Initial Consultation

Before prescribing POP, the clinician should check the woman is medically eligible.  UKMEC has the full criteria for medical eligibility.  As seen above it has few health risks though caution should be taken when prescribing for long stretcheslong term in women with known CVD, or for those who have significant liver disease.  Like other hormonal contraception, it is contraindicated in women who have breast cancer.  POP should also be avoided in those onwomen taking liver enzyme inducers. 

If there are no contraindications, women should be counselled about altered bleeding and other potential side effects.  They should be advised that once stopped, they rapidly become fertile again. 

 FSRH does not recommend BP or weight check, though, depending on the age of the woman, this may be appropriate.  Cervical screening should be encouraged.   

 It is reasonable to offer DSG 75μg first line POP, in light of the longer missed pill window, though this should be discussed with the patient (likely increased incidence of (may alter unscheduled bleeding more).   The script can be for 12 months from first prescribing.   Historically, many prescribers have issued 2 POPs a day for patients who were very overweight.  However, there is insufficient evidence to support this and FSRH does not recommend it. 

 For women starting within the first 5 days of their cycle, no extra precautions are required. At any other time or for those switching from CHC or Intrauterine contraception, it is advised to use extra precautions for a further 48 hours.   Women must be advised about the need to take the pill at the same time each day (within a 3 hour period NET/LNG, or 12 hours period DSG).  They should be counselled about the missed day rules (see Box 5). 

Pill2

Box 5Summary of POP Initial Consultation 

Discuss all contraception options 
Medical eligibility 

Avoid if: 

  • Taking enzyme Inducing medication 
  • History of breast cancer 

Caution if: 

  • Those on long term and history of CVD 
  • Significant liver disease 
Discuss possible side effects
  • Altered bleeding
  • Mood change/reduced libido
  • 10% of pregnancies on POP will be ectopic
Examinations needed
None needed Consider if appropriate:
  • Cervical smear
  • BP & BMI screen
Extra precautions needed
  • If starting within 5 days of cycle none needed
  • After 5 days, extra precautions for 48 hours
  • If switching from CHC or intrauterine contraception, extra precautions for 48 hours*
Missed pill rules
3hour window LNG/NET; 12hour window DSG If missed pill:
  • take another straight away
  • take next pill at normal time
  • extra precautions for 48h
Vomited/severe watery diarrhoea within 2 hours take another pill If more than one pill missed and SI consider emergency contraception
Prescribe
  • Advise to take daily at same time
  • Issue 1 year
*Up to day 5 only applies to true cycles.  These rules do not apply for women on CHC.  For women on CHC, 48 hours extra precautions are needed if started from day 3 of HFI and during first week of taking CHC.  If POP started week 2 or 3 then no extra precautions needed.

 


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