COCP

Question 1

What COCP pill is usually used for first time users?

Answer 1

Microgynon 30

30mcg ethinyloestradiol with levonorgestrel/norethisterone

Question 2

Describe the difference between Qlaira and normal COCP

Answer 2

• Estradiol valerate (as opposed to the usual ethinylestradiol) and dienogest
• Qaudraphasic dosage regimen.
• A more natural cycle.
• The dose of estradiol gradually reduces and dieongest increases
• 28 Pills - last 2 are dummy pills.

Question 3

How does the efficacy of Qlaira compare with other COCPs?

Answer 3

It’s efficacy is similar.

Question 4

What are some disadvantages of Qlaira?

Answer 4

• Cost - £8.39 a month (normal pill <70p)
• Limited safety data to date.
  
  • There are different missed pill rules for Qlaira

Question 5

What are the missed pill rules for Qlaira?

Answer 5

• Missed pill timing:
  
  • Qlaira = Missed pill = 12 hours late
  • Standard COCP = Missed pill = 24 hours late.
• If 2 pills missed then emergency contraception may be needed.
• If 1 pill missed:
  
  • Day 1-17 - Take missed pill immediately and the next tablet at the usual time. (even if two taken on the same day). Then take the tablet as normal and use additional contraception for 9 days.
  • Day 18-24 - Discard the rest of the packet. Start taking the Day 1 pill from the new packet immediately and continue taking these pills at the correct time. Abstain for 9 days.
  • Day 25-26 - Take the missed pill immediately and the next tablet at the usual time. (even if two taken on the same day) Additional contraception not necessary.
  • Day 27-28 - discard the forgotten tablet and continue tablet taking in the normal way. Additional contraception not necessary.

Question 6

What is Yaz (a new COCP)?

Answer 6

• It is a 24/4 regime rather than 21/7 cycle.
• A shorter pill-free period is more natural
• Better at stopping ovulation
• Helps with premenstrual symptoms.
• Reduces blood loss by 50-60%

Question 7

If 1 pill is missed for the COCP (30-35 micrograms of ethinylestradiol) at any time of the cycle, what should be done?

Answer 7

• Take the last pill now even if it means taking two pills in one day and then continue taking pills daily, one each day.
• No additional contraceptive protection is needed.
• Take your 7 day break as normal.

Question 8

If 2 or more pills are missed for the COCP (30-35 micrograms of ethinylestradiol) at any time of the cycle, what should be done?

Answer 8

• Take the last pill you missed now even if it means taking two pills in one day
• Leave any earlier missed pills.
• Continue taking the rest of the pack as usual.
• Use an extra method of contraception for the next 7 days.
• You may need emergency contraception (see below)
• You may need to start the next pack of pills without a break (see below).

If pills are missed in week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1

if pills are missed in week 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception.

if pills are missed in week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval

Question 9

Do women using the COCP need to use additional precautions when taking antibiotics?

Answer 9

Only when using enzyme inducing antibiotics such as rifampicin.

Question 10

When switching from 1 combined oral contraceptive to another, what should your strategy be?

Answer 10

FSRH have stated that the pill free interval does not need to be omitted.

The BNF however advises missing the pill free interval if the progesterone changes.

Given the uncertainty it is best to follow the BNF