Mechanism of action:

• alter cerical mucus

  • prevent sperm penetration into upper reproductive tract

• upto 60% LNG anovulatory

Efficacy

• pill taken at or around same time every day

• no pill free interval

• >99% effective

• efficacy may be reduced in women >70kg

  • 2 pills/day

  • or cerezette(desogestrel-only)

Starting:

• started up to and including D5 after start of menstrual cycle - no additional

• any other time:

  • 2 day rule

• amenorrhoeic and not pregnant

  • 2 day rule

• before D21 post partum

  • no additional

• after D21 cpost partum

  • 2 day rule

Missed pills

• if >27hrs since last POP = missed pill:

  • take pill ASAP

    • if >1 then take 1

  • take next pill @ usual time

    • may mean taking 2 pills one day

      • not harmful

  • Additional method of contraception for next 2 days

    • ECP considered if UPSI within this period

• if vomitis within 2 hours of taking POP then take another one

  • if now >3hrs late: missed pill

• not changed by gut flora

• liver enzyme induction: use additonal contraceptive

return of fertility:

• no delay in return

Contraindications:

• UKMEC 4

  • current breast cancer

• UKMEC 3

  • history of breast cancer

  • gestational trophoblastic neoplasia

  • active viral hepatitis

  • severe decompensated cirrhosis

  • liver tumours

  • use of liver enzyme inducing medications

  • continuations:

    • new:

      • IHD

      • CVA

      • migraine wiht aura

      • may initiate (UKMEC2) with these

Side effects

Bleeding patterns

• half POP experience prolonged bleeding

• 7-% breatkthrough

• 20% amenorrhoeic

• 40% bleed regularly

• 40% erratic bleeding

Weight change, headache, depression

• no causal relationship

Cardiovascular disease

• little or no increase risk of VTE, Stroke, MI

breast cancer

• no causeal relationship

managing bleeding

• bleeding may settle

• other causes of bleeding should be considered

• change type and dose of progestogen

  • no evidence but may help

  • consider alternate method