Healthed asked more than 1000 doctors for their questions about OCPs, and put them to sexual health experts, Dr Terri Foran and Professor Deborah Bateson in this recent Healthed podcast.

Dr Foran is a sexual health physician and lecturer at the School of Women’s and Children’s Health, UNSW, and Professor Deborah Bateson is a clinician, researcher and educator in sexual and reproductive health and Professor of Practice at The Daffodil Centre in the Faculty of Medicine and Health at The University of Sydney.

Here are some highlights.

Q. What are the most important differences between combination vs progestogen-only pills?

A. Professor Deborah Bateson:

“As we’d all know, progesterone pills don’t have oestrogen. They’ve only got progesterone, and of course, the combined pills that’s a combination of an oestrogen and progesterone. And they come with some advantages and some disadvantages,” Professor Bateson says.

Both Dr Foran and Professor Bateson will be speaking at The Annual Women’s & Children’s Health Update in Adelaide, Brisbane, Melbourne, Sydney and Perth. Register now to an event near you and hear many more important topics affecting women and children.

One advantage, she says is that most people can use the progesterone pill.

“There are more contraindications for combined pills. For instance, for someone with migraine with aura or a smoker who is over 35 years of age, … it’s not indicated to use oestrogen pills so there are more limitations.”

When it comes to the “mini pills, the low dose progestogen only pills, … in real life there’s a three-hour window to take them [which] may make them a bit less effective.
Irregular bleeding patterns can be an issue with the progesterone pills, she says.

One of the main benefits of the combined pill is that the oestrogen “is very useful for acne.”

Q. What are the rules on missed and late pills?

A. Dr Terri Foran:

“I think the first thing to do is to make the distinction between late and missed. Late means anything less than 24 hours and missed is when it’s more than 24 hours.

For the combined pills:

“If it’s late, then all you need to do is to continue to take the pill as you would normally, but if it’s missed, there are some additional rules,” Dr Foran says.

She says the patient should be advised to take their pill as soon as possible and also use additional methods of contraception for 7 days.

“There’s one little additional rule and that is that the vulnerable time when you take a combined pill is around the time that you would normally be taking those sugar pills.

“The problem there is that the levels are scheduled to go down anyway. And if you extend that for more than the scheduled seven days, then that can make that woman really at risk of pregnancy.

“So, if she misses a pill in the last week of the active pills, she’s advised to keep taking active pills and to miss the sugar pills. … and still use another method of protection.”

The Progestogen Pills:

“With progestogen only pills, …if you’re more than three hours late taking it, that’s considered a missed pill.

“The good news is that it is only three days before that cover kicks back in again, so you need to use additional protection for a shorter period of time.
There are two exceptions: Slinda that’s just like the combined pill and has a 24 hour leeway. And the other exception is Qlaira. She advises patients to read the Qlaira PI carefully as a very complicated set of instructions.

Dr Foran’s preference for emergency contraception is levonorgestrel. She says the newer EllaOne can interact with the combined and progestogen pills and as a result may be less effective.

Stay tuned for more OCP questions answered next week. You can also complete the OCP masterclass here.

Both Dr Foran and Professor Bateson will be speaking at The Annual Women’s & Children’s Health Update in Adelaide, Brisbane, Melbourne, Sydney and Perth. Sign up to hear more on important topics affecting women and children.

You’ll get 8hrs of CPD in the Educational Activities category PLUS you can earn another 4hrs of CPD in the Reviewing Performance category by completing the post-seminar quizzes Healthed will manage the CPD upload process to RACGP and ACRRM.

Register now to secure your seat.