Professional Documents
Culture Documents
Breakthrough bleeding
Weight gain
Mood swings
Check compliance, pregnancy, poor absorption interacting medication, diahorrea, vomiting, infection e.g. Chlamydia, local causes e.g. cervical polyp, ectropion tumours (rare)
Likely to be hormonal
To take full history as for example; all the time or in relation to withdrawal bleed
Side effects Remember consider other causes history, examination and investigation if necessary Lower the dose of oestrogen (3rd generation COC) e.g. Mercilon Switching Pills {21 day to 21 day} Changing to combined preparation containing different progesterone (21 day combined preparations) continue current pack until last tablet and start first tablet of new brand the next day. If a seven day break is taken before starting new brand, additional precautions (barrier methods) should be used during the first 7 days of taking the new brand. Switching Pills {28 day to 21 day} When switching from an ED brand (28 tablets) all placebo tablets should be omitted and the new brand started without a break. If placebo tablets are taken continue to the end of the pack and then start new brand additional precautions (barrier methods) should be used during the first 7 days of taking the new brand.
Triphasic COC
November 2007
Loestin 20
Low Strength
(2nd generation COC)
Standard Strength
(2nd generation COC)
Phased COC
Clients in whom effective cycle control is not achieved with (6 x ethynylestradiol 30mcg, levonorgestrel 50mcg; Microgynon 30 or Brevinor 5 x ethynylestradiol 40mcg, levonorgestrel 75mcg; (Please refer to PGD for specific exclusion criteria) 10 ethinylestradiol 30mcg, levonorgestrel 125mcg)
Marvelon
Standard Strength
Clients who experience unacceptable side effects on Microgynon or any other second generation COC, do not have any contraindications to 3rd generation COCs and are willing to accept the increased risk of venous thromboembolism.
(Please refer to PGD for specific exclusion criteria)
Mercilon
Low Strength
Clients who experience unacceptable side effects on Microgynon or any other second generation COC, do not have any contraindications to 3rd generation COCs and are willing to accept the increased risk of venous thromboembolism.
(Please refer to PGD for specific exclusion criteria)
November 2007
First line progestogen only oral contraceptive: Second line progestogen only oral contraceptive: Second line progestogen only oral contraceptive:
Noriday (Norethisterone 350mcg) Femulen (Etynodiol diacetate 500mcg) Cerazette (Desogestrel 75mg)
Clients requesting to commence or continue progestogen only oral contraception who have no contraindications to POPs
(Please refer to PGD for specific exclusion criteria)
Initiation in patients who experience difficulty in complying with stricter dosage regimen of other POPs (3 hour rule)
(Please refer to PGD for specific exclusion criteria)
POP Dosage: 1 tablet daily at the same time each day, starting on day 1 of the cycle then continuously. If administration is delayed for 3 hours (12 hours for Cerazette) or more it should be regarded as a missed pill Changing from a COC to a POP. Cerazette, Femulen, Micronor, Norgeston, and Noriday are started without a break on the day following the combined contraceptive. No additional contraception is necessary with Cerazette, Micronor, or Noriday, but additional contraception for the first 14 days after switching is recommended for Femulen and Norgeston.
November 2007