Combined oral contraceptives Flashcards
(19 cards)
COC
Contains oestrogen + progesterone
Inhibits ovulation
Monophasic preparation
Fixed amount of oestrogen + progesterone
Phasic preparation
Varying amounts of oestrogen + progesterone
- For women who do not have withdrawal bleeding OR
- Have breakthrough bleeding with monophasic preparations
Every day preparation
Pill free interval replaced with inactive pills
Low strength-oestrogen preparation
Suitable for those with a risk factor for circulatory disease
Contains 20 mg Ethinylestradiol
Oestrogen - increases risk of?
VTE
ATE (arterial thromboembolism)
VTE risk factors
Avoid COC if 2 or more are present
- Obesity BM1 >30
- Smoking
- First degree relative under 45 with VTE
- Superficial thrombophlebitis
- Long-term immobilisation
- Age >35
- Type of progesterone (Desogestrel, gestodene, drosperinone)
ATE risk factors
Avoid COC if 2 or more present
- Diabetes
- Hypertension
- Migraine without aura
Surgery
- Stop 4 weeks before (major surgery/surgery to legs/surgery that causes immobilisation)
- POP is alternative
- Restart usual contraception on 1st period at least 2 weeks after full mobilisation.
Emergency surgery/COC not stopped
Thormboprophylaxis
Travel
3+ hour journeys = compression stocking and leg exercises
Reasons to stop
VTE
Stroke
Hepatotoxicity
Prolonged immobility after surgery/leg injury
Risk factor that C/I treatment
VTE
PE = chest pain, breathlessness, cough with blood sputum
DVT = unexplained swelling or severe pain in calf of one leg
BP
> 160/95 mmHg
Stroke
- Prolonged, severe headhace
- Partial/complete loss of vision
- Hearing disturbance
- Perceptual disorders
- Slurred speech
- Seizure
- Weakness
- Numbness on one side of the body
Risk factors that C/I treatment
Smoker (40+)
Personal history of VTE or ATE
Migraine with aura
Migraine 72 hours
Migraine treated with ergot derivatives
Diabetes with complications
Heart disease with pulmonary hypertension/risk of embolus
Valvular heart disease
BMI >35
50+
TIA
BP >160/95 mmHg
2 or more risk factors for VTE/ATE
How to take
OD for 3 weeks
1 week pill free interval (withdrawal bleeding)
Start anytime in cycle
Started on day 6 or later = protection for 7 days
What age cannot use?
50+
Benefits of COC
Reduced risk of ovarian + endometrial cancer
Reduces:
- Dysmenorrhea
- Menorrhagia
- PMS
Less risk of PID
Less symptomatic fibroids or functional ovarian cysts
