Choice of contraceptive
Combined hormonal contraceptives have several advantages over progestogen-only contraceptives (such as reduced risk of dysmenorrhoea, menorrhagia, ovarian or endometrial cancer) and are usually considered first
Combined hormonal contraceptives
- If a woman forgets to take a pill, she should take another one as soon as she remembers
- If this pill is taken 24 or more hours late, it is considered a missed pill.
- If a woman misses a single pill, she should resume normal pill-taking and no additional precautions are necessary
- If a woman misses two or more pills, she should resume normal pill taking and must also either abstain from sex or use an additional method of contraception (e.g. a barrier method) for the next seven days
- If a patch is detached for less than 24 hours, the same patch should be reapplied to the same site or a new patch may be applied but no additional precautions are necessary
- If a patch is detached for longer than 24 hours or if the patient is unsure when the patch became detached, they should apply a new patch giving a new ‘day 1’ of the cycle and must use additional method of contraception (e.g. a barrier method) for the next seven days
When to stop combined hormonal contraceptives immediately
- Combined hormonal contraceptives are associated with an increased risk of venous thrombosis and it is important to be aware of the symptoms that would warrant immediately termination of treatment. These symptoms include the following:
- Sudden chest pain
- Sudden breathlessness
- Swelling and pain in one calf
- Serious neurological effects, such as sudden, prolonged, and progressively worse headache
- Combined oral contraceptives should also not be taken by those who remain immobile for prolonged periods of time
- Usually considered if combined hormonal contraceptives are poorly tolerated or contraindicated
- Appropriate for smokers, obese patients etc.
- Patients that take progestogen-only contraceptives must routinely do so at the same time each day.
- If a pill is taken more than three hours late (except cerazette which is more than 12 hours late), the woman may not be protected and should resume normal pill taking and use another method of contraception (e.g. a barrier method) for the next 2 days
Additional points to remember
- If a patient suffers vomiting or persistent diarrhoea within 2 hours of taking a combined or progestogen-only contraceptive, it may not have been sufficiently absorbed and another pill should be taken as a soon as possible