QuestionSBA
QuestionChoice
This injection must be provided every 3 months; therefore, for contraceptive cover this would be impractical due to the patient going abroad for 4 months. Moreover, it does not necessarily stop periods in all patients, with some patients having spotting and irregular bleeding.
53061
e
Intramuscular progesterone injection
QuestionChoice
The progesterone-only pill could provide reliable contraceptive cover if taken daily and may also help with endometriosis. However, it does not protect against irregular bleeding or reliably stop periods and so it would not be the best choice in this patient.
53058
b
Progesterone-only pill
QuestionChoice
The combined oral contraceptive pill provides reliable contraceptive cover and can be taken back to back to prevent bleeding. It can also help with endometriosis-related pain. This patient has no contraindications for the combined oral contraceptive pill such as migraine with aura or smoking and so can be offered this.
53057
a
Combined oral contraceptive pill
QuestionChoice
Intrauterine devices are copper-based systems that do not stop periods and can in fact make them heavier and more prolonged. They will not help with endometriosis-related pain although will offer good contraception. Therefore, it does not fulfil all of the patient's criteria.
53059
c
Intrauterine device
QuestionChoice
Intrauterine systems release local progestogens and help thin the lining of the uterus, reducing bleeding and providing effective contraception. They can help with endometriosis pain. However, they do not reliably stop periods or breakthrough bleeding; therefore, they are not a suitable option for the patient.
53060
d
Intrauterine system
QuestionComment
but then wont she have a bleed during the 'pill free' week?

37969
QuestionComment
they can be given continuously without a pill free week, so they won't have a bleed
44277
User
subscriber
Intubation Hypertension
User
subscriber
Malignant Serotonin
Concept
Chapter
# Management of missed combined oral contraception pills


​If patients are sick (vomit) within 3 hours of taking a combined pill, or within 2 hours of taking a progestogen-only pill, it probably will not have been absorbed by their body. Patients should take another pill straight away.
As long as they're not sick again, they will still be protected against pregnancy.
Patient should be advised to take their next pill as usual.


The pill free week is the 7 days between taking packets of pills. There is occasionally a breakthrough bleed, a small bleed similar to a period, however the absence of a breakthrough bleed does not indicate pregnancy.


Missed pill rules:


- If pills are missed in week 1: use emergency contraception if she had UPSI in pill free interval for 1 week


- If pills are missed in week 2: no need for emergency contraception


- If pills are missed in week 3: Take the last pill that was missed, finish the current pack and start the next pack immediately after.


# References


[Click here to see information on NICE about missed pills](https://cks.nice.org.uk/topics/contraception-combined-hormonal-methods/management/combined-oral-contraceptive/#missed-coc-pills-except-qlaira-zoely)
8
3456
Missed combined oral contraceptive pills
Topic
27
Genitourinary medicine
10672
The combined oral contraceptive pill is effective for contraception and can alleviate endometriosis-related pain while suppressing menstrual bleeding.
Presentation
171
Contraception request/advice
UkmlaTopic
12
General practice and primary healthcare
A 22-year-old woman attends her GP for contraceptive advice. She is going abroad for 4 months and would like to have a reliable form of contraception, which will also prevent her having any periods or bleeding while away. She has known endometriosis with chronic menstrual pain and adhesions. She takes no regular medications and has never smoked. On examination, her body mass index is 20.

Which of the following is the most appropriate option for this patient?
a