COCs+common+problems

=Managing Common Problems Associated With COCs=

- change to progestin-only pill || - change to a more potent progestin - change to progestin-only pill || - change to progestin with mild diuretic effect || - increase progestin dose || - oestradiol 50-100 microgram patch during pill-free week - tri-monthly or continuous pill taking regimen || - consider non-combined or non-hormonal contraception || - change progestin ||
 * **Problem** || **Mechanism** || **Management** ||
 * nausea || mechanism uncertain || - reduce oestrogen dose
 * breast tenderness || combined effects of oestrogen and progestogen on the development of mammary tissue. || - reduce oestrogen dose
 * bloating and fluid retention || increased activity of the rennin-angiotensinaldosterone system via increased hepatic production of angiotensinogen || - reduce oestrogen dose
 * dysmenorrhea ||  || - reduce oestrogen dose
 * menstrual migraine ||  || - reduce oestrogen dose
 * decreased libido || all combined OCPs increase sex hormone binding globulin, which produces lower circulating free androgen levels || - consider changing from anti-androgenic progestins to an alternative progestin
 * breakthrough bleeding ||  || - increased oestrogen dose (stabilises endometrium)


 * Disease risk when using oral contraceptives:**

- small increase in the risk of venous thromboembolism that is oestrogen dose dependent. This is presumably due to the prothrombotic effects of oestrogens on serum clotting proteins. - small increase in risk of breast cancer, presumably due to growth promoting effect of oestrogen plus progestogen on mammary tissue - risk of endometrial cancer may be decreased due to progestogen’s antiproliferative effect (decrease oestrogen receptor expression and convert endometrium from a proliferative to a secretory state) - risk of ovarian cancer may be decreased due to decreased ovarian stimulation by gonadotrophins

Resources
[|NPS: Hormonal contraceptives: tailoring for the individual] (page 6)