Providing information
Providing information
All patients should receive the product in its original packaging with the PIL. The patient should also be provided with written information or links to trusted online resources to help them use the COC safely and effectively.
Medication information
This can be standard or tailored in order to broaden contraceptive choice.
- Monophasic COCs are usually taken continuously for 21 days followed by a seven-day hormone-free interval (this regimen is usually referred to as ‘standard use’) but the latter period can be truncated to four days (known as ‘shortened hormone-free interval’) and active pills taken for three cycles before a four or seven-day interval is observed (‘extended use’ or ‘tricycling’).
Unbroken use of active pills is also possible (‘continuous use’), with some patients opting to take a four-day break if they experience breakthrough bleeding that lasts three to four days (‘flexible extended use’).
In all cases, active pills should be taken at the same time each day, starting on day 1-5 of the menstrual cycle with no need for additional precautions.
- Monophasic and phasic 21-day pills, as well as every day (ED) pills, should be taken at the same time every day, starting as described for monophasic pills, although there are some exceptions. Individual SPCs should always be checked.
Note that some of the above comprises off-label use but is within FSRH guidance so is still allowed. Consideration should be given to explaining this to the patient as part of the consent process.
Up to 12 months’ supply can be given at a time in appropriately labelled original packs, keeping in mind that an individual’s regimen may differ from the standard dosing on the product packaging and this should be explained to avoid confusion. Repeat supplies are allowed as long as the patient continues to meet the inclusion criteria.
It is advisable to mention the most commonly reported side-effects of COCs, namely nausea, breast tenderness, headache and migraine, menstrual disturbances, mood changes including depression, fluid retention, libido changes and skin changes including acne. However, every product is different – as is every patient – so attention should be given to the information provided by the manufacturer.
Serious reactions should also be highlighted e.g. venous and arterial thromboembolic events, stroke and hypertension. The patient should be advised to stop taking the COC and seek urgent medical help if they experience calf swelling, heat or pain in the calf, shortness of breath, chest pain or haemoptysis.
They should also be advised to reduce periods of immobility e.g. after surgery and when travelling, and to seek advice if they experience migraine for the first time or develop aura with an existing migraine condition. Report adverse effects using the Yellow Card scheme.
Other information
- Advise on what to do if the patient misses a pill or experiences severe vomiting or diarrhoea
- Provide reassurance and bust myths around interactions (e.g. broad spectrum antibiotics)
- Reassure the patient that although COCs are associated with an increased risk of breast and cervical cancers, this is small and reduces with time after stopping the product. Consider mentioning that COCs reduce the risk of ovarian and endometrial cancer; this is sustained after stopping the product
- Check the patient knows to seek advice before starting any new medicines (including OTC and nutritional supplements) and has contact details for local sexual health services.