Dr. Álvaro Monterrosa Castro, MD
TOWhen prescribing oral contraceptives, precise instructions must be given to the user on how they should be taken. How they act. The reasons why they may fail and what to do if you forget to take it one day.
It should be emphasized that oral contraceptives do not protect against sexually transmitted diseases or AIDS. (51). And inform about the potential risks and numerous non-contraceptive benefits of its use. (64). Adequate information will help avoid myths. The user will be able to correctly interpret the symptoms presented. And you will use the method correctly and with confidence (16).
(Read Also: Oral Contraceptives Side Effects)
Guidelines for the use of oral contraceptives
Oral contraceptives should be started on the first day of the cycle. One tablet should be taken daily, preferably at the same time of day. To obtain more stable hormonal levels. Once you have completed the 21 tablets containing the active ingredient, you will proceed to allow 7 days to pass without taking tablets.
During this period, bleeding similar to menstruation will occur. On the eighth day a new packaging will begin, continuing like this. If you are using CD forms (28 tablets). Continue at 9 p.m. active with the seven placebos and the next day start a new box. During taking the placebos you will have the equivalent of menstrual flow (7.19).
For some years now the modality has been recommended: Always Sunday. To prevent the patient from having her periods on weekends, so that they do not interfere with social activities. When she has her period, the patient will start the tablets on the following Sunday. Therefore she will finish the box on a Saturday. She will take the 7 day break and continue with a new pack next Sunday.
The rules will generally be presented in the middle of the week, recommending the Always Sunday modality. It is very important to remember that during the first cycle of contraceptives, the couple must complement the protection with a barrier method.
Contraindications and Guidelines for the use of oral contraceptives
In the puerperium itself, the patient can start the pill. If she is not going to breastfeed, for example in case of stillbirth. The DTB (Drug and Therapeutics Bulletin). It suggests starting oral contraceptives at the fourth week postpartum. If breastfeeding is not carried out and if there are no risk factors for thromboembolism (64).
Wilde and Balfour (7) They advise starting them 21 days after delivery. If there are no puerperal complications and the patient can walk normally. In postpartum amenorrhea, without breastfeeding, greater than six weeks postpartum. Exclude the possibility of a new pregnancy and start the tablet accompanied by protection with a barrier method for two weeks (64).
Although there are controversies, combined oral contraceptives should not be administered during breastfeeding. It should be suggested to wait until breastfeeding is finished. Because it is not known with certainty whether the estrogen present in the oral contraceptive affects the quantity and quality of milk. The minipill is indicated during breastfeeding.
Women who have had a spontaneous or induced abortion. You can start the tablets immediately without having to wait for the start of your periods. (7). Ovulation is considered to return within a six-week period in three-quarters of post-abortion women.
Oral contraceptives should be stopped four weeks before major surgery. From lower limb surgery or a procedure that causes immobilization. They can be restarted on the first day of the next cycle, or two weeks after ambulatory activity has been fully recovered. Remembering the use of the barrier method for the following two weeks.
If the patient presents acute hepatitis.
Oral contraceptives should be suspended until liver tests return to normal and the guidelines already indicated should be started. If the condition has been severe and/or there is altered liver function as a consequence, it is preferable to switch to a non-hormonal method.
If the patient presents any entity manifested by vomiting or diarrhea. You must complement planning with a barrier method in the rest of the cycle (7).
Additional protection with spermicides or condoms. It should be used while receiving Rifampicin, Ampicillin or Griseofulvin. And continue up to 7 days after ending use (7).
Oral contraceptives are only effective as long as the woman takes them regularly. Forgetting one or more tablets can lead to an unwanted pregnancy. If the patient forgets to take a tablet You should take it immediately you remember and take the next tablet at the usual time. This means taking two tablets on the same day. You do not need to supplement with another method to maintain contraceptive effectiveness.
If you forget to take 2 tablets in a row during the first or second week of the cycle. You should take 2 tablets when you remember. You will take two the next day and continue with one daily until you finish the box. The patient can become pregnant if she has sexual relations in the days following forgetting. Therefore, it must be complemented with a barrier method until the next cycle.
If you forget to take 2 tablets during the third week or 3 continuous tablets in any of the weeks of the cycle. Any missing tablets will be discarded and a new box will be started on the same day as remembered.
A barrier method should be used as a complement to ensure contraceptive efficacy.
Health personnel must monitor oral contraceptive users. Dropout rates are likely to be high if minor problems are not addressed and responded to. And if security and confidence are not inspired in women (10,16).
During the medical visit, the correct use of contraceptives should be verified and the presence of adverse effects should be asked. Irregular use will nullify the high contraceptive efficacy and predispose to unwanted pregnancy.
A general physical examination must be performed. Emphasizing the measurement of blood pressure, weight, and examination of mammary glands. Pelvic examination and insist on annual cervical-vaginal cytology (64).
Dr. Álvaro Monterrosa Castro, MD
