Methods of Family Planning - Hormonal COCs PDF

Prevents Ovulation Normally decreased estrogen and progesterone levels triggers the secretion of FSH Due to the sustained high levels of estrogen and progestin, as an effect of taking the pills, FSH secretion does not happen No FSH secretion means no follicles in the...

Prevents Ovulation Normally decreased estrogen and progesterone levels triggers the secretion of FSH Due to the sustained high levels of estrogen and progestin, as an effect of taking the pills, FSH secretion does not happen No FSH secretion means no follicles in the ovary maturing There will be no matured ovum for ovulation  ❖ Thickens the cervical mucus (difficult for sperm to pass through) ❖ Low-dose COCs do not disrupt an existing pregnancy Effectiveness ❖ Perfectly used at 99.7% ❖ Typically used at 92% Possible Side Effects  SIDE EFFECTS POSSIBLE CAUSE/S MANAGEMENT Amenorrhea/scanty ▪ Possible pregnancy ▪ Check for pregnancy menses ▪ Inadequate endometrial build-up ▪ Reassurance Spotting/ ▪ Missed pills ▪ Encourage regular intake of pills at the breakthrough ▪ More common with low dose COCs same time each day bleeding ▪ Taking pills at different times of the ▪ Avoid missing pills day ▪ Take another pill from another pack ▪ Vomiting and/or diarrhea within when diarrhea or vomiting occurs within two hours of intake two hours of intake ▪ Drug interaction ▪ Change method if taking rifampicin or anti-convulsants Nausea ▪ Possible flu or infection ▪ Check for flu, infection or pregnancy ▪ Possible pregnancy ▪ Take pills at bedtime or with food ▪ Taking pills on an empty stomach Headaches ▪ Estrogen effect ▪ Take analgesics (Paracetamol) ▪ Refer if getting worse Breast tenderness ▪ Effect of hormones in pills ▪ Recommend use of supportive bra ▪ Take pain relievers ▪ Try hot or cold compress J Jaundice A Abdominal pain (severe) C Chest pain H Headaches (severe) E Eye problems such as brief loss of vision, seeing flashes of light or zigzag lines S Severe leg pains  Advise the client to take one pill a day regularly, preferably at the same time, even if she is not having sex daily  A pack of 21 pills containing the “active” hormones estrogen and progestogen ▪ This requires a seven-day rest period before starting a new pack  A 28-day pack with 7 additional placebo (non-hormone tablets of different color) ▪ No rest period required  Taken within the first 5 days of the menstrual period since conception is virtually nil at this time  If started after the 7th day of onset of menstruation, abstinence must be practiced or back up contraceptive is used for the next seven days  A woman misses one or two active COC pill in any day of the first three weeks or starts a pack one day late Take the Continue taking one Take missed pill scheduled pill pill at a time until pack as soon as she at the usual is finished. No back-up remembers time is necessary If a woman misses three or more active COC pills in the first two weeks or starts a pack two or more days late Take the last Take the pill Abstain from sex missed pill as Continue taking scheduled for the or use back up the pill until pack soon as she day at the regular method for the is finished time next seven days remembers  If a woman misses three or more active pills on the third week Discard inactive pills. Abstain from Take the last Continue taking Immediately start a new pack sex or use back missed pill as the remaining and continue taking up method for soon as she active pills until the pill until the seven remembers consumed pack is finished days If a woman misses any non-hormonal pill (any of the last seven pills in a 28-pill pack) Start a new pack as usual Discard the missed and keep taking COCs non-hormonal pill(s) one each day Compliance and continued use of COCs are increased when: 1. Clients are properly counseled 2. Client’s questions and concerns are thoughtfully responded to 3. Accurate, detailed and understandable information is provided.  No apparent overall effect on risk of breast cancer May be used by healthy, non-smoking women throughout their reproductive lives from teen-age years and into their forties Clients should be provided with enough pills for more than 3 cycles (have a safe place to store and program has enough stocks) Give them more than 3 cycles only after they have completed a three-month trial period on the Lowdose COCs  Do not protect against STIs and HIV (must also be offered condoms) Not recommended for breastfeeding women (can reduce the milk supply) A woman is protected only as long as she takes the pill regularly COCs do not disrupt an existing pregnancy Does not cause birth defects if the woman becomes pregnant or accidentally starts the pill when she is already pregnant Most women do not gain or lose weight Do not change mood or sex drive of a woman Cannot be used as a pregnancy test  Safe for women with varicose veins Can be safely taken by a woman throughout her life Women younger than age 35 who smoke can use low dose COCs Should be taken at the same time each day to reduce side effects and for consistent use