GUIDELINES FOR ORAL PILL ADMINISTRATION FOR MEDICAL OFFICERS
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- Title
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GUIDELINES
FOR
ORAL PILL
ADMINISTRATION
FOR MEDICAL OFFICERS - extracted text
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GUIDELINES
FOR
ORAL PILL
ADMINISTRATION
FOR MEDICAL OFFICERS
Issued by
Technical Operations Division
Ministry of Health & Family Welfare
(Department of Family Welfare)
Government of India
Nirman Bhavan, New Delhi-11.
GUIDELINES
FOR
ORAL PILL
ADMINISTRATION
FOR MEDICAL OFFICERS
Issued by
Technical Operations Division
Ministry of Health & Family Welfare
(Department of Family Welfare)
Government of India
Norman Bhavan, New Delhi-11.
PR E F A C E
1 he Government of India is giving high priority to Family Welfare
Programme, the ultimate objective being to reduce the country’s birth rate to
21 per thousand by the year 2000 AD. In order to achieve this goal, efforts
are being made to promote various contraceptive methods for birth spacing especially lor young couples. The oral contraceptive pill has been found to be
a simple, safe, effective and reversible method of contraception. The
composition of pill presently being used has been found to be most suitable for
the Indian woman.
This brochure on oral contraceptive pills will help the medical officers
at Primary Health Centres in proper selection of beneficiaries, proper
counselling, follow up, regular reporting, etc.
My thanks arc due to the experts and staff members of the Ministry
who have helped to bring out the publication.
I hope this book will be useful to the doctors for promoting oral
contraceptive pills in the National Family Welfare Programme.
NEW DELHI - 110011
(ADARSII MISRA)
Joint Secretary to the
Government of India
CONTENTS
PREFACE
Acknowledgement
1.0 Facts About Oral Contraceptive Pills
1.1 Oral Contraceptives in National Family Welfare Programmes
1.2 Mechanism of Action
1.3 Selection of Acceptors
1.4 Absolute Contraindications
1.5 Relative Contraindications
2.0 Special Situations for Oral Contraceptive Use
2.1 Lactation
2.2 Drug Interaction
2.3 Diarrhoea and Vomiting
2.4 Planned Surgery
2.5 Hormonal Pregnancy Test
3.0 Effectiveness and Other Advantages
3.1 Beneficial Effects
4.0 Side Effects and Risks
4.1 Minor Side Effects
4.2 Adverse Effects
4.3 Other effects
5.0 Instructions for use of 28 Pills Pack
5.1 When to Start Pills
5.2 How to take the Pill
5.3 If a Pill is Missed
5.4 Back up Contraception
5.5 Duration of use
5.6 Danger Signs
6.0 Follow up services
6.1 First Visit
6.2 Second Visit
6.3 Subsequent Visits
6.4 Medical Check up
7.0 Logistics and Monitoring of Oral Pill Programme
7.1 Procurement and Storage of Oral Pills
7.2 Management Information System
7.3 Monthly Statistical Returns/Reports
Annexure 1
Annexure II
Annexure III
Annexure IV
Annexure V
Annexure VI
OBJECTIVE
The objective of these guidelines is to enable you to have the
necessary knowledge to provide oral contraceptive pill services
including counselling, appropriate screening and selection of
clients, management of side effects and offer follow up services
1.0 Facts about Oral Pill
At present about 70 million women worldwide and about 2.3 million women in India are
using oral contraceptive pills. The first oral contraceptive pill in 1960s contained high doses of
oestrogen and progestogens. Currently there has been a significant reduction in both components
of oral contraceptive pills, which has led to a decrease in adverse effects. Oral contraceptive pills
have been studied more thoroughly than any other medication in common use. The benefits of
health apart from preventing- pregnancy far outweigh the possible side effects and infrequent
complications which may occur in a small number of women. Thus, the oral pill is one of the most
effective (if used regularly), safe and reversible temporary method of contraception available at
present. It is a contraceptive of choice available to women who want to postpone first pregnancy
by a reliable method.
In spite of safety and high efficacy, the national usage is very low. The percentage of
married women aged between 13 and 49 years who are currently using pills was only 1.2%
according to National Family Health Survey 1992-93. To some extent this is because of
misconceptions and misbeliefs regarding health hazards of pills in the minds of lay people.
Even many medical practitioners are not fully aware of the safety aspects of the pills. In order to
remove misconceptions and propagate correct and sustained use, the myths regarding the pills need
to be clarified.
Myths
1. Pills may lead to cancer
Reality
. Pills offer protection against cancer of
Ovary and endometrium.
. No demonstrated increased risk of
breast cancer.
2. Pills cause infertility
. Pills do not lead to permanent infertility.
. After discontinuation of pills fertility
returns rapidly in majority of women.
3. Pills harm w omen’s
health permanently.
. Pills in current use contain very low
amounts of hormones; and hence do not
lead to major complications.
Observations on millions of women
have proved that when carefully chosen
screened women arc given oral pills
there are no permanent ill effects.
. Taking pills is safer than pregnancy
and childbirth.
4. Baby may be deformed
.Even if pills are accidentally used during
undiagnosed early pregnancy, there is
no increase in the risk of foetal abnormalities.
5. Pills should be discontinued
Intermittently
. Pills can be sefely used continuously
for 5 years.
. Interruption of pills without use of
another contraceptive can result in
unwanted pregnancy.
1.1
Oral Contraceptives in National Family Welfare Programme
Based on the results of several clinical trials conducted in India and elsewhere, it has been
decided to use low dose oral pills with the following composition in the National Family Welfare
Programme.
DL Norgestrel 0.30 mg. per tablet
Ethinyl Estradiol 0.03 mg per tablet
Oral pills are being made available to acceptors under the brand name Mala-N under the free
distribution scheme and Mala-D under social marketing programmes available over the counter at
a subsidized cost.
These are monophasic combination pills containing the same amount of oestrogen and
progestogen in each pill. Each packet of Mala-N and Mala-D contains 21 contraceptive pills and
7 iron tablets. Some other brands of oral pills available commercially are enlisted in Annexure - 1.
1.2
Mechanism of Action
Oral Contraceptive Pills provide effective protection against pregnancy in view of its
multiple sites of action, which include:
I. Inhibition of ovulation by suppressing FSH and LH release
ii. Affecting implantation by altering endometrium
iii. Reducing transportation of sperms by making cervical mucus scanty and viscid.
1.3
Selection of Acceptors
Careful selection of acceptors is essential to reduce the rare and serious risks associated with
the use of oral pills. Complete clinical history and medical examination should be carried out
including body weight and blood pressure recordings before starting pills. The medical examination
should include abdominal and pelvic examinations to exclude contraindications.
A check list js provided in Annexure II which will help proper selection of the client. After filling
in check list, a decision about suitability of the acceptor for pill use can be taken.
further a simpler check list for paramedical workers is provided in Annexure III. Where
doctors are not available, the health personnel like Public Health Nurse/Lady Health
Visitor/Auxillary Nurse Midwife/Multipurpose Worker (female)/Health Assistant (female)/ Doctors
from indigenous systems of medicine should give oral pills to an acceptor only after making sure
that all points listed in the check list are satisfied and also after checking the weight and blood
pressure. They must ensure that the acceptor is examined by a doctor within 3 months of initial
acceptance.
1.4
Absolute Contraindications
1. Pregnancy
ii. H/o Thromboembolism
iii. H/o Cerebrovascular accident
iv. Cardiac disease
v. Malignancy of Breast
vi. Malignancy of genital tract
vii. Active liver disease
H/o
viii.
Cholestatic jaundice during pregnancy.
ix. Migraine
1.5
Relative Contraindications
1. Undiagnosed abnormal uterine bleeding
ii. Lactating mothers in first 6 months
iii. Age over 40 years : : over 35 years if smoker
iv. Mild Hypertension
v. Gross Obesity
vi. Diabetes Mellitus
vii. Epilepsy
viii. Recent history of depression
ix. Recent history of oligomenorrhoea
x. Recent history of amenorrhoea
xi. H/o Jaundice within last 6 months
xii. Sickle cell disease (trait not a contraindication)
2.0 Special Situations for Oral Contraceptive use
2.1
Lactation : Combined oral contraceptives containing oestrogen adversely affect both the
quantity and quality of the breast milk and also’ reduce the duration of lactation. Combined oral
contraceptives should be witheld until six months after delivery or till the infact is weaned;
whichever is earlier. No deleterious effects have been so far reported from the transfer to the infant
of a small amount of contraceptive steroids in the breast milk. However, long term epidemiological
studies are still continuing.
2.2
Drug Interaction: Drugs which may reduce the efficacy of oral contraceptive pills are
Rifampicin, Antibiotics, Anticonvulsants and Antifungal drugs. Management varies according to
the duration of such medication. A back up contraceptive method; e.g. condom is recommended
for short term use upto one week. Clients taking medication for more than one week should be
advised to switch over to another contraceptive method.
2.3
Diarrhoea and Vomiting : Irregular absorption of drug during such illness can reduce the
efficacy. To avoid failure of pills a back up method such as condom should be used during
diarrhoea and/or vomiting and continued for seven days after controlling t e symp oms.
2.4
Planned Surgery in Oral Contraceptive user : Oestrogenic component of the pills
increases the coagulability of blood. Hence oral contraceptives should be iscon tnue a east or
four weeks prior to contemplated surgery to reduce the risk of post operative t rom osis.
2.5
The use of oral contraceptive steroids for pregnancy test is not recommended.
2.6
Adolescents - Caution is recommended until menstruation is established, while presciibing
oral contraceptive for adolescents.
3.0
Effectiveness and Other Advantages :
1. Highly effective method with correct and regular intake by the acceptor.
ii. Safe
iii. Reversible
iv. User dependent: decision with women herself
v. Non-invasive
vi. Privacy not required
3.1
Beneficial Effects :
1. Highly effective in preventing pregnancy if taken regularly.
ii. Reduces the incidence of ectopic pregnancy - a life threatening condition
iii. Menstrual benefits :
. Relief from menorrhagia, indirectly reducing chances of anaemia
. Relief from dysmenorrhoea
. Relief from premenstrual tension
. Rcgularisation of menstrual cycles
iv. Reduced incidence of Pelvic Inflammatory Diseases as compared to nonusers
v. Relief from acne - specially premenstrual type
vi. Protection against neoplasia
. Benign breast tumours
. Benign ovarian cysts
. Carcinoma endometrium
. Carcinoma ovary
4.0
Side Effects and Risks :
Oral Contraceptives produce some metabolic, biochemical and functional changes which are
responsible lor a lew minor side el feels and adverse effects
4.1
Minor Side Effects :
Women on oral contraceptive pills experience some minor side effects
1. Nausea. Vomitting
ii. Breast tenderness
iii. Headache
iv. Depression
v. Breakthrough bleeding
vi. Mild elevation of blood pressure (which usinllv r
t'Miicn usually disappears on discontinuation of
vii.
pills)
Weight gain
Breakthrough Bleeding
Breakthrough bleeding is usually due to low oestrogencontent in oral contraceptives. Mostly
it stops with continued use.
Disturbing Breakthrough Bleeding may be relieved by an
additional Tablet for 2 - 3 days or changing to a preparation containing 50 ug. Ethinyl
estradiol. Gynaecological pathology should be excluded before labelling the bleeding as
Breakthrough bleeding
Many of these symptoms disappear on continued use of pills hence you need to assure the
user for the first three cycles.
Some side effects are due to the oestrogenic component while some are due to progestogen
in the pill. Few of them can be managed by changing the dose of oestrogen or progestogen (by
changing the preparation). Recommended actions and management for persistent and unacceptable
side effects are given in Annexure - IV.
4.2
Adverse Effects :
Major side effects are rare with currently used low dose pills. The reported effects include:
1.
Atherosclerotic cardiovascular disease, hypertension and myocardial infarction.
Progesterone component of the pill increases low density lipoproteins (LDL) and decreases high
density lipoproteins (HDL), thus increasing the risk of atherosclerosis. The oestrogen component
has got an opposite effect. As a result, these effects are balanced in currently used low dose pills.
The risk factors for cardiovascular complications are :
. Age > 40 years
. Smoking
. Hypertension
. Diabetes Mellitus
. Hyperlipidaemia
ii.
Venous Thromboembolism : The oestrogen component of the oral contraceptive pill
increases the coagulability of blood.
iii.
Liver Disorder: Cholestatic jaundice may occur in women having a history of
Cholestatic jaundice during pregnancy.
There is an increased risk of developing benign liver cell adenoma. However, this is an
extremely rare condition.
iv.
Carcinogenicity :
. Breast: There is no conclusive evidence to indicate that oral contraceptives cause
breast cancer.
Cervix : Epidemiologic studies of OC use and cervical cancer have been inconclusive,
most early studies found no links but recent research has produced mixed
findings. Although slightly higher risk of cervical cancer and precancerous lesions
have been associated with prolonged OC use (more than 5-years) by some. 1 lowever,
the effect of other variables as sexual behaviour and smoking has not been considered
in these studies.
In view of this, ail oral contraceptive users should have periodic speculum
examination and cervical cytology wherever possible.
. Liver: Long term oral contraceptive use may be associated with liver
cancer which is an extremely rare cancer.
iv.
4.3
Postpill Amenorrhoea :
. Enquire about regularity of intake
. Exclude pregnancy
. Postpill amenorrhoea is usually seen in women with a previous histofy of
Infrequent periods. If amenorrhoea continues for two or more cycles, oral
contraceptive pill should be discontinued.
Other Effects
I.
Return of Menstruation and Fertility : 'The incidence of post Oral Contraceptive pill
amenorrhoea is low and there is no evidence of decreased fertility in oral contraceptive
users.
ii.
Pregnancy Outcome : There is no evidence to indicate increased incidence of
spontaneous abortion or foetal abnormalities in oral contraceptive users including in
those who conceive soon after discontinuing Oral Contraceptives. Where pregnancy
has occurred during oral contraceptive use and the worpan has inadvertantly
continued pills after missing the period, no increased risk of foetal abnormality
has been demonstrated. However, pills should be discontinued in the event of
suspicion of pregnancy.
5.0
Instructions For Use Of 28 Pill Pack
5.1
When to start Pills?
Start the Pill
1. Day 5 of Menstruation
2. Day 1 of MTP/Spontancous abortion
3. After delivery . Nursing mother: after 6 months
. Non-lactating : after 6 weeks
5.2
How to take the pill ?
I. Before starting the pills, read the instruction leaflet carefully.
ii. The first course should be started on the fifth day of the menstrual cycle (counting
first day of bleeding as day number one, by taking the pill from the pack marked
as START.
iii. For subsequent days, one pill a day should be taken from the pack in the order
indicated by the arrows; till all the pills in that pack are over.
iv. The pill should be taken every day at a fixed time, preferably while retiring to bed.
v. The next pack should be started the very next day by taking the first pill from the
pack marked as START.
vi. Consult a doctor within three months after starting the pill.
vii. Keep the pills away from children.
5.3
If a Pill is missed
If a Pill is Missed
•
•
If a woman misses a pill on a particular night, the missed pill
•
should be taken the next day as soon as she remembers. She
•
should take another pill at night as usual. In other words, on the day
•
following a missed pill day, she has to take two pills. If she misses
•
2-3 pills, she should continue taking pills regularly but in addition
•
she should also use another contraceptive method like condoms till
•__________________ the next cycle starts.____________________________________________
5.4
Back up Contraception
In certain situations there is a possibility of reduced efficacy of the pill and use of additional
contraceptive protection may be necessary. Condom can be a good back up contraceptive. Ten
pieces of condom may be given to a pill user for use in situations like missing two or more pills,
during diarrhoea and vomiting, or use of drugs reducing efficacy of the pills.
5.5
Duration of Use
In India continuous use of oral contraceptive pills over 5 years is not recommended.
However, in women who are otherwise well, low dose oral contraceptives may be continued for
several years under medical supervision and there is no need for periodic discontinuation. For
women over 40 years of age, oral contraceptives may be prescribed with caution.
5.6
Danger Signs
Ask the oral contraceptive useers to report immediately if:
ACHES
Abdominal pain (severe)
Chest Pain, shortness of breath
Headache - Severe throbbing unilateral
Eye problems (visual loss, double vision, blurring of vision)
Severe leg pains or swelling
Refer such women to higher centre.
6.0 Follow up Services
Initially a woman can be given one packet of ora! contraceptive pills. Later when the pills
are found to be suitable for her, she can be given a supply for a further three months. She must
return regularly to the clinic/service centres for getting the required supply and for necessary check
up at a regular interval every year thereafter. The follow-up services/visits to the acceptors of oral
pills may be undertaken by paramedical staff working in the National Family Welfare Programme.
The Medical Officers will instruct the paramedical workers to follow the following schedule
during routine home visits.
6.1
First Visit
Within 2 weeks after she has been put on pills:
I. Enquire how she is feeling.
ii. Treat minor ailments and reassure her.
iii. Check the pill count from the packet.
iv. Stress the need to take the pill regularly and to return for more pills before
the packet is over.
6.2
Second Visit
The second visit is scheduled one month after she has been put on oral pills.
I. Find out whether she is taking pills regularly, if not enquire as to why she
has discontinued the pills.
ii. Ask if she has any complaints; if none, give her 3 packets. Stress the need
to take pills regularly and to return for more pills before the third packet
is over.
Reassure the beneficiary in case of any complaints and persuade her to
iii.
continue pills.
6.3
Subsequent Visits
Monthly : Until the side effects cease and the woman is well adjusted to taking
the pills regularly.
After six months.
Annually thereafter; or earlier if there is any problem.
1. Ascertain that she is taking pills regularly.
ii. Reassure her as needed.
iii. Treat or refer her for side effects.
iv. Give her supplies of pills.
v. Get following information:
. Date of LMP
. Make sure she does not have any problems
. If any problems, see as per check list and return to the Doctor.
. Any irregularity in periods
6.4
Medical Check up for Oral Contraceptive Users
First: Before starting the pills or within three months of starting the pills
Subsequently after 6 months, 12 months and then yearly or as and when referred
by paramedical workers
. Weight
. Blood Pressure
. Breast palpation
. Per abdominal examination - Liver
. Per speculum and per vaginal examination.
. Urine examination for albumin and sugar
. I l.D. estimation.
. Cervical smear (if available)
7.0 Logistics and Monitoring of Oral Pill Programme
7.1
Procurement and Storage of Oral Pills
The oral pills arc procured by the Government of India, Ministry of Health and Family
Welfare and are stored in various medical stores depots. These pills arc supplied to States/Union
Territories as per instructions from the Ministry of Health and Family Welfare on the basis of the
requirements from States/Union Territories from time to time. A requisition in the following form
is required to be sent by the States/Union Territories for supply of oral pills to them.
Requisition
Form
I. Balance as on 1.4.
2. Stock received during the period/year under report.
3. Quantity (in cycles) consumed during the period/year under report.
4. Balance available as on I I
5. Quantity (in cycles) required
6. Instructions for supply if any.
7. Any other remarks.
It is important that the medical institution/hospital and other peripheral centres should
normally have a stock of oral pills for 6-8 weeks depending upon their monthly consumption. It
may be noted that the oral contraceptive pills have no expiry date. However, they should be stored
by the acceptor with due care. The acceptor should also store the packet of pills carefully in her
home and at such a place where children have no access
7.2
Management Information System
This is one of the most important components for the growth of oral pill acceptors in the
National Family Welfare Programme. The working of the oral contraceptive programme should be
monitored effectively for the reporting of information in time and regularity by the concerned
peripheral centres etc. The following records of acceptors in the register for the users of oral ppills
may be maintained at the peripheral centres for reporting of information in the prescribed proforma
from time to time.
Register for Users of Oral Pills
1. Serial No.
2. Name of the oral pill acceptor
3. Age of the acceptor (in years)
4. Residential/Home Address
5. Quantity of oral pill supplied (in cycles)
6. Date of commencement of oral pills
7. Follow up record
8. Cumulative number of cycles of oral pills supplied
from 1.4. To the date under report
9. Remarks
Discontinued
Reasons
No. Of cycles of use
7.3
Monthly Statistical Returns/Rcports
With a view to monitor and evaluate the working of the oral contraceptive pill programme
it is essential that the peripheral centres should report information regularly to the concerned District
Family Welfare Officer for consolidation as per proforma given at Annexure VI. He would further
be sending the consolidated monthly report for the entire district to the State Family Welfare
Officer, who in turn would be compiling the information for all the districts in the state for onward
transmission to the Government of India for evaluation and feed back to the Statc/UT Government
with comments/views for further improvement in the reporting system of information.
The peripheral centres are required to submit their monthly reports on the working of the
Oral Contraceptive Programme to the District Family Welfare Officer through the concerned
authority.
The District Health Family Welfare Officer may send the information to the State Family
Welfare Officer. Regular and timely reporting is an indicator for the efficient runnning of this
programme and as such it is desirable that State Family Welfare Officer should ensure the
submission of monthly progress report on oral contraceptive pill programme within 20 days after
the close of the month.
ANNEXURE1
Other Brands of Oral Pills
Preparation
1. Low Dose Pil
. Oval L
. Primovlar 30
. Novelon
Progestogen
Ostrogen
L Norgestrel 0.15 mg
L Norgestrel 0.25 mg
Desogestrel 0.15 mg
Ethinyl Estradiol 0.03 mg
Ethinyl Estradiol 0.03 mg
Ethinyl Estradiol 0.03 mg
2. Standard Dose Pills
. Ovral
. Lyndiol
Norgestrel 0.25 mg
Lynestrenoi 1.0 mg
Ethinyl Estradiol 0.05 mg
Ethinyl Estradiol 0.05 mg
3. Triphasic Pill
. Triquilar
6 Tablets
5 Tablets
10 Tablets
Norgestrel 0.050 mg
Norgestrel 0.075 mg
Norgestrel 0.125 mg
Ethinyl Estradiol 0.03 mg
Ethinyl Estradiol 0.04 mg
Ethinyl Estradiol 0.03 mg
ANNEXURE II
Check List for Selection of Oral Pill Acceptors
History/Examination
I. Age more than 40 years
2. Smoker t- Age more than 35 years
3. Taking Oral Contraceptive continuously over 5 years
4. Pregnancy
5. Nursing a baby less than 6 months
6. H/o Jaundice within past 6 months
7, H/o Jaundice during pregnancy
8. H/o Migraine
9. H/o Stroke
10. H/o Thromoboembolism
11. H/o Fits
12. Abnormal vaginal bleeding - intermenstrual/Post Coital
13. H/o Amenorrhoea/Oligomenorrhoea
14. H/o Taking Drugs - see Annexure V.
15. Gross Obesity
16. Hypertension
17. Jaundice
18. Dyspnoea
19. Oedema over legs
20. Severe varicosities
21. Lump in breast
22. CVS - abnormality
23. Liver - enlarged/tender
24. Sugar in urine
25. Hb below 8 gm
No
Yes
ANNEXURE - III
Check List
Fill the following check list before selecting an acceptor for oral pill.
If any of them is positive, then she should be referred to medical officer.
Yes
No
1. Age above 40 years
2. Smoker aged above 35 years
3. Taking Oral Pills continuously for more than 5 years
4. Pregnancy
5. Lactating less than 6 months
6. Complaint of prolonged/frequent headache
7. Visual disturbances
8. Breathlessness on exertion
9. Fits
10. Persistent/frequent attacks of pain in abdomen
11. Irregular vaginal bleeding
12. History of taking drugs
13. Repeated skin rashes
14. Gross malnutrition
15. Gross obesity
16. Yellow skin and conjunctiva (Jaundice)
17. Pulse rate above 120/min
18. Oedema of extremities
19. Lump in breast
20. Sugar in urine - Diabetes
21. Albumin in urine
If the above are answered in negative, except No. 2.She may be selected for oral
contraceptive. If any of the above, except 2, are answered in positive the patient must be seen by
a physician before oral contraceptive is prescribed.
Patient with history of toxaemia of pregnancy should not be put on oral pill.
ANNEXURE- IV
Management of Side Effects
Side Effect
Action
Management
. Nausea
Exclude pregnancy and
Other causes (e.g.
Hepatitis).
Instruct to take the pill at bedtime
. Weight gain
Enquire about diet and
exercise.
Advise proper nutrition and exercise.
Assure her that pills have only slight
effect on weight.
. Spotting/
Breakthrough
bleeding
Exclude gynaecological
problem by doingP/S,
P/V examination
Reassure
I f unacceptable . Pills containing 50 ugm Ethinyl
Estradiol or Triphasic pill may be
tried for 3 cycles
. Return back to low dose pills
. Acne
Enquire about cleaning
face, use of face creams
Advise cleaning the face
Stop using face creams
Pills containing 50 ugm Ethinyl
estradiol may be tried.
. Hypertension
. Check B.P. after rest
for 15 minutes
. Weekly record for 3
visits
. Discontinue if B.P. above 190 mm
Systolic /110 mm diastolic.
. Discontinue ifB.P. above 160 mm
systolic/90 mm diastolic.
Amenorrhoea
Ensure regular intake
Exclude pregnancy
. Continue for 2 cycles
. Discontinue if 2 periods are missed
. For persistence of amenorrhoea
even after discontinuation of pills,
Investigate for secondary
amenorrhoea
. Use of pills containing 50 ugm Ethinyl
estradiol may be tried.
Headache
Depression
Worsening on pills
Worsening on pills
Discontinue
Discontinue
ANNEXURE- V
Drugs Reducing Efficacy of Pills
Antibiotics
Anticonvulsants
Antifungal
. Rifampicin
. Barbiturates
(Phenobarbitone)
. Griseofulvin
. Sulfonamides
. Carbamezapine (Tegretol)
. Cephalosporins
. Phenytoin (Dilantin)
. Metronidazole
Efficacy of Drugs Affected by Pills
Drug
1. Phenytoin
2. Aminophyline/
Theophylline
3. Tricyclin antidepressants
4. Beta blocking agents
5. Diazepam
6. Antidiabetic agents
7. Methyl Dopa
Effect
Increased risk of toxicity
Increased risk of toxicity
1 ncreased effect
Increased effect
Increased effect
Decreased effect
Decreased effect
ANNEXURE VI
Monthly report of Pill Usage
1. Name of the Centre
2.
Number of New Users
3.
Continuing Users
< 3 months
4-6 months
6-12 months
13-24 months
25 -36 months
37 - 48 months
49 - 60 months
.> 60 months
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