Thursday, September 02, 2010
How much do you know about Oral contraceptives part 2
Vol.17, No.04,
April 2009
1. A monthly withdrawal bleed (triggered by several days’ worth of hormone-free pills in each pack) has been shown to help prevent:
- a) menorrhagia
- b) endometriosis
- c) hormone withdrawal symptoms
- d) premenstrual dysphoric disorder
- e) none of the above
2. Guidelines put out by the Society of Obstetricians and Gynaecologists of Canada stipulate that continuous OC pills (without monthly bleeding) should be used only in women suffering from dysmenorrhea.
- a) true
- b) false
3. The risk of venous thromboembolism in OCP users, compared to matched controls, is elevated:
- a) two times
- b) three–four times
- c) 10 times
- d) not at all
4. Evidence suggests that low-estrogen formulations bring lower risk of VTE.
- a) true
- b) false
5. Occasionally, the Pill is stopped before surgery due to its procoagulant effects. How long must it be discontinued before these effects wear off?
- a) one week
- b) two weeks
- c) one month
- d) three months
6. Which of the following, according to WHO guidelines, is NOT an absolute contraindication to OCP use?
- a) smoking, over age 35
- b) migraine with aura
- c) known thrombophilia (e.g. factor V Leiden)
- d) breastfeeding
- e) hypertension > 160/> 100
- f) diabetes with nephropathy, retinopathy, or neuropathy
ANSWER
- e) None of the above. In fact, all of these conditions have been treated with continuous OC use that prevents menstruation. There is currently no evidence that a monthly withdrawal bleed is medically necessary.
- b) False. SOGC guidelines say that in the absence of contraindications, continuous OCPs may be given on the basis of patient preference.
- b) The risk of VTE is elevated three or fourfold in OCP users.
- b) False. Estrogen dose has not been shown to affect VTE rates, though progestin type might.
- c) One month.
- d) Breastfeeding. OCP use is only contraindicated for the first six weeks of breastfeeding. The concern is not that hormones will enter breastmilk — they don’t — but that milk production will be reduced if the Pill is started before regular breastfeeding is established.
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