Initial Consultation
Before prescribing CHC, the clinician should check the woman is medically eligible. UKMEC has the full criteria for medical eligibility but the essential areas to consider are:
- Thrombophilia or previous history of VTE
- Cardiovascular disease, cerebrovascular disease and peripheral vascular disease
- Additional risk factors for the above (e.g. smoking, obesity, hypertension, migraines, recent child birth, valvular heart disease, hyperlipidaemia, immobility)
- Breast feeding
- Liver disease
- Breast cancer/genetic predisposition
- Medication that affect CHC metabolism
- Malabsorption (e.g. short bowel syndrome, IBD, bariatric surgery)
The patient should have an up to date blood pressure and BMI taken. Hypertension and BMI over 35 are both UKMEC 3.
Having established medical eligibility, the clinician should discuss the effectiveness (and factors affecting this), health risks, side effects and health benefits of taking CHC. Most women will choose an oral CHC and FSRH advises prescribing </= 30ug EE with levonorgesterol or norethisterone as first line choice.
The clinician should discuss taking the pill in the standard way, with pill free interval, as well as tailored regimens/continuously taking.
The consultation should also include what to do about missed pills or potentially malabsorbed pills (e.g D+V) and be given a list of new diagnoses that will make ongoing CHC use inadvisable (see Boxes 1 & 2).
Once happy, the prescriber can issue up to 12 months of CHC at the first consultation (except the ring which is 3 monthly).