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Birth Control Pill Problems

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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Birth Control Pill Problems

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  1. Birth Control Pill Problems CAPT Mike Hughey, MC USNR

  2. 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.

  3. SUN MON TUE WED THU FRI SAT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 When to Start the Pills • 1st Sunday after flow begins • 1st day of flow • 5 days after onset

  4. When are They Effective? • About 98% effective after the first pill • About 99.9% effective after the 1st cycle

  5. 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.

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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.

  11. Side Effects • 80% have no side effects at all. • Among the 20% who do: • Nausea • Breast Tenderness • Spotting • Headaches • Depression • Decreased Libido

  12. Headaches, Depression, Decreased Libido • Nuisances • Usually disappear after 1st month • If they persist, change OCPs • If symptoms severe, discontinue OCPs

  13. Nausea • Nuisance • Usually disappears after 1st month • If it persists ... change OCPs • If symptoms severe...discontinue OCPs • Rule out pregnancy

  14. Breast Pain • Common in 1st month • Usually disappears after 1st month • If it persists ... change OCPs • Exam to rule out malignancy • Rule out pregnancy

  15. Spotting Between Periods • Common in 1st month • Try monophasic pills • Rule out: • Pregnancy (HCG) • Cervical Disease (Pap) • Ovarian neoplasm (Exam)

  16. 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.

  17. 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

  18. Thinks She May Be Pregnant • She may be • Better find out!

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