Birth Control Pill Problems CAPT Mike Hughey MC

Birth Control Pill Problems CAPT Mike Hughey, MC USNR Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide

Which Pill Should I Start? • It doesn’t usually matter. • 90% will do well on any pill. • 9% will do well on some pills but not others. • 1% won’t do well, no matter what pill you use. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 2

When to Start the Pills • 1 st Sunday after flow begins SUN MON TUE WED THU FRI SAT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 • 1 st day of flow • 5 days after onset Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide

When are They Effective? • About 98% effective after the first pill • About 99. 9% effective after the 1 st cycle Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 4

What if the pill she normally takes is not available? • Give her one that is available. • 90% will do well on any pill. • Switch at the normal break. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 5

What if she skips some pills? 2 pills 1 pill • Take as soon as remembered • Continue the rest normally • Stop pills, wait 5 days for menses • Resume a fresh pack • Use backup contraception. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 6

Light Period or No Period Rule out pregnancy with an HCG • Physiologic with low-dose pills • Stop pills • Change pills • Add estrogen (Premarin. 625 QD) • Live with it Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide

Menses at the wrong time Don't forget to rule out pregnancy • Usually due to ovulation • Rx: Keep taking the pills • Rx: Restart a new pack • If it persists, refer to GYN Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide

Painful Menses If symptoms persist, refer to gynecologist within weeks to months • • • Unusual (BCPs usually improve cramps) HCG Fibroids, PID, endometriosis, ovarian cyst, etc. Monophasic pills Continuous OCPs Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide

How can I postpone a period using BCPs? • Go directly from one pack into the next. • Monophasic works best. • May not postpone it. • Spotting is common. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 10

Side Effects • 80% have no side effects at all. • Among the 20% who do: – – – Nausea Breast Tenderness Spotting Headaches Depression Decreased Libido Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 11

Headaches, Depression, Decreased Libido • Nuisances • Usually disappear after 1 st month • If they persist, change OCPs • If symptoms severe, discontinue OCPs Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide

Nausea • Nuisance • Usually disappears after 1 st month • If it persists. . . change OCPs • If symptoms severe. . . discontinue OCPs • Rule out pregnancy Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide

Breast Pain • Common in 1 st month • Usually disappears after 1 st month • If it persists. . . change OCPs • Exam to rule out malignancy • Rule out pregnancy Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide

Spotting Between Periods • Common in 1 st month • Try monophasic pills • Rule out: – Pregnancy (HCG) – Cervical Disease (Pap) – Ovarian neoplasm (Exam) Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide

Does the pill cause weight gain? • • • Yes and no Generally, people gain weight as they age. Average weight gain due to BCPs is 1 pound in 5 years. Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide

Emergency Contraception Within 72 hours: 2 Ovrals 12 Hours Later 2 Ovrals • No abnormal bleeding. • 50% have nausea and vomiting. • Reduces pregnancy risk by 75%. (8% to 2%) • Theoretical concern over exposure. • We don't know how it works. • May use 4/4 Lo. Ovral, 4/4 Nordette, 4/4 Levelen Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide