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ORAL CONTRACEPTION

Efficacy of COC . Pearl Index 0.1 (failure rate /100 women year) . Composition . Oestrogen [ethinyl oestrodiol 35 mcg or less]Progestogen 2nd generation Norethisterone 1mgLevnogestrel 150mcg2nd/3rd generationNorgetimate 250mcg3rd generationDesogestrel 150mcgGes

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ORAL CONTRACEPTION

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    1. ORAL CONTRACEPTION Mahreen Chawdhery GP Registrar Elizabeth House Surgery, Warlingham

    2. Efficacy of COC Pearl Index 0.1 (failure rate /100 women year)

    3. Composition Oestrogen [ethinyl oestrodiol 35 mcg or less] Progestogen 2nd generation Norethisterone 1mg Levnogestrel 150mcg 2nd/3rd generation Norgetimate 250mcg 3rd generation Desogestrel 150mcg Gestodene 150mcg Cyproterone acetate2mg&Drospirenone3mg Behave as 3rd generation

    4. Mode of Action Prevents ovulation Disrupts endometrium Thickens cervical mucus

    5. Advantages Reliable Regular bleeds , usually lighter, reduces dysmenorrhoea & menorrhagia Controls PMS Improves acne Protection against Ca overy & endometrium Protection against benign breast disease May reduce symptoms of endometriosis May reduce symptoms of Rh artritis

    6. Potential Problems Cardiovascular effects Increased risk of Ca breast Reduced efficacy with some drugs Reduced efficacy with D & V Minor SE common

    7. Management Which pill ? First prescription Take careful history: exclude any contra-indication Check BP & BMI Discuss risks & benefits of COC Advise what symptoms to report immediately Discuss common SE [most settle in first 3/12] Teach pill taking support all above with PIL

    8. Starting Regime Immediate protection Normal period Day 1-5 Post partum ( NL) Day 21 Post TOP/miscarriage Day 1-5 Post POP Day I of period 7 days extra precaution Normal period after day 5 Post emergency pill Amenorrhea Quickstart

    9. Management Continuing COC Pill for 21 days followed by 7 days pill free interval Missed pill advise Follow up first follow up at 3/12 with 6 monthly checks there after

    10. Management of Common Problems BTB Breast tenderness Bloating Weight gain Headaches ( non migranous) Depression Loss of libido Acne cholasma

    11. Management of Common Problems Dry vagina PMS Nausea Recurrent vaginal thrush Missed withdrawl bleeds Previous pill failure hypertension

    12. Absolute Contraindication (1) Allergy to a constituent Undiagnosed abnormal genital tract bleeding Actual or possible pregnancy Woman uncertain re-using method WHO 4 PH arterial or venous thrombosis Ischemic heart disease/cardiomyopathies BMI >39 BP >160/100 Severe DM Migraine with aura FH +abnormal lipid profile

    13. Absolute Contraindication (2) Combination of less sever risk factors Thrombophilia 4 weeks before surgery until 2 weeks after full mobilization Altitude over 4500m Sever IBD PH of TIA or cerebral haemmorge Active liver disease/adenoma/carcinoma Cholestatic jaundice Ac porphyria, SLE Trophoblastic disease until HCG normal

    14. POP Efficacy Pearl index = 0.3 4.0

    15. POP Composition 2nd genration progestogens LNG or NET ie Neogest Microval Femulen Micronor 3rd generation progestogen DSG Cerazette

    16. POP Mode of action Cervical mucus thickening Ovarian inhibition

    17. Advantages of POP Suitable for breast feeding mothers Rapid return of fertility when stopped Avoid risks & SE of oestrogen

    18. Potential problems Efficacy slightly less than COC Need to take strictly on time to maximise effectiveness Irregular menstural cycle & spotting Increase in follicular cysts Doesn’t protect so well from Ectopic pregnancy Efficacy reduced by enzyme inducing drugs & severe malabsorption Minor SE ie headache, weight gain, mastalgia, acne & mood changes

    19. Management Which pill? Consider cost & effectiveness Sp reasons for choosing Cerazette First pill & follow up As for COC Starting regime Immediate protection Normal period Day 1-5 Post partum Day 21 Post Top /miscarriage Day 1-5

    20. Management Immediate protection Normal cycle – Day 1-5 Post partum – Day 21 Post TOP/miscarriage – Day 1-5 48hrs extra precaution Normal cycle – after day 5 Amenorrhoea - Quickstart Management of SE

    21. Oral Emergency Contraception Progestogen only regime Efficacy Composition Mode of action Advantage Possible problems contraindication

    22. Thank you

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