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Lafene Health Center

Combined Contraceptive Information

Combined Oral Contraceptives, Contraceptive Patch or Ring and antibiotic use (Excluding Rifampin)

If you are on a combined contraceptive and choose to use a back-up method while on antibiotics, please read the following information.

  1. Some clinicians strongly recommend a back-up contraceptive for women on broad-spectrum antibiotics, and others do not. Some women choose to use a back-up contraceptive method if on a broad-spectrum antibiotic and others do not. The choice is yours to make.
  2. If you choose to use a back-up contraception while taking an antibiotic, follow these steps:
    1. Take your contraceptive pills or use the ring or patch the whole time you are on the antibiotic and for 7 additional days after completing the antibiotic. Omit the pill-free interval or apply a new patch or insert a new ring if necessary to avoid any hormone-free days.
    2. You must also use a condom this entire time.
  3. If you will be starting antibiotics long-term and want to use a back-up method:
    1. Take your contraceptive pill, or use the ring or patch for the first two weeks when starting the medication and for an additional 7 days (3 weeks total). Omit the pill-free interval or apply a new patch or insert a new ring if necessary to avoid any hormone-free days during the three weeks.
    2. You must also use a condom this entire time.

Combined contraceptive informed consent/information

How combined contraceptives work
Who should not use combined contraceptives
Advantages
Disadvantages
Possible side effects
Warning signs: ACHES
Patient responsibility

How combined contraceptives work

Combined contraceptives are contraceptives that contain estrogen and progesterone. These hormones prevent pregnancy in three ways:

  • The ovaries are stopped from releasing eggs.
  • The lining of the uterus is thinned.
  • Thick and sticky cervical mucous is created so sperm have trouble reaching your uterus.

If used correctly all of the time, combined contraceptives are 99% effective. Combined contraceptives do not protect against sexually transmitted infections. You will need to use condoms or avoid intercourse and other sexual contact if there is any risk of sexually transmitted infection.

Who should not use combined contraceptives

Combined contraceptives are not a wise choice for women with certain medical problems:

  • Deep venous thrombosis (blood clots in veins) or embolism (clots in lung, eye, or brain)
  • Cardiovascular disease (heart disease, high blood pressure, or stroke)
  • Breast cancer
  • Severe active liver disease or liver tumors
  • Blood clotting disorder
  • Certain types of severe headaches
  • Diabetics with complications

Before starting a combined contraceptive, be sure to discuss any serious medical conditions you have with your clinician. If you are taking any medications, including over-the-counter medication or supplements, please discuss it with your clinician. It is possible that combined contraceptives may not work as well for women taking epilepsy drugs such as Dilantin or Tegretol or certain antibiotics, especially Rifampin. For those taking antibiotics such as amoxicillin and doxycycline, some strongly recommend a back-up method and others do not. Some women on these antibiotics choose to use a back-up method and others do not. The choice is up to you. Herbal products containing St. John’s Wort may reduce effectiveness of contraceptive agents. This could increase the incidences of breakthrough bleeding. Anytime a medication is prescribed or surgery is planned, inform your clinician that you are taking combined contraceptives.

Advantages

Highly effective, easy to use, easy to stop, reversible, decreased menstrual flow, decreased menstrual cramps, regular periods, decreased risk of benign (non-cancerous) breast disease, protects against cancer of the uterus (endometrial) and ovaries (ovarian), protects against pelvic inflammation, may improve acne, and may enhance sexual enjoyment.

Disadvantages

May have some side effects including increased risk of cardiovascular disease (blood clots, heart attack, and stroke) especially in smokers, gallbladder disease, and non-cancerous liver tumors.

Possible side effects can include

Nausea, fluid retention, breast tenderness/enlargement, spotting between periods, weight gain/loss, mood changes, acne changes, sex drive changes, changes in vaginal discharge, blood pressure elevation, and headaches.

Serious complications are more likely to occur in women who are smokers, sedentary, overweight, hypertensive, diabetic, or have severe headaches.

Warning signs: ACHES

A bdominal pain, severe
C hest pain, severe
H eadache, severe (blurred vision, spots, zigzag lines, weakness)
E ye problems (blurred vision, spots, zigzag lines)
S evere leg pain (calf or thigh)

If you develop any of these warning signs, you should contact your provider as soon as possible.

Responsibility

I understand that the prevention of pregnancy provided by this method depends on my compliance with the combined contraception.

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