persist, change OCPs
  • If symptoms severe, discontinue OCPs
nausea
Nausea
  • Nuisance
  • Usually disappears after 1st month
  • If it persists ... change OCPs
  • If symptoms severe...discontinue OCPs
  • Rule out pregnancy
breast pain
Breast Pain
  • Common in 1st month
  • Usually disappears after 1st month
  • If it persists ... change OCPs
  • Exam to rule out malignancy
  • Rule out pregnancy
spotting between periods
Spotting Between Periods
  • Common in 1st month
  • Try monophasic pills
  • Rule out:
    • Pregnancy (HCG)
    • Cervical Disease (Pap)
    • Ovarian neoplasm (Exam)
does the pill cause weight gain
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.
emergency contraception
Emergency Contraception

Within 72 hours:

2 Ovrals

12 Hours Later

2 Ovrals

  • 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
thinks she may be pregnant
Thinks She May Be Pregnant
  • She may be
  • Better find out!
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