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KMID : 0377619970620100846
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Korean Jungang Medical Journal
1997 Volume.62 No. 10 p.846 ~ p.850
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Practical Oral Contraceptive Prescribing
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Guillebaud, John
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Abstract
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Two points have to be considered whenever the Pill is to be prescribed : features of the individual woman, and the most appropriate particular Pill.
Subsequent to the new data in 1995-6 on an apparent increased risk of venous thromboembolism in users of newer desogestrel-or gestodene- containing products relative to products of the ´second generation´, varying views have been expressed, Worldwide. This matter, along with the possible relative benefit in the opposite direction, in favor of the same newer products for risk of arterial disease and for quality of life for some women, will be discussed.
Maintaining Effectiveness
Provided the Pill is taken correctly and consistently, is absorbed normally, and its metabolism is not affected by interaction with other medication, its reliability is nearly 100 %. In practice the failure rare is 0.2-3 per 100 woman-years, or higher, depending mainly on the population studied.
Careful teaching of the woman and sometimes her partner is essential. Some of the manufacturers have now greatly improved their packaging and leaflets, but in other cases the leaflet included in each packet is in small print and often not up-to-date. A user-friendly written leaflet is very helpful, and each Pill-taker should be advised to keep it for future reference when she is concerned about maintaining efficacy or possible side effects.
Patients with undercurrent disease
There are some conditions in which the COC must be avoided, but many others which are positively benefited or at least not affected. Medical myths abound : it is un fortune that women are often unnecessarily deprived of the Pill for wrong reasons like hypo-estrogenic menorrhea, candidiasis, fibroids, sickle cell trait, on duration grounds after(say) 10 years satisfactory use, or at age 35 in healthy non-smokers. There are other conditions (including the recognized so-called ´risk factor´ for arterial and venous circulatory disease) in which, again, the woman need not necessarily be refused this choice of method, provided some specific guidelines are followed.
Most medical conditions can be grouped into broad categories :
1. Disorders in which COCs are not known to have and- effect good or bad way. Seven Pills omitted thereafter will not lead to ovulation(as indeed is the routine during the Pill-free week) More than seven Pills missed in total at any time risks ovulation.
The implications of the above physiology to the following will be discussed :
? Routine advice for missed Pills according to what time in the cycle they were missed
? Vomiting, diarrhea
? Manipulation of the menstrual cycle - the so-called tricycle regimen
? Short and long term drug interactions, with enzyme inducers or broad spectrum antibiotics
? Management of a past ´breakthrough´ pregnancy
Conclusion
Even more important than following a prescribing scheme such as the one to be described in this presentation is the appropriate attitude of the doctor and the nurse, who should be ready to advise and counsel the patient in a non-directive way while she is on the Pill. They must be not only conscientious and up-to-date in their knowledge, but also relate this successfully to the woman´s needs.
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