Data gathering

  • Red flags – migraine with aura, HTN, liver disease, breast cancer, DVT, heart disease, smoking
  • Others – LMP, current contraception, menstrual history, OTC meds
  • Examine – BP, BMI


Clinical management

  • Explanation / Treatment
    • How it works – two hormones, prevents egg releasing, thickens mucus and prevents implantation
    • How to take – 21d pill, one tablet for 21 days then no tablet for 7 days. During the 7 day break, you will get a withdrawal bleed.
    • When to start – If you start the pill on the first day of your period, or up to day 5 (of 28d cycle), you will be protected straight away, otherwise, you need to be on it for 7days before it is effective.
    • Advantages – regular bleeds which are lighter and less painful. Helps with PMS.
    • Disadvantages – headaches, nausea, breast tenderness, mood changes. Increase BP, DVT, breast cancer, cervical cancer.
    • Missed pill – if one is missed/late, take it straight away, even if it means taking two at once. if you miss more than one pill, refer to missed pill rules.
    • Diarrhoea/vomiting – use barrier contraception
  • Followup
    • 3 month check then 6 monthly check – BP
    • PIL – with missed pill rules