Dosing and Missed Doses – Oral Contraceptives (OCs) (Nursing)

00:00 Okay, now let's talk about the dosing of oral contraceptives. This probably looks pretty familiar to you. If you look at a traditional package, we think about a 28-day cycle. Now, you'll see different combinations of this but usually it's 21 days of active pills and 7 days can be any one of these things. It can be a placebo which is just a sugar pill, it can be an iron pill, or if you're really good no pill is taken. Now usually in the states there is something there mostly because it's hard for people to remember to do something everyday and if they take 7 days off it's hard for them to get back in the bad habit so some people prefer to take a placebo for those 7 days but some people don't take anything. So, that is a discussion you want to have with your client. Wow. How good are you at remembering things to do everyday, do you have a process, what's your preference, you definitely need to have that conversation with the patient and with the healthcare provider. Now you can either start it on the first day of menses or on the first Sunday after menses starts. Some people like to just start everything on Sunday so it's kind of organized and some people like to start in the first day of their menses but no if you wait until the first day of your menses you need to be using an alternate form of birth control before then. Now there's some super cool extended dosing. Some people really like this, you may not, but it's 91 days. Remember the traditional is 28 days, this is a 91-day product. So there's a 91-day cycle or continuous. Now you have decreased episodes of withdrawal bleeding and menstrual associated effects with this medication, that's why some people really liked it. They will suppress endometrial thickening for the full 91 days. So, what does that mean to a female? Well, for 91 days since I don't have endometrial thickening, there is no reason for that lining to be sloughing so you don't have a period for that period of time. Now, that makes some people uncomfortable and makes some people celebrate. You just have to decide what's most important to you.

02:09 So, what should I teach a patient about missing a dose of oral contraceptives? Okay. I'm not even going to let you try and explain this on your own because we've got a lot of information here for you. So let's just keep going through it because it depends on what type of oral contraceptives your patient is taking and trust me it gets a little complicated. I don't think there's any way that you could memorize all this stuff but we just want to educate you about what the options are. So, missed doses if it's a 28-day cycle. This is what you recommend they do if one or more pills are missed in the first week. Take 1 pill as soon as possible and continue with the rest of the pack. Make sure you use an alternate form of birth control for 7 days. Now, what if one or two pills are missed in a second week? Again, take 1 pill as soon as possible, continue with the active pills in the pack. Just skip the placebo pills and go straight to the next next pack. Right? Okay, so in a 28-day cycle, if I missed 1 in the first week just take 1 pill as soon as possible and use an alternate form of birth control for a week. If I'm in the second week, you see it moves down in the graphic, if I'm in the second week take 1 pill as soon as possible, continue with the active pack and just skip the placebo pills at the end. Now, if you missed 3 or more pills in the 2nd or 3rd week, wow, do what we recommend in the 2nd week and use an alternate form of birth control for 7 days. Now why do we have to educate patients about this? Because it happens all the time. People's lives are busy and they're crazy and it's hard to remember things so it's really important that your patient understand exactly what to do depending if one of this situation occurs and trust me if they're on birth control for very long, this will happen.

03:59 Now what about the extended cycle? Nahh, it's more complex directions in the 28-day cycle so they'll need to refer to the package insert and you should go over that insert with them to help them understand and see if they have any questions. Now, kind of a cool thing about this.

04:14 Some can miss up to 7 days with little impact on effectiveness if they've had no misses in the previous 3 weeks. Okay, that is pretty cool but they have to be right on it for the previous 3 weeks in order to miss that many days without an impact on effectiveness. Now what about the progestin only? We call it the minipill. I don't know why. We started calling that but that's what you'll hear people call that in the community. There's no estrogen included that's why it's a progestin-only pill. Now we want to minimize the risk for thrombosis and headaches and nausea that are associated with combination medications. That's when we would use a minipill. So, one of the reasons selecting a minipills because they tried the oral combination and they ended up with headaches and they didn't feel good and their stomach was upset and also minimizes the risk for them making clots. It's less effective but it's more likely to cause some irregular bleeding. So that's usually the most common reason where people go. Oh, I don't like that one either because it's more likely to cause an irregular bleeding issue. So, why would I choose progestin? Cause I couldn't tolerate the combination. Why would I say progestin only isn't for me? Because it might cause irregular bleeding. Okay. So what do I do about the missed dose with progestin? Well, minipills are taken continuously. It's not on a cycle like the combination so that's one important difference.

05:46 If you miss 1 pill, just take 1 as soon as possible and use an alternate birth control for at least 2 days. If you missed 2 pills, restart the regimen on the next day and use an alternate birth control for 2 days. Now if you missed more than 2 pills and you haven't any menstrual bleeding, oh oh, I don't have good news for you. So if you've missed more than 2 pills and you haven't started bleeding, you're going to need to do a pregnancy test before you decide what the next best step is.