Consultation Summary
Box 1: CHC consultation summary
| Discuss all contraception options |
| Medical eligibility |
- Thrombophilia/ VTE
- CVD/PVD/valvular heart disease
- Smoking/High BMI/Hyperlipidaemia
- Migraines
- Liver disease
|
- Breast cancer/BRCA
- Medication that affect CHC metabolism (see Box 3)
- Malabsorption
- Immobility
- Recent childbirth/breastfeeding
|
| Discuss possible side effects |
- Altered bleeding
- Headache/Dizziness
- Nausea/Bloating
|
- Breast tenderness
- Mood disturbance
|
| Examinations needed |
- BP
- BMI
- Consider smear if appropriate
|
|
Extra precautions needed
|
- If starting within 5 days of cycle none needed*
- After 5 days, extra precautions for 7 days*
- If switching from Desogestrel POP/Injection/Implant, none needed
- If switching from traditional POP/LNG-IUS, extra precautions for 7 Days**
|
| Missed pill rules |
|
24hour window for COC If missed pill;
- take another straight away
- take next pill at normal time
- extra precautions for 7 days if more than 2 or more pills missed or prolonged pill free interval
- Consider EC if SI occurred (see box 4 in this module)
Vomited/severe watery diarrhoea within 2 hours take another pill
|
| Prescribe |
- Advise to take daily at same time
- Discuss traditional use vs tailored regimes
- Issue 1 year
- Advise to return if problems (including new medical diagnoses, see Box 2)
|
*use extra precautions for 9 days if women using QIaira, if pill missed or if pill started after Day 1 of cycle
**Desogestrel, progestogen implant and injection all predominantly work by inhibiting ovulation. The older oral progestogens and LNG-intrauterinie devices do not so extra precautions are recommended when starting CHC
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