TEALE FENNING

docsubhi · Joined: 03 Sep 2007 Posts: 59 Location: london

A reapply the patch, and keep the same change date

B Continue use of patches as per usual

C Apply a new patch but keep the same change date

D Omit patch free week and continue with patches for up to 6 weeks in total

E Perform a pregnancy test

F Take COC pill as soon as possible and barrier contraception for 7 days

G Take COC pill as soon as possible and omit pill-free week

H Give combined emergency contraceptive pill

I Give progesterone only emergency contraception.

J Insert copper IUCD

K Apply new patch and use barrier contraception for 7 days

L Replace with a new patch and use barrier contraception for 7 days

M Abandon patch use and consider alternative contraceptives.

Questions

1) Patch detached 20 hours after application. This was her second patch. UPSI yesterday

2) Regular patch user since last 2 months, taken up sauna, spends 2 hours everyday. Worried about contraceptive efficacy

3) Now she's been using it for 3 years and develos minor DVT. No family history and thrombophilia screen negative

Maud · Joined: 11 Oct 2007 Posts: 73 Location: Bristol

1C
2B
3M

1: Really not sure. I think u mean by 2nd patch that she is in her 2nd week and if it works like the COC does, the 2nd week is a "safe" week to forget pills. Don't know how long the patch has been off for though and don't know whether new patch is required or can stick same 1 back on again. I went for the relatively safer option, though the safest would hav been using barrier for a week as well...

2. I thought sauna is ok as long as patch doesn't come off? Swimming & bathing should b ok as well, though 2 hours a day is a lot!!

3. absolute contraindication WHO 4, needs to change

docsubhi · Joined: 03 Sep 2007 Posts: 59 Location: london

Spot on Maud !

For 1 - the patch was her second one and it detached 20 hrs after application , but she would still be protected by her first patch for upto 9 days, so doesnt need additional protection, but does need a new pach.

Pharmakokinetic data suggest there is sufficient absorption of norelgestromin and EE to maintain serum levels within the reference range for up to ten days.

Women do not therefore need to reapply a new patch at exactly the same time every week. If women forget to remove the patch on day seven, evidence suggests that contraceptive protection is provided for a further 2 days. If the patch remains applied for more than 9 days, contraceptive protection is assumed lost. If women wish to delay menses, the patch-free week can be delayed. However, after six consecutive patches have been used, SPC recommends there should be a patch-free week.

Nick Raine-Fenning · Posted: Sat Aug 16, 2008 8:26 am Post subject:

This is a good question - well done.

Can we have a few more regarding the other forms of contraception?

Please do not disrupt your revision plans though and concentrate on what you had planned to do. Wink