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Prescribing the COCP

Prescribing the COCP. Ellen Aston. Before starting…. Who should never have it? >35yrs and a smoker BMI >30

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Prescribing the COCP

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  1. Prescribing the COCP Ellen Aston

  2. Before starting… • Who should never have it? • >35yrs and a smoker • BMI >30 • Current Guidelines avoid if BMI >40 or use with caution when >30. (The WHO/family planning guidelines are subtly different to the BNF). BMI >30 doubles risk – likely guidelines will change. • BP >140/90 • VTE • Migraine and aura • Who usually shouldn’t have it? • Which pill? • What choice for second line? • What monitoring?

  3. Martha’s Baby Really Screams She Shouldn’t Have Missed A Day Mode of action Benefits Risks Side effects Safe sex Starting How to take Missed pill Antibiotic advice Diarrhoea and Vomiting Pill Start

  4. Why choose Microgynon 30 first? • Use a pill with 30µg Oestrogen and Norethisterone or Levonorgetrel because: • Lower risk of VTE (15/100 000/year) • Increased bleeding with 20µg pill • No evidence to support biphasic/triphasic pills • Microgynon 30, Ovranette, Brevinor, Loestrin 30…..

  5. What next? • If after 3 months • Breakthrough bleeding, acne, headache, depression, weight gain, breast symptoms • Try a 3rd generation pill… • Desogestrel (Marvelon) or Gestodene (Femodene) • ….or try Cilest • Yasmin - only if significant water retention problems, not 1st or 2nd line

  6. Just keep going Take missed pill asap and carry on as normal If in week 3 omit the pill-free week Back up method for 7 days if 3 OR MORE If in days 1-7 offer Emergency contraception if UPSI during pill-free week If 1 or 2 pills missed If 3 or more pills missed Take missed pills when remembered Take remaining pills at the usual time Take missed pill when remembered Continue with remaining pills at usual time Used condoms or abstain for 7 days DAYS 1-7 Emergency contraception if UPSI during PFI DAYS 8-14 No need for emergency contraception DAYS 14-21 Omit the PFI

  7. Pill Check • Review at 3 months • Check BP • Safe sex • If no concerns 12 months prescription and review if necessary “What day of the week do you start each new pack?”

  8. Any Questions?

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