614 Obstetrics and Gynecology Board Review •••
❍ In lactating women, how soon after delivery can COC pills be started?
COCs may be started once milk production is well established, usually 6 weeks postpartum. Progestin only pills,
however, are a better choice because they are not associated with decreased milk production, although studies have
not shown less weight gain in babies whose mothers take COCs.
❍ In nonlactating postpartum women when should combination pills be started?
After 4 weeks postpartum. This avoids the immediate postpartum hypercoagulable state.
❍ Among nonlactating postpartum women when does the first ovulation occur?
On average 45 to 94 days postpartum.
❍ How effective is breastfeeding alone in preventing pregnancy?
Ninety-eight percent for the first 6 months in women who have not resumed their menses and are exclusively
breastfeeding.
❍ Are women more likely to gain or lose weight with oral contraceptive use?
Both are equally likely. The effect on weight is small.
❍ What is NuvaRing?
It is a combined hormonal contraceptive. The ring is placed in the vagina for 3 weeks and then removed for a week
to allow withdrawal bleeding. A new ring is then placed 7 days later.
❍ How does NuvaRing work?
NuvaRing releases 15 mg ethinyl estradiol and 120 mg etonogestrel daily.
❍ Is it necessary to remove NuvaRing for sexual intercourse?
No. The ring should not be removed for sexual intercourse. However, if the ring is displaced outside the vagina
during intercourse, it may be rinsed and should be placed back in the vagina within 3 hours.
❍ How does the transdermal contraceptive patch work?
Ortho Evra patches deliver 20 mg of ethinyl estradiol and 150 mg of norelgestromin daily. The patch is changed
once a week for 3 weeks, followed by 1 week of no patch.
❍ What are the most frequent side effects of the patch?
Breast symptoms, headache, application site reaction, and nausea. Few women considered these side effects a
reason to discontinue the patch. Reaction at the application site is the leading cause to stop using the patch.
❍ Is the patch more effective than OCPs?
No. The efficacy of these methods is similar. However, the efficacy may decrease in women with weight >90 kg.
❍ What should be recommended if the patch becomes detached?
A partially detached patch for <24 hours duration should be reattached or replaced if it has lost its stickiness. For
longer detachment, a new patch should be applied and 7-day backup contraception should be provided.