Describe the regiments of the COC.
- available as 28-day regimens, where active tablets are taken for 21, 24 or 26 days followed by inactive tablets or tablet-free days
- shortening hormone-free interval reduces hormone withdrawal symptoms
- regimens are either monophasic or multiphasic
- start with a monophasic regimen containing a standard dose of ethinyloestradiol (30–35 micrograms) and either levonorgestrel or norethisterone (note: only progestogen on PBS contained in COCs are levonorgestrel and norethisterone)
Describe the monophasic oral contraceptives.
- each active tablet contains the same doses of oestrogen and progestogen
- may be further classified by the dose of oestrogen:
o Standard dose: 30–35mcg ethinyloestradiol or 50mcg mestranol
o Low dose: 20mcg ethinyloestradiol or 1.5mg oestradiol
o High dose: 50mcg ethinyloestradiol (increased risk of S/Es)
Describe the multiphasic oral contraceptives.
- progestogen, or both oestrogen and progestogen, content varies throughout the cycle
- regimens are more complex and may be associated with cyclical symptoms, eg fluid retention, premenstrual syndrome
- no advantage over monophasic regimens
How would you counsel a patient on COCs?
• take one tablet daily, at the same time each day
28 day pack:
- start in coloured section on the 1st day of bleeding, selecting the appropriate day
- continue around pack following the marked days
- cycle will adopt to that imposed by the pill and withdraw bleeding occurs about two days after the last active pill
- pack designed so menstruation doesn’t commence at the weekend
- when pack is completed go to the next pack, starting on the appropriate day in the coloured section
- different types
> coloured section with 5 placebo and 2 active, contraception is not ensured until 14 days of active tablets have been taken, therefore use other methods of contraception such as condoms.
> coloured starting section contains all active, contraceptive cover effective from day one
21 day pack:
- start on the first day of bleeding, contraceptive cover from day one
- continue around the pack following the marked days
- when the pack is completed, wait one week then start the next pack on the same day as the first pack ie. day of the week after the first pack was finished
- in some cases, a period may not occur while taking the pill. Continue taking the tablets as normal but consider the possibility of pregnancy if the pill has not been taken correctly or if 2 periods in a row are missed.
- irregular bleeding or spotting is common at first but this usually settles down after 2–3 months
- if you experience severe/sudden pain in the chest, severe headache, sudden blurred vision or loss of sight, unexplained tenderness/pain and swelling in one leg, while on the pill, stop taking it and seek urgent medical advice
- if you miss a pill, you have a 12 hour window to take the pill (vs. progestogens which only have a 3 hour window if dose is missed)
- if you vomit within 2hrs of taking an active pill, take another active pill as soon as possible
- the pill does not protect against STIs, will need to use barrier methods such as condoms
What is tricyclics?
- taking active tablets (of a monophasic COC) for 9 weeks in a row followed by a 7-day hormone-free interval
- this decreases the frequency of withdrawal bleeds
- may be used for women with headaches or other symptoms in the withdrawal week, heavy or painful periods, endometriosis or to avoid withdrawal bleeds
What AEs are associated with the COCs?
Common:
- breakthrough bleeding
- nausea & vomiting
- breast enlargement/tenderness
- headache
- mood changes (eg depression)
- changes in libido
- increased BP
- fluid retention
- acne
- thrush
- chloasma (skin discolouration)
Rare:
- VTE
- stroke
- liver and cervical cancer
What would you monitor in patients taking the COCs?
- BP
- cervical cancer (ensure users of COCs are included in cervical screening program)
- LFTs? (jaundice a SE)
What is the 7 day rule for missed doses?
> if 2 or ore tablets are missed in the first 7 days of active tablets
- continue to take tablets as usual
- use emergency contraception if sexual intercourse has occurred
- use additional non hormonal method of contraception for the next 7 days
if 2 or ore tablets are missed in the second 7 days of active tablets
- continue to take tablets as usual
- ensure next 7 active tablets are taken at the usual time
- no need for extra contraceptive measures
if 2 or ore tablets are missed in the last 7 days of active tablets
- continue to take tablets as usual
- skip placebo tablets
- begin active tablets in the next pack
- no need for extra contraceptive measures
What is the different between Yasmin and Yaz?
Yaz:
- drospirenone 3 mg, ethinyloestradiol 20mcg, 24 tab
- inactive, 4 tab
Yasmin:
- drospirenone 3 mg, ethinyloestradiol 30 mcg, 21 tab
- inactive, 7 tab
What is Loette®? Discuss.
Loette®:
- COC
- monophasic
- low dose
- contains: levonorgestrel 100mcg, ethinyloestradiol 20mcg
- 21 active tab, 7 inactive tab
What is the active of
- Diane-35 ED
- Juliet-35 ED
- Brenda-35 ED
- Estelle-35 ED
- Laila-35 ED
- cyproterone 2 mg, ethinyloestradiol 35 mcg
- 21 active tab, 7 inactive tab
