6. COCP
Examples of COCP
available in Malaysia:
•Regulon
•Rigevidon
•Microgynon
•Mercilon
•Marvelon
7. When to start COCP?
● Day 1 – 5 of menses
● At any other time if patient is sure NOT pregnant, but with
additional protection for the first 7 days ie. condom
8. When to start COCP?
Postpartum
1. Fully breastfeeding
-> 6 months postpartum
2. Not breastfeeding
-> 3weeks postpartum
10. WHO medical eligibility
criteria
Categories Classification
1 Use the method in any
circumstances
2 Generally use the method
3 Use of the method is not
usually recommended unless
other more appropriate
methods are not available
4 Methods not to be used
12. Relative Contraindication
WHO Category 2&3
• Age above 40
• Age >35 and smoking
• Migraine
• Hypertension
• Diabetes
• Obesity
• Sickle cell disease
• Varicose vein
13. Missed pills (COCP)
1st question to ask patient:
Which type ooff CCOOCCPP tthhaann yyoouu aarree ttaakkiinngg??
30 mcg or 20 mcg of ethinyloestradiol
14. Missed pills (COCP)
For COCP containing 30mcg of ethinyloestradiol
•If 1 or 2 pills are missed at anytime, take the pill ASAP
(NO NEED EXTRA COVER, DO NOT STOP)
•If 3 or more pills are missed in the:
1st week, needs emergency contraception if
unprotected sex and use condoms for 7 days
2nd week, use condom for 7 days
3rd week, use condom for 7 days and continue
with next packet without a break
15. Missed pills (COCP)
For COCP containing 20mcg of ethinyloestradiol
•If 2 or more pills are missed, apply the rules of
missing 3 or more 30mcg pills.
17. When to start POP?
• Day 1 till up to day 5 of menses
• At any time when patient is sure not pregnant, but with
additional protection for the next 48 hours i.e. condom
18. When to start POP?
• Postpartum
Up to day 21 postpartum with no additional
contraception
After day 21 postpartum, need additional
contraception (ie condom) or avoid sexual intercourse
for the next 48 hours.
19. Side effects of POP
• Amenorrhoea
• Irregular bleeding or spotting
• Weight gain or loss (change in apetite)
• Breast tenderness
• Headaches, acnes
• Increased risk of benign functional ovarian cysts
24. When to start Injectable
Progestogen?
• Day 1 to 5 of menses
no backup contraceptive method is necessary
• Anytime during the menstrual cycle when patient is sure not
pregnant
additional contraceptive method should be used for the next 7
days, ie condom
25. When to start Injectable
Progestogen?
• Postpartum
Maybe initiated up to day 21 postpartum with immediate
contraception cover
If initiated after day 21, then condom or avoid sexual
intercourse for the next 7 days.
26. Disadvantages
• Changes in menstrual cycle
20% amenorrhoeic
40% menses regularly
40% erractic bleeding
• Delay in return of fertility
average of 9-10 months from the date of last injection
• Weight gain (evidence is not strong)
• Headache & dizziness
27. Disadvantages
• Nausea
• Mood changes (depression)
• Hirsutism
• Hyperpigmentation over injection site
• Loss of libido
28. Missed injection??
Come early/late for
injection??
IM Depo Provera / IM NET-EN
can be given 2 weeks earlier or late
32. Risk of IUCD
• Uterine perforation 1 in 1000
• Pelvic infection 1 in 100
• Expulsion 1 in 20 particularly within 3 months of insertion
• Abnormal bleeding
Cu-IUD: first 3-6 months of insertion
Mirena (LNG-IUS): Irregular bleeding first 6 months,
amenorrhoea or light bleeding by 1 year
33. Contraindication
• Current PID or in the last 3 months
• STD
• Distorted uterine cavity
• Pregnancy
• Unexplained abnormal PV bleed
34. Timing of insertion
● Anytime during the menstrual cycle when you can be sure
that the client is not pregnant
● Postpartum
Immediately after expulsion of placenta or after 4
weeks postpartum
● Post-miscarriage
Within 48 hours or delay until 4 weeks later
37. Choice of contraception should be tailored to her
health condition & the couple wish.
Counseling to her involving the spouse will ensure
success for contraception & prepregnancy care.
