Starting the pill
The Five key questions to ask before starting someone on the Combined Oral Contraceptive:
Have you got any history of cardiovascular events?
This is their own history and family history. Ask about stroke, MI, hypertension, and DVT. Say words like clots and blood pressure. If they have had these, they should probably go on something else, but either way you must make clear their increased risk. If its family history of DVT, do a thrombophilia screen.
Have you just been pregnant?
You shouldn't go on the pill until a month after birth. There is a lot of talk about three weeks after, but generally the best guidance is: use condoms for the first month, and then go on the pill. However, make sure you also ask: are you breast feeding? Because if so, the pill's a no...
Do you get headaches?
If you have a history of migraine, the evidence says that the risks of getting more headaches outweigh the benefits of the pill.
Are you a fat old smoker?
- BMI more than 30 - you are at an increased risk of CV events
- Old and smoker - more risk than benefit
Are you on antibiotics?
Antibiotics - will render the pill ineffective. Use condoms with these!