|Ethinyl oestradiol||50 micrograms|
|1.||Start by taking the white tablet in the circle on the package on the first day of your menstrual cycle (i.e. the day bleeding commences).|
|2.||Take one white tablet each day immediately after the evening meal or at bedtime, as nearly as possible at the same time each day for 21 days, following the arrows until all 21 white tablets are finished.|
|3.||Then start taking one red coloured tablet each day (again following the arrows) until all the red tablets are finished.|
|4.||On the following day start a new package taking the first white tablet in the circle to commence the next course.|
|1.||The incidence of diseases of the circulatory system in women using combined oral contraceptives is significantly greater than those of controls, and the mortality is slightly increased. Coronary thrombosis, cerebrovascular accidents, myocardial infarction and venous thrombosis are more likely to occur in smokers over the age of 35 years and nonsmokers over the age of 40, particularly if they have used the contraceptive for longer than five years, if they are obese or if they are hypertensive. Additional risk factors are diabetes, hypercholesterolaemia and familial hyperlipoprotelinaemia. However, with the exception of women 35 years and older who smoke and nonsmokers 40 and older, the risk of mortality associated with all methods of birth control is less than that associated with childbirth. Since cigarette smoking increases the risk of serious side-effects, women who use oral contraceptives should be strongly advised not to smoke.|
|2.||Hypertension may occur in association with the use of oral contraceptives. Regular blood pressure checks, including a pretreatment level, are advisable.|
|3.||Prolonged amenorrhoea following the use of oral contraceptives may occur. The incidence is in the order of 1% of users. Caution is advised where oligomenorrhoea or amenorrhoea have occurred in the past.|
|4.||Mood changes, mass gain, skin pigmentation, ocular lesions, vaginal candidiasis, gall bladder disease, jaundice, gastrointestinal irritation and fluid retention may occur.|
|5.||Case reports have been published of benign hepatic tumours in women on oral contraceptives for a prolonged time, but a causal relationship has not been established.|
|The preparation should be discontinued if persistent upper abdominal pain develops.|
|6.||Interactions with other drugs and efficacy:|
|Oral contraceptive failure, may occur with concomitant antibiotic therapy. For maximal protection, additional non-hormonal contraception should be recommended for the duration of antibiotic therapy and for seven days afterwards.|
Those on long term antibiotic therapy need take only extra precautions for the first two weeks of antibiotic therapy.
Spotting and breakthrough bleeding are possible signs of diminished contraceptive effectiveness.
The efficacy of the contraceptive pill may be decreased when it is administered concomitantly with other drugs such as anti-epileptic agents (i.e. phenytoin and phenobarbital), rifampicin, phenylbutazone and ampicillin. With vomiting or diarrhoea, the absorption of oral contraceptives may be diminished and women should be advised to use additional methods of contraception at the time of such disorders.
|7.||Effects on laboratory tests:|
|Oral contraceptives may interfere with some laboratory estimations, in particular hormones, glucose tolerance, thyroid function, blood coagulation, serum triglycerides and liver function tests.|
|8.||Surgery or prolonged periods of immobilisation are more likely to be associated with an increased incidence of thrombotic side-effects. Oral contraceptives should be discontinued four weeks prior to elective surgery or during periods of immobilisation.|
|9.||Decreased glucose tolerance and increase in triglycerides and total phospholipids can be observed in patients on oral contraceptives. Diabetic and prediabetic patients should be monitored closely.|