Diane

Activity 1-Writing a presciption

This week we are talking about oral hormonal contraception. If the contraceptive pill is the method the woman decides to use, once you have taken a history and have checked that it is an appropriate choice, then you will need to know how to write a prescription for the pill. You can access this powerpoint from clinical pharmacology for details.  You can see that in the top right hand corner of a script you need to write your name and your medical council number. Over on the left hand side there are various code letters

a)      Which one will you circle if you are writing a script for Levlen ED ?

b)      You can prescribe the pill for 6 months unlike other medications which are usually 3 months-how will you write the prescription

               Rx.....................

c)      How much will a 6 month script of Levlen cost?............................

Check your answers and your script writing when you go to your Family Planning clinic visit.

Activity 2.Rules for missed pills

At your Family Planning clinic visit you will have been shown how to teach a woman to take:

1. The combined pill (a) the 21 active pill/7 day placebo pill method on which the woman has a withdrawal bleed and (b)the continuous hormone pill method with no withdrawal bleed

2. The low dose progestogen only pill

3. The high dose progestogen only pill

Fill in the following queries

1(a) With a combined pill taken21 /7, a woman is not contraceptively safe if she is more than --- hours since the last pill was taken

2. With the low dose pop, a woman is not  contraceptively safe if she is more than --- hours since the last pill was taken

3. With the high dose pop,a woman is not  contraceptively safe if she is more than --- hours since the last pill was taken

Once you have done this you may want to check here for the answers

For 1a look at the Family Planning pill teach pamphlet -as you can see there are 4 main points if pills are missed

(i) You will not be safe until you have taken7 hormone pills in a row

(ii) Use another method of contraception such as condoms or do not have sexual intercourse while taking the 7 hormone pills

(iii) If during this time a condom breaks or slips off, you will need an emergency contraceptive pill (ECP)

(iv) If there are less than 7 hormone pills left in the pack, finish the hormone pills and  start your new pack immediately (miss  the 7 inactive pills or the 7 day break).

So we initially teach women one 7 day rule with these points but just have a think about the three different weeks of pill taking because really there is only one of those weeks where she needs to (i),(ii) and (iii).

Which week is that?

You will find this picture helpful in your decision making.

Remember the combined pill works by stopping ovulation ie once the woman starts to take it FSH suppression commences. We often say that it takes one week of hormones to put the ovaries to sleep and one week off hormones for the ovaries to start to wake up.

Click here for our answer

A young 23 year old woman comes to see you following a pregnancy termination.She wishes to use the combined pill but wants you to tell her what the likely side effects may be. Use this reading by David Grimes on the non specific side effects of the pill to think about what you will tell her ie evidence based side effects and what you should not discuss i.e.  non evidence based side effects.Why is it important NOT to give non evidence based side effects to women considering pill use? 

To answer the questions below you need to look at The summary sheets of UK Medical Eligibility Criteria. Select Yes or No for whether or not the COC can be used for each option given: 

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