612 Obstetrics and Gynecology Board Review •••
❍ Is depression a contraindication for COCs?
No. Symptoms are not exacerbated by them.
❍ What precautions should women with epilepsy on anticonvulsants take?
They should take a pill with at least 30 mg ethinyl estradiol because of the decreased effectiveness of the COC in
women taking these medications. Use of other contraception should be encouraged.
❍ Should COCs be discontinued prior to major surgery?
It is suggested that oral contraceptives be discontinued approximately 6 weeks prior to any major surgery with
prolonged immobilization. If they are continued, heparin prophylaxis should be provided.
❍ Can women with dyslipidemia use COCs?
Yes, provided that their disease is well controlled. The parameters for poor disease control include LDL >160 mg/mL,
triglycerides >250 mg/day or comorbidities of the disease. The patients who meet criteria should be started on a
low-dose estrogen pill.
❍ Should patients on depot medroxyprogesterone acetate (DMPA) be assessed for bone mineral density
(DXA scan)?
No. At this time, the short-term data does not support the need for DXA for patients on DMPA.
❍ Name the conditions where progestin-only methods may be more appropriate than combination
contraceptives.
The conditions include migraine headaches, smokers, obesity, hypertension, hyperlipidemia, history of
thromboembolism, thrombogenic mutations, SLE (use with caution in those with positive antiphospholipid
antibodies and thrombocytopenia), sickle cell disease, cardiovascular, and cerebrovascular disease.
❍ Which anticonvulsants may decrease the effectiveness of COCs?
Barbiturates, carbamazepine, felbamate, phenytoin, topiramate, primidone, and vigabatrin.
❍ What are the regimens available for emergency contraception?
The most commonly used oral emergency contraception regimens are the progestin-only regimen, which consists
of two 0.75 mg levonorgestrel pills taken at the same time (Plan B), and the combined estrogen-progestin regimen,
which consists of two doses—each containing 100 μg of ethinyl estradiol plus 0.5 mg of levonorgestrel—taken
12 hours apart. If there is low risk of sexually transmitted infections, placement of a copper IUD can be used
for emergency contraception with the added benefit of being a highly effective method for up to 10 years after
placement.
❍ How long after exposure can emergency oral contraceptives be given?
Up to 120 hours. It is most effective if initiated in 12 to 24 hours.
❍ What is the most common side effect of oral contraceptives when used for emergency contraception?
Nausea. It occurs in 50% to 70% of those treated. Up to 22% may vomit.