Birth Control Pill Problems

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• Birth Control Pill Problems

CAPT Mike Hughey, MC USNR
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Which Pill Should I Start?

• It doesnt usually matter.
• 90 will do well on any pill.
• 9 will do well on some pills but not others.
• 1 wont do well, no matter what pill you use.

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When to Start the Pills
1st Sunday after flow begins 1st day of
flow 5 days after onset
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When are They Effective?

• About 98 effective after the first pill
• About 99.9 effective after the 1st cycle

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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.

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What if she skips some pills?
2 pills
1 pill

• Stop pills, wait 5 days for menses
• Resume a fresh pack
• Use backup contraception.

• Take as soon as remembered
• Continue the rest normally

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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

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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

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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

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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.

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Side Effects

• 80 have no side effects at all.
• Among the 20 who do
• Nausea
• Breast Tenderness
• Spotting
• Headaches
• Depression
• Decreased Libido

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Headaches, Depression, Decreased Libido

• Nuisances
• Usually disappear after 1st month
• If they persist, change OCPs
• If symptoms severe, discontinue OCPs

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Nausea

• Nuisance
• Usually disappears after 1st month
• If it persists ... change OCPs
• If symptoms severe...discontinue OCPs
• Rule out pregnancy

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Breast Pain

• Common in 1st month
• Usually disappears after 1st month
• If it persists ... change OCPs
• Exam to rule out malignancy
• Rule out pregnancy

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Spotting Between Periods

• Common in 1st month
• Try monophasic pills
• Rule out
• Pregnancy (HCG)
• Cervical Disease (Pap)
• Ovarian neoplasm (Exam)

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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.

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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 LoOvral, 4/4 Nordette, 4/4 Levelen

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Thinks She May Be Pregnant

• She may be
• Better find out!

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