Can combined oral contraceptive pills interact with other medication?

Some medications, such as those used in the treatment of epilepsy, increase the rate that the liver breaks down chemicals including the oestrogen and progestogen in the combined oral contraceptive pill. Rifampicin, used for a short course for those at risk of meningococcal meningitis, is so powerful at speeding up chemical breakdown pathways that although given for only 2 days, its effects may last for 4 weeks; additional contraceptive precautions are advisable to cover this. Rifampicin may also be prescribed for several months during treatment of tuberculosis. This may make the lower dose pills in particular less effective and breakthrough bleeding more likely. Higher dose pills (e.g. 50mg ethinyl oestradiol), in these circumstances, achieve similar hormone levels to lower dose pills taken by women not taking the anti-epileptic treatment.

Some broad-spectrum antibiotics (effective against a wide variety of bacteria) can reduce the absorption of oestrogen. Break-through bleeding may occur if the hormone levels fall below a threshold. For those on long-term broad spectrum antibiotics (e.g. For treatment of acne) the bacteria in the intestine become resistant to the antibiotic and after the first two weeks there is no need for additional contraception.

The combined oral contraceptive pills may interfere with treatment for diabetes, depression and high blood pressure; appropriate adjustments may be required.

Please click on the required question.

Q16. 1 What are the different types of combined oral contraceptive pills?

Q16. 1a What is the new Evra Patch?

Q16. 2 What are the benefits and problems of the phasic pills?

Q16. 3 How will my doctor help me to decide which is likely to be the best pill for me?

Q16. 4 Whilst I am taking the combined oral contraceptive pill, what monitoring should I receive?

Q16. 5 A member of my family has a history of a deep venous thrombosis (DVT) or pulmonary embolism (thromboembolism). Should I have a screening blood test?

Q16. 6 Does an aeroplane journey increase the risks of taking the combined oral contraceptive pill?

Q16. 7 Are there times when the combined oral contraceptive pill should be prescribed only with special caution?

Q16. 8 Are there any contraindications to taking the combined oral contraceptive pill?

Q16. 9 On which day of my menstrual cycle should I start my first course of the combined oral contraceptive pill?

Q16. 10 Can I start the combined oral contraceptive pill whilst I am breast-feeding?

Q16. 11 Can I take the combined oral contraceptive pill if I have had episodes when I did not see my periods (amenorrhoea)

Q16. 12 Can I start the combined oral contraceptive pill if I am not currently seeing my periods?

Q16. 13 Does it matter if I do not see a period whilst taking the combined oral contraceptive pill?

Q16. 14 What is the advice when my changing pill preparation?

Q16. 15 What should be done if breakthrough bleeding occurs whilst I am taking the combined oral contraceptive pill?

Q16. 16 Can my pill withdrawal bleed be planned to avoid weekends?

Q16. 17 Can I take the combined oral contraceptive pill without a seven-day pill-free gap?

Q16. 18 What should be done if a pill is missed?

Q16. 19 Could I conceive whilst I am taking the combined oral contraceptive pill?

Q16. 20 Can combined oral contraceptive pills interact with other medication?

Q16. 21 I am taking the combined oral contraceptive pill. Will this reduce my future fertility?

Q16. 22 I have been on the combined oral contraceptive pill for sometime. Is there any need to take a break from it?

Q16. 23 I am due to have an operation. Should I stop taking my pill?

Q16. 24 What is the advice with regard to third generation combined oral contraceptive pills?

Q16. 25 Until what age can I take the combined oral contraceptive pill?

Q16. 26 I have taken the combined oral contraceptive pill. Will this change the time when I will go through the menopause?

Q16. 27 I am taking the combined oral contraceptive pill. How will I know if I have reached my menopause?

Q16. 28 In what circumstances should the combined oral contraceptive pill be stopped immediately?

Q16. 29 What symptoms are commonly associated with taking the oral contraceptive pill?

Q16. 30 Should the combined oral contraceptive pill be discontinued if I develop headaches?

Q16. 31 If I have varicose veins can I take the combined oral contraceptive pill?

Q16. 32 I have developed vomiting and diarrhoea. How does this affect my pill taking?

Q16. 33 How long before starting a pregnancy should I stop taking the combined oral contraceptive pill?

Q16. 34 Family Planning Support Groups.

Q16. 35 Support Groups.

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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London.

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