By Emeritus Professor of Family Planning and Reproductive Health John Guillebaud
(Martin Dunitz) Margaret Pyke Centre, London, united kingdom. Pocket consultant for physicians overlaying oral birth control, progestogen-only capsule, injectables, implants, intrauterine and postcoital birth control, and extra. colour illustrations. past version: c1998.
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Additional info for Contraception Today: A Pocketbook for General Practitioners
Even if the whole difference is accepted as real, however: Using the rates given and assuming an estimated 1–2% mortality for VTE, there is only a 1–2 per million difference in annual VTE mortality between DSG/GSD products and LNG/ NET products. This difference, from Figure 6, equates to choosing, on one Sunday afternoon in a whole year, to risk a 2hour drive in the country rather than sitting in one’s garden! In short, autonomy in a woman’s choice now has impeccable scientific and regulatory support.
Breathlessness or cough with bloodstained sputum 10. Severe abdominal pain 11. Immobilization, as after sudden orthopaedic injury or major surgery or leg surgery: stop COC and consider heparin treatment. If elective procedure and pill stopped more than 2 weeks ahead, anticoagulation often unnecessary Other reasons for early discontinuation: 12. Acute jaundice 13. Blood pressure above 160/100 mmHg on repeated measurement 14. g. erythema multiforme) 15. g. onset of diabetes or SLE, diagnosis of a structural heart lesion such as atrial septal defect (ASD), detection of breast cancer The ‘pill-free interval’ (PFI) As no contraceptive is being taken during the PFI, it has considerable efficacy implications (Figure 9).
The POP or Implanon are good alternative options, with perhaps a modern copper IUD, the LNG IUS or sterilization to follow later. Hypertension Hypertension is an important risk factor for heart disease and stroke. In most women on COCs there is a slight increase in both systolic and diastolic blood pressure within the normotensive range. Approximately 1% become clinically hypertensive (WHO 4 for the pill, if clearly pill-induced) and the rate increases with age and duration of use. Past pregnancy-induced hypertension does not predispose to hypertension during COC use but it is a risk factor for myocardial infarction, very markedly so if the women also smokes, and is then WHO 3.