By John Guillebaud

Previous variations of this best-selling pocketbook were famous because the gold-standard introductory consultant to contraceptive perform. the objective viewers, kinfolk practitioners and perform nurses, are usually good positioned to supply strong contraceptive suggestion simply because they already comprehend the patient's well-being and situations. the most recent variation summarizes all on hand equipment of birth control and a number of the elements to be thought of in utilizing them.

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Extra info for Contraception Today: A Pocketbook for Primary Care Practitioners, Sixth Edition

Sample text

Moreover ethosuximide, valproate and clonazepam and most newer anti-epileptic drugs (including vigabatrin and lamotrigine) do not pose this COC-efficacy-reducing problem. • Lamotrigine levels can be lowered by COCs, so starting a COC in a patient already taking this drug may result in poorer control of the epilepsy: awareness and a small increment in the dose of lamotrigine is all that is required. Moreover, be aware of the same possibility with all progestogen-only methods (but no good data). – There is no problem in giving lamotrigine to patients already taking a COC, because the dose of anti-epileptic drug is as usual titrated to the patient’s needs.

You felt nauseated or sick in your stomach? 2. You were bothered by light a lot more than when you don’t have headache. 3. ’ Two ‘yes’ answers out of the three means a diagnosis of migraine. Migraine and stroke risk • Studies have shown an increased risk of ischaemic stroke in migraine sufferers and in COC-users, and if combined, there is ‘summation’ of risk. • There is good evidence of exacerbation of risk by arterial risk factors, including smoking and increasing age above 35 years. • The presence of aura before (or sometimes even without) the headache is the main marker of risk (WHO 4) – indeed, not only for ischaemic stroke but also for coronary artery disease and myocardial infarction.

51 all job 14/5/07 8:43 am Page 52 Longer-term use of antimicrobials The large-bowel flora responsible for recycling estrogens are reconstituted with resistant organisms within about 2 weeks. In practice, therefore, if COCs are commenced in a woman who has been taking a tetracycline long-term, there is no need to advise extra contraceptive precautions. e. when the tetracycline is first introduced to treat a long-term COC user. Even then: • • Extra precautions need only be sustained for a maximum of 21 days, which includes the usual 7 days for ovarian suppression, along with: Elimination of the next PFI if the 2 weeks of antimicrobial use involved any of the last seven pills of a pack.

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