What are the advantages of combined hormonal contraceptives?
Reliability and Reversibility: Effective contraception that can be discontinued when pregnancy is desired.
Reduced Dysmenorrhea and Menorrhagia: Alleviates painful periods and heavy menstrual bleeding.
Decreased Premenstrual Tension: Reduces symptoms associated with premenstrual syndrome (PMS).
Risk Reduction:
Lowers the risk of:
- Symptomatic fibroids
- Functional ovarian cysts
- Benign breast disease
- Ovarian and endometrial cancer
Lower Risk of Pelvic Inflammatory Disease: Provides protective effects against infections in the reproductive tract.
How is the choice of combined hormonal contraceptive determined?
selecting a preparation with the lowest estrogen and progestogen content
that provides good cycle control
and minimal side effects.
Is it recommended to continue combined hormonal contraceptives beyond the age of 50?
No
more suitable alternatives exist at that age
What types of combined hormonal contraceptive preparations are suitable for women with risk factors for circulatory disease?
Low-strength preparations (20mcg ethinylestradiol, not 30-35)
What is a risk of standard- strength preparations of hormonal contraceptives?
deep vein thrombosis (DVT)
Which progestogens may be considered for women experiencing side effects with other progestogens?
Desogestrel, drospirenone, and gestodene (in combination with ethinylestradiol)
may be considered for women experiencing side effects such as acne, headache, depression, breast symptoms, and breakthrough bleeding with other progestogens.
What symptoms or conditions warrant the immediate cessation of combined hormonal contraceptives or hormone replacement therapy (HRT)?
- sudden severe chest pain
- sudden breathlessness
- cough with blood
- unexplained swelling or severe pain in one leg
- severe stomach pain
- serious neurological effects
- hepatitis
- jaundice
- liver enlargement
- blood pressure above systolic 160 mmHg or diastolic 95 mmHg
- prolonged immobility after surgery or leg injury
- or detection of a risk factor that contraindicates treatment.
What neurological symptoms should prompt the immediate discontinuation of combined hormonal contraceptives or HRT?
- severe, prolonged headache
- sudden partial or complete loss of vision
- sudden disturbance of hearing
- bad fainting attack
- unexplained epileptic seizure or weakness
- motor disturbances
- very marked numbness suddenly affecting one side or one part of the body
What precaution should be taken for individuals traveling for long periods while using combined hormonal contraceptives?
Increased risk of deep-vein thrombosis during travel involving long periods of immobility (over 3 hours)
may be reduced by appropriate exercise and possibly by wearing graduated compression hosiery
What factors should be considered when assessing the risk of venous thromboembolism with combined hormonal contraceptives?
- family history of venous thromboembolism in a first-degree relative aged under 45 years
- history of superficial thrombophlebitis
- obesity (avoid if BMI ≥ 35 kg)
- long-term immobilization (avoid if bed-bound)
- age over 35 years (avoid if over 50 years)
- smoking
They should be used with caution if any of the mentioned factors are present, but they should be avoided if two or more factors are present
Superficial thrombophlebitis is an inflammation of a vein just below the surface of the skin, which results from a blood clot.
What factors should be considered when assessing the risk of arterial disease with combined hormonal contraceptives?
- a family history of arterial disease in a first-degree relative aged under 45 years
- diabetes mellitus (avoid if diabetes complications present)
- hypertension (avoid if blood pressure above systolic 160 mmHg or diastolic 95 mmHg)
- smoking (avoid if smoking 40 or more cigarettes daily)
- age over 35 years (avoid if over 50 years)
- obesity (avoid if BMI ≥ 35 kg),
- migraine without aura (avoid if migraine with aura).
What is the association between combined hormonal contraceptives and breast cancer?
There is a small increase in the risk of benign breast cancer in women taking the combined pill.
However, the risk diminishes after stopping
and disappears by about 10 years.
How does long-term use of combined hormonal contraceptives relate to cervical cancer risk?
Use for 5 years or longer is associated with a small increased risk of cervical cancer
however, the risk diminishes after stopping
and disappears by about 10 years.
When is a pill considered missed, and what should be done if only one pill is missed?
A missed pill is one that is 24 or more hours late.
If only one pill is missed, the woman should take an active pill as soon as she remembers and then resume normal pill-taking, even if this means taking 2 pills together.
No additional precautions are necessary.
What should be done if two or more pills are missed, especially from the first 7 in a packet?
If two or more pills are missed, especially from the first 7 in a packet, the woman may not be protected.
She should take an active pill as soon as she remembers and then resume normal pill-taking.
Additionally, she must either abstain from sex or use an additional method of contraception such as a condom for the next 7 days.
If these 7 days run beyond the end of the packet, the next packet should be started at once, omitting the pill-free interval.
What is recommended if 2 or more combined oral contraceptive tablets are missed from the first 7 tablets in a packet and unprotected intercourse has occurred?
Emergency contraception is recommended in this scenario.
What action should be taken if vomiting occurs within 2 hours of taking a combined oral contraceptive pill?
Another pill should be taken as soon as possible.
When should additional contraception be used if vomiting or severe diarrhea persists?
If vomiting or severe diarrhea lasts for more than 24 hours, additional contraception should be used during and for 7 days after recovery.
What should be done if vomiting and diarrhea occur during the last 7 tablets of the pill pack?
: If vomiting and diarrhea occur during the last 7 tablets, the next pill-free interval should be omitted.
When are progestogen-only contraceptives considered suitable alternatives to combined hormonal contraceptives?
when estrogens are contraindicated, such as in individuals with:
- venous thrombosis or a past history of it
- heavy smokers (>40 a day)
- hypertension above systolic 160 mmHg or diastolic 95 mmHg
- valvular heart disease
- diabetes mellitus with complications
- migraine with aura
What are the two types of hormonal emergency contraceptives mentioned?
levonorgestrel and ulipristal
Within what time frame is levonorgestrel effective if taken after unprotected intercourse?
if taken within 72 hours (3 days) of unprotected intercourse.
Within what time frame is ulipristal effective if taken after unprotected intercourse?
within 120 hours (5 days) of unprotected intercourse.
Within how many hours after unprotected sex can an intra-uterine device (IUD) be inserted?
It can be inserted up to 120 hours (5 days) after unprotected sex.
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