Method
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What is it and how it works
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Benefits
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Side effects and risks
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Combined oral contraceptive pill (“the pill”)
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- Daily tablet containing oestrogen and progestogen
- Prevents ovulation, thickens cervical mucus
- With typical use, 93% effective. If used perfectly, up to 99% effective
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- Periods usually lighter, less painful, more regular
- No period if hormone free tablets are skipped
- Acne can improve
- Reduction in risk of endometrial cancer
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- Not reliable contraception if dose missed or taken >24 hrs late
- Vomiting, severe diarrhoea, certain medications or malabsorption reduce efficacy
- Use is contraindicated in malabsorption and severe liver disease
- Side effects not common, may include irregular menstrual bleeding, nausea, headaches, tender breasts, bloating, skin changes, mood changes
- Return of periods may be delayed up to 3 months after cessation
- Very small increased risk of developing deep vein thrombosis (7-10 per
10 000 woman years), acute myocardial infarction or stroke
- Slight increase in risk of breast and cervical cancer - reduces with time after stopping
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Prescribing information
A low-dose pill containing ≤35 micrograms ethinyloestradiol (EE), and either levonorgestrel or norethisterone is the recommended first choice in Australia. This combination is considered to have the ‘gold standard’ safety profile, with a low risk of VTE. Most low-dose pills are listed on the PBS and are cost-effective options.
Risk factors for venous or arterial thrombosis include smoking, increased BMI, immobilisation, personal or family history of thromboembolism or thrombogenic mutations, migraine with aura, diabetes with vascular complications or uncontrolled hypertension. In patients with these conditions, alternative contraception methods are preferrable.
Source: NPS
Combined oral contraceptive pills
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Combined contraceptive ring (Nuvaring™
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- Soft plastic ring containing oestrogen and progestogen, inserted into vagina for 3 weeks every month
- Prevents ovulation, thickens cervical mucus
- With typical use, 93% effective. If used perfectly, up to 99% effective
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- Periods usually lighter, less painful and more regular
- Acne can improve
- Reduction in risk of endometrial cancer
- Periods return to normal quickly after stopping
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- May be less effective if ring is removed and not reinserted within 24 hours
- Risks and side effects as per combined oral contraceptive pill
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Progestogen only pill (POP)
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- Daily tablet
- Thickens cervical mucus, may inhibit ovulation
- With typical use, 93% effective. If used perfectly, up to 99% effective
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- Contraceptive option if oestrogen is contraindicated or not tolerated
- Periods return to normal quickly after stopping
- No increased risk of venous thromboembolism
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- Not reliable contraception if dose missed or taken ≥3 hours late (levonorgesterel/ northisterone POPs) or ≥24 hours late (drospirenone POP)
- Side effects include irregular menstrual bleeding, tender breasts, headaches, skin changes and mood changes
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Prescribing information
POPs containing either levongesterel or northisterone are available on the PBS. A drospirenone POP is also available, not listed on PBS.
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Contraceptive injections (“depo”)
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- Injection of progestogen, administered every 12 weeks
- Thickens cervical mucus and prevents ovulation
- With typical use, 96% effective. If used perfectly, up to 99% effective
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- 50-60% have no period or light bleeding
- Periods less painful
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- Frequent or prolonged menstrual bleeding can occur but usually transient
- Weight gain
- Small decrease in bone density, usually returns to normal after cessation
- Mood change, tender breasts, headaches, skin changes
- Return of periods may be delayed up to 6-12 months after cessation
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