Monday, January 18, 2010

Contraception - The Pill




Monday 18th January 2010

Welcome to the first part of our series on contraception. Today we are going to kick off the show by taking a closer look at the Combined Oral Contraceptive (COC).

The combined oral contraceptive pill contains two hormones, oestrogen and progestogen. It may be taken by women to prevent pregnancy. Sometimes, the COC pill may also be taken for:
  • painful or heavy periods,
  • premenstrual syndrome, or
  • endometriosis.

It works by:
  • Preventing ovulation (the release of an egg from the ovary each month).
  • Thickening the mucus in the neck of the womb, so it is harder for sperm to penetrate into the womb and reach an egg.
  • Thinning the lining of the womb, so there is less chance of a fertilised egg implanting into the womb and being able to grow.

The COC pill is one of the most effective methods of contraception. When taken correctly, less than 1 woman out of a 1000 taking the COC pill for a year, will get pregnant.

Starting the COC pill

The COC pill is usually started on the first day of your period (Day 1 of the menstrual cycle). If this is done, you will be protected from pregnancy straight away and you won't need additional contraception.
The COC pill may also be started up to Day 5 of your menstrual cycle. This gives protection from pregnancy straight away unless you have a short menstrual cycle (your period is every 23 days or less). If you have a short menstrual cycle, you will need additional contraception (e.g. condoms) until you have taken the COC pill for 7 days.
The COC pill may be started at any other time in your menstrual cycle. However, you will not be protected from pregnancy straight away and you will need additional contraception until you have taken the COC pill for 7 days.
If you have had a miscarriage or abortion, the COC pill can be started up to 7 days after this and you will be protected from pregnancy straight away. If started more than 7 days after the miscarriage or abortion then use additional contraception until you have taken the COC pill for 7 days.
If you have just had a baby and are not breastfeeding, the COC pill can be started on Day 21 after the birth. You will be protected against pregnancy straight away. If started later than 21 days after giving birth, you will need to use additional contraception until you have taken the COC pill for 7 days.

The Combined Oral Contraceptive (COC) pill is generally well tolerated and very few women will experience side effects.

Some of the side effects reported include:

  • breakthrough bleeding and spotting - especially during the first 3 months of taking,
  • breast tenderness and breast enlargement,
  • change in shape of the cornea (front covering of the eye) resulting in discomfort when wearing contact lenses,
  • depression (low mood),
  • fluid retention,
  • headache,
  • migraine,
  • nausea (feeling sick) or vomiting (being sick),
  • reduced libido (interest in sex),
  • rise in blood pressure,
  • rise in blood sugar,
  • stomach upset,
  • temporary infertility after stopping the COC pill,
  • vaginal thrush,
  • weight gain.

The Combined Oral Contraceptive (COC) pill may interact with other medicines. Some of the more commonly known interactions are listed below. However, this is not a complete list. If you want to check that your medicines are safe to take with the COC pill, you can ask your doctor or pharmacist (chemist) or read the Patient Information Leaflets that come with your medicines.

The COC pill may interact with broad spectrum antibiotics. These include the following:

  • amoxicillin,
  • ampicillin,
  • azithromycin,
  • cefadroxil,
  • cefixime,
  • cefradine,
  • cefalexin,
  • cefpodoxime,
  • clarithromycin,
  • co-amoxiclav,
  • co-fluampicil,
  • doxycycline,
  • erythromycin,
  • metronidazole,
  • minocycline,
  • oxytetracycline,
  • tetracycline,and
  • tinidazole.

Broad spectrum antibiotics may reduce the effectiveness of the COC pill.

If you are prescribed one of these antibiotics, use additional contraception (e.g. condoms) while you are taking the antibiotic and for 7 days after finishing the course. If the 7 days runs beyond the end of a pill pack, skip the pill free break and start a new pack straight away. In the case of the Every Day (ED) pill - if the 7 days runs into the inactive pills, skip the inactive pills and start a new pack straight away.
If you are prescribed a long course of one of these antibiotics, after you have taken it for 3 weeks or more you don't need additional contraception. But, if you are then also prescribed a short course of a different antibiotic later, you will need to use additional contraception again as above.

The COC pill may also interact with medicines that speed up how quickly the liver breaks down oestrogen and progestogen. These include:

  • aprepitant,
  • bosentan,
  • carbamazepine,
  • griseofulvin,
  • modafinil,
  • nelfinavir,
  • nevirapine,
  • oxcarbazepine,
  • phenytoin,
  • phenobarbital,
  • primidone,
  • rifabutin,
  • rifampicin,
  • ritonavir,
  • rufinamide,
  • St John's Wort (Hypericum), and
  • topiramate.


As these medicines speed up the process of the liver breaking down the oestrogen and progestogen in the COC pill, they reduce the effectiveness of the COC pill.

If you are prescribed a short course of one of these medicines, use additional contraception while you are taking the medicine, and for four weeks after you stop taking it.

If you are prescribed a long course of one of the above medicines, remind your prescriber that you are taking a COC pill. You will need to think about switching to another method of contraception while you are taking it, and for 4-8 weeks after you stop taking it.

Talk to your GP, or prescriber, about other methods of contraception. An alternative (except when taking rifampicin, or rifabutin) is to take two COC pills a day. However, this is an unlicensed use of the COC pill and it should only be taken in this way on the advice of your GP.

Lamotrigine

The combined oral contraceptive (COC) pill can speed up how quickly the liver breaks down lamotrigine. This reduces the amount of lamotrigine in the blood, making it less effective at controlling fits. Tell your GP if you decide to start (or stop) taking the COC pill because your dose of lamotrigine may need to be adjusted.

As you can see, although the combined oral contraceptive is extremely effective, it does have it's negative side.

If you are considering taking the pill and have any more questions about it, please feel free to ask them in the comments box below.

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