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Postpartum
If a woman is breast feeding we would not normally prescribe the COC as there is some data that suggests it may decrease milk supply. However she could use a progestogen only method - pill or injection, or barriers or IUD. We discussed the efficacy of lactational amenorrhoea in the section 1.
Activity: Questions and responses
If Diane decided to use the progestogen only pill (POP) you would likely prescribe Noriday as it is fully funded ($5 for 6 months). She asks you the following questions. How would you respond? You will have been taught some of these answers at your Family Planning visit.
- What is the likely failure rate?
- How do I take it?
- What do I do if I miss a pill?
- Do I need to be more careful if I am taking antibiotics?
- Which is the best pop?
- One of the side effects of progestogen only methods is irregular spotting in between periods. If Diane has this problem what should you advise?
Click here to view our answers
1) The low dose pop Noriday works mainly by making the cervical mucus thick and thus decreasing sperm penetration. The failure rate is thus higher than that of the combined pill (or the high dose POP Cerazette) which stops ovulation. The rate is often quoted as 0.3-4% with the lower rate for women over the age of 40 who will be already themselves less fertile.
2) and 3) Like the COC need to start with Day 1-5 of the period and then covered straight away. Starting at any other time means needing to wait for 7 days until the effect on the cervical mucus has built up (condoms or no sex during this time).Take a pill every day at the same time but definitely within 3 hours. If late with the pill - more than 27 hours since last pill taken - then need to take 2 more days of the pill until the mucus effect is built up again (ie 48 hours).Once finished the packet go onto next packet straight away.
4) No. However if using any medication that is an enzyme inducer the POP would not be effective.
5) You have prescribed Noriday which is subsidised but you could have prescribed Cerazette -a POP which works by stopping ovulation and thus should have a lower failure rate.
6)
- check recent smear is normal and cervix looks healthy
- carry out STI check cervical infection
- check whether missing the pill or taking it late
- check if diahorrea or vomiting
- check if using medications such as enzyme inducers
- Irregular bleeding is a common side effect of all progestogen only pills - double/treble dose of POP is often suggested to help -however not a lot of evidence based research to support this advice - if really troublesome may need to consider another method.
