ࡱ> EGDO #bjbj 46օeօe////,[$/pvxxxxxx$l۱^vv:(Rb0zF`. : ORAL CONTRACEPTION Objectives of this tutorial:  INCLUDEPICTURE "http://www.pencoedmedical.co.uk/_themes/network/anetbul1.gif" \* MERGEFORMATINET To know the advantages and disadvantages of taking the pill INCLUDEPICTURE "http://www.pencoedmedical.co.uk/_themes/network/anetbul1.gif" \* MERGEFORMATINET To know when to start the pill INCLUDEPICTURE "http://www.pencoedmedical.co.uk/_themes/network/anetbul1.gif" \* MERGEFORMATINET To know how and when to follow up women who are on the COCP INCLUDEPICTURE "http://www.pencoedmedical.co.uk/_themes/network/anetbul1.gif" \* MERGEFORMATINET Missed pill adviceStarting the Combined Oral Contraceptive ("The Pill") There are two main types of pill - The combined oral contraceptive ("The Pill") and the progesterone only pill ("The Mini Pill"). This tutorial applies only to the combined oral contraceptive. The information given in this tutorial does not apply to the progesterone only pill (or "Mini Pill"). What are the advantages of the pill? Its a very effective means of contraception if taken as it is directed! Bleeds should be lighter, less painful and very regular. Certain tumours (e.g. ovary) are less common in pill takers. It may help some women who are prone to cysts on the ovary. What are the disadvantages? Smoking is even more dangerous for women who are taking the pill. Blood clots (thrombosis) are very rare but they occur more often in pill taking women than those who do not take the pill (but the highest risk of thrombosis is for pregnant women). For a full list of side effects, please refer to the BNF or MIMS.  HYPERLINK "http://www.open.gov.uk/mca/cpvol24asec2.htm" The Pill and Cancer Risk How and when do women start? Packets of pills will contain 21 tablets. They can start the pill on any day of their monthly cycle. It is better to start the pill on the first day of the cycle (i.e. the day the period starts) because it will provide immediate contraceptive cover if the pill is started then. If the pill is started at any other time of the cycle, it will take a week for the contraceptive action to take effect - so women should abstain or use alternative contraception (e.g. condoms) for that first week. Whatever day your patient decides to start her packet, she will then take a pill every day for 21 days. After that 21 days, she will have 7 days without taking any pills, before starting the next packet. She should start the next packet 28 days to the day after starting the previous packet. For example, if she started her pill on a Thursday, she will then have 21 days of taking the pill followed by a pill free week. She would start the next packet on the Thursday that is exactly 4 weeks after she started the previous packet. She should bleed during the pill free days. Some women find it confusing to take a pill for 21 days followed by a week off. For this reason, doctors may prescribe a type of pill packet that contains 21 active tablets followed by 7 blank tablets. These women still have a "week off" in between packets, although they dont realise it because the last 7 tablets are blanks - they simply take a pill every day. This type of pill packet is called an "ED" pill and contains the letters "ED" after the name of the pill e.g. "Logynon ED". Starting the pill after having a baby If the patient is breast-feeding, she should not take the combined oral contraceptive pill (but she can take the "mini pill"). Providing she is not breast-feeding, it is usually safe to start after the 21st day following birth. She does not need to wait for a period before she starts (in fact, if she has a period then she would have ovulated 14 days previously and liable to get pregnant!). Are there any circumstances when the pill might not work? The pill is absorbed from the GI tract. If your patient has a bout of diarrhoea or vomiting, her pill will not have time to be absorbed and may not work (but she must continue to take her pills all the same). Any new medicines, especially antibiotics, may stop the pill from working. She should not stop taking her pill during these instances, but she should take extra precautions. How often do patients need to see their doctor? The first time they are given the pill, they will usually be given 3 months supply to try. When she returns for review after 3 months her doctor will check her blood pressure and suggest she has a smear test (if she is due to have one or if she is over 20 yrs of age and has not had one in the past). If all is well, she will be given 6 months supply and she should return every 6 months for a fresh supply and blood pressure check. If you have given contraceptive advice you must fill in a FP1001 claim form and hand it to the practice manager. This is very important! If a woman stops the pill, will there be a delay before becoming fertile again? Taking the pill does not affect future fertility. The ovaries will normally "wake up" within seven days of stopping the pill. All other factors being normal, a woman can become pregnant as soon as she stops taking the pill. Other factors can lead to infertility, but "having been on the pill in the past" does not seem to be one of them! MISSED PILL ADVICE: The golden rule is this - "take it as soon as you remember and do not stop taking the rest of your pills, even if that means taking the forgotten pill and the next scheduled pill at the same time. It takes seven continuous days of pill taking to put your ovaries back to sleep again". Less than 12 hours late: Provided she remembers, and takes, her forgotten pill within 12 hours of the scheduled time she will be safe. More than 12 hours late: If she is more than 12 hours late, she should consider herself at high risk of becoming pregnant. She should take the forgotten pill as soon as she remembers and dont stop taking the rest of her pills, even if this means taking the forgotten pill and the next pill at the same time. However, it will take seven continuous days of pill taking for the pill to regain its contraceptive effect. If she is at the end of her packet (e.g. only 2 pills left in the packet) and unable to take seven continuous days of pill taking, she should start her next packet immediately (without the usual 7 day break). That way, she can take 7 days of continuous pill taking and should regain contraceptive cover a week after her forgotten pill. Of course, if she takes 2 packets in a row, she may not have a period in the middle. This will cause no harm (in fact, she may advised you to do this if ever she wishes to postpone a period e.g. going on holidays). What happens if she forgets an "ED" pill? Women taking the "ED" type of pill need to take a pill every day without a break. The last 7 pills in each packet are placebos, so if she forget one of these, it doesnt matter! If she forgets any of the other pills in the packet, the same advice applies as does a "Non-ED" formulation (above).  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