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Marvelon A Combined Oral Contraceptive Pill containing Ethinylestradiol and Desogestrel | ||
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What is Marvelon?Marvelon is taken by mouth with the objective of preventing pregnancy. Each pack of Marvelon contains three strips of 21 tablets. There is also a 28 day pack with 7 blanks Marvelon ED Marvelon tablets are a type of hormonal contraception commonly known as
'the pill' or combined
oral contraceptive pill. Marvelon tablets contain ethinylestradiol and
Desogestrel. They are synthetic versions of the naturally occurring female sex
hormones,
oestrogen and
progesterone. Ethinylestradiol (spelt ethinyloestradiol in the UK) is a
synthetic version of oestrogen and norethisterone is a synthetic form of
progesterone.
Marvelon Each Marvelon tablet contains the active ingredients Desogestrel 0.15mg and ethinylestradiol 30 micrograms. Marvelon is a monophasic pill - each tablet has the same dose of hormones in it. One tablet is taken every day for 21 days and you then have a seven day break from pill-taking. During your seven day break, the levels of the hormones in your blood drop, which results in a withdrawal bleed that is similar to your normal period. You start the next pack after the seven pill-free days are up, even if you are still bleeding. Marvelon is a third generation combined oral contraceptive pill. At one time, there was an view that there were increased risks with third generation pills but on the balance of evidence, it is now accepted that these pills may be offered as a first choice option. Related Medical Abstracts - Click on the paper title:-
In 1921 it was suggested that extracts from ovaries could be used as birth controls. Diosgenin was first extracted from the Mexican yam in 1941 and this continues to provide a source for the production of sex steroids including norethisterone (norethindrone in the USA) and progesterone (Progest progesterone and progestogen in PMS; progesterone replacement therapy) and Crinone (progesterone and progestogen in PMS). How popular are birth control pills?A birth control was first used in a clinical trial in 1956. The pill became available in the USA in 1960 and in the UK in 1961. By 1986, 95% of sexually active women in the UK under the age of 30 had used the combined birth control pill at some time and by 1991 almost half the women aged 20 years in the UK were taking it. A survey in 1995 found that 25% of the 13 million women in the UK aged 16-49 were currently using the combined birth control pill. The peak age group was 20-24 with 48% of all women and 70% of contraceptive users choosing this method. The use of the various methods of contraception varies from country to country. In Japan less than 2% of women use the combined birth control pill whereas in Holland 40% of sexually active women do so. Recommended Books:
The Pill and Other Forms of Hormonal Contraception (Facts) What are the benefits of Marvelon?Marvelon suppresses the natural hormone cycle providing:
The additional benefits include:
The four-weekly bleeds that occur whilst taking the combined birth control pill are not periods (menstruation) but withdrawal bleeds. Menstruation is a bleed that occurs each month spontaneously and not in women who are taking hormonal treatment such as the combined birth control pill. WWill Marvelon improve my periods?The majority of patients report reduced flow and less period pain. There are
occasional exceptions so that a few ladies with light periods find their
menstrual flow increased by the combined birth control pill. During early pill
cycles in particular there may be some breakthrough bleeding. Some women do not
have a withdrawal bleed during pill-free interval. If this happens for two
consecutive cycles a pregnancy test should be considered. Absence of the
withdrawal bleed is not detrimental to health. When Marvelon is discontinued,
the periods may take a few months to return to normal. Premenstrual syndrome is
less common whilst taking Marvelon although there may still be some symptoms for
the last few days of the cycle. Related Medical Abstracts - Click on the paper title:- Could Marvelon alter my libido?Relieved of the stress of possible unwanted pregnancy, some women report increased initiation of sexual activity. Others find their libido reduced, perhaps as there is some sub-conscious wish to have a child. If libido is reduced, vaginal discomfort due to infection should be excluded. Otherwise a change to a less progestogenic pill may help.
Related Medical Abstracts - Click on the paper title:- What are the risks of taking Marvelon?Thromboembolism (blood clots): The early combined oral contraceptive pills contained 150 mg of the oestrogen mestranol together with norethynodrel which is a progestogen. The first report of thromboembolism (a blood clot forming in a vein within the leg or pelvis and then travelling to the lungs) in association with Marvelon came soon after the combined oral contraceptive pills were introduced. The pharmaceutical industry has made enormous efforts to reduce the risks associated with the oral contraceptive pills whilst maintaining their contraceptive effectiveness. Essentially there have been two avenues that have been explored. Firstly, the amount of oestrogen in Marvelon has been reduced and secondly newer progestogens have been developed. The oestrogen in Marvelon reduces LH and FSH production and therefore suppresses follicular development and ovulation (Q 2.3). There has been concern that reducing the amount of oestrogen in the combined oral contraceptive pills could lead to contraceptive failure. Over the years it has been found that the lowest dose of oestrogen that remains effective is much lower than originally contemplated. The original 150 mg was reduced to 100mg then 50mg. The majority of pills prescribed today have less than 50mg of ethinyl oestradiol and two have just 20mg (Marvelon 20 – Parke Davis; Mercilon – Organon). At this level, the oestrogen content is only a little more than that found in hormone replacement therapy (HRT). HRT does not suppress follicular development or ovulation and it therefore follows that the 20mg oestrogen pills will be the minimum effective dose. Mortality risks/b> are negligible. Related Medical Abstracts - Click on the paper title:- What side effects could I have whilst taking Marvelon?The vast majority of patients taking Marvelon feel very well but, as with any medicine that has benefits, some minor side effects are occasionally reported. These include: These side effects usually settle within two or three months. What is the effect of birth pills on body weight?All of us are intermittently gaining or losing weight. IInevitably some patients find that they gain weight around the time of starting Marvelon but others observe a weight loss. In a personal computer search of the medical literature from 1966 to date I found exactly fifty papers (articles in medical journals) where weight change in relation to Marvelon had been studied. Related Medical Abstracts - Click on the paper title:- Will Marvelon increase my vaginal discharge?Cervical ectopy (erosion - cervical erosion) appears to be more common in women taking the combined oral contraceptive pill although the newer lower dose pill seem to cause this less frequently. Cervical ectopy only requires treatment if there are persistent significant symptoms after excluding other problems such as infection. Contrary to popular belief, there is no evidence that Marvelon increases the incidence of candida (thrush). Does Marvelon increase my chance of pelvic infections?There is no increase in the incidence of Candida infection in pill users. The incidence is the same as in women with intrauterine devices and those using no contraception. Bacterial infections that gain entry to the pelvis through the cervix are less common in pill users as the progestogen makes the cervical mucus thick. However, there is no protection against viruses or chlamydia. Related Medical Abstracts - Click on the paper title:-/p> What is the relationship between Marvelon and fibroids?Surprisingly, studies show that the combined oral contraceptive pill reduces
the chance of fibroid development. It is a surprise because both oestrogen and
progesterone are factors in fibroid development so fibroids shrink after the
menopause (HRT-Add-Back)).
The current presumption is that the total of these hormones provided by the
combined oral contraceptive pill in a month must be less than the natural
hormone output by the ovaries. Related Medical Abstracts - Click on the paper title:- Will Marvelon increase my blood pressure? |
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Figure 15.1
A study by the World Health Organisation (WHO) published in 1995 provided evidence that the newer pills with their lower oestrogen content are associated with lower incidence of thromboembolism than the earlier higher oestrogen dose pills. This study also brought attention to the relationship between the progestogen in the combined oral contraceptive pill and thromboembolism.
TThe combined oral contraceptive pill has slight adverse effects on the lipids (“fat” chemicals) in the blood and these changes are known risk factors for heart disease. Heart attacks before the menopause are rare. Studies of patients on the early high dose preparations of the combined oral contraceptive pill found a five-fold increase in the incidence of heart attacks. Further studies demonstrated that there are usually confounding (additional) factors contributing to the attacks. In particular, smoking increases the risks. With the more modern low dose pills the risks are probably lower. The latest evidence suggests that there is no increased risk of heart attacks for oral contraceptive users.
The current recommended advice is that smokers should discontinue the
combined oral contraceptive pill at the age of 35years. The best advice is that
smokers should stop smoking.
Related Medical Abstracts - Click on the paper title:-/p>
Strokes are uncommon in young women but there is a marginal statistical
increase in those who have taken the combined oral contraceptive pill. Strokes
may involve haemorrhage (bleeding) within the brain or reduced blood supply (ischaemia)
to part of the brain. In young women it is the bleed variety of stroke that is
the more common. One study in Europe found no significant increase in the chance
of the bleed variety of stroke in association with the combined oral
contraceptive pill. Smoking and high blood pressure are more important risk
factors and these confuse any analysis of the risks of the combined oral
contraceptive pill.
Related Medical Abstracts - Click on the paper title:-/p>
Many women find that their breasts are slightly larger when taking the combined oral contraceptive pill. Breast discomfort (mastalgia) may respond to vitamin B 6 (pyridoxine) 50 mg once or twice daily. Otherwise a change of pill should be considered. Should milk production occur (galactorrhoea) investigation of the prolactin hormone level is indicated (hyperprolactinaemia). Benign breast disease (Q 27.16) tends to improve when the combined oral contraceptive pill is taken.
A few women describe a little depression when taking the combined oral contraceptive pill. The pill does not cause severe depression. If a change of pill does not solve the problem, pyridoxine (Vitamin B6) 50mg daily may be beneficial but it can take up to two months to be effective.br>
Related Medical Abstracts - Click on the paper title:-
Several studies have provided convincing evidence that ovarian cancer is less
likely to occur in women who have taken the combined oral contraceptive pill.
Your risk of ovarian cancer is reduced by about 50% if you have taken the
combined oral contraceptive pill for at least five years. The protection
continues for about 15 to 20 years after you stop taking the combined oral
contraceptive pill. This protection appears to be independent of the brand of
pill used. It is likely that the combined oral contraceptive pill needs to have
been taken for a minimum of two years to achieve this protection. The incidence
of ovarian cancer seems to be falling and this is likely to be related to this
benefit of the combined oral contraceptive pill.
Related Medical Abstracts - Click on the paper title:-
Progesterone and progestogens protect against endometrial (lining of the
womb) cancer. The combined oral contraceptive pill provides progestogen for 21
days each month. Studies indicate a 40% reduction in the incidence of
endometrial cancer when the combined oral contraceptive pill has been taken for
more than five years. Protection continues for more than fifteen years after the
combined oral contraceptive pill is discontinued.
Related Medical Abstracts - Click on the paper title:-
Sexual activity and number of partners are the factors that have large impacts on the incidence of pre-malignant and malignant conditions of the cervix (neck of the womb - Q32.16). The sheath (condom) provides mechanical protection not only against pregnancy but also against sexually transmitted disease. It prevents transmission of the human papilloma virus believed to be responsible for cervical cancer. It may be that the early studies suggesting that the combined oral contraceptive pill increased the risk were only reflecting the prevention of transmission of the virus with the barrier method.
There has been a suggestion that the combined oral contraceptive pill may increase the chance of pre-malignant conditions of the cervix developing in women at risk but this remains an area of debate requiring more data. There is no reason to stop Marvelon if you have been found to have an abnormal smear test provided appropriate investigations and treatment are undertaken (Pap Test).
Related Medical Abstracts - Click on the paper title:-
This question is discussed in Q32.43.
The objective is to choose an effective pill, with the lowest side effects and the lowest possible hormone content. A pill with 30 or 35mg ethinyl oestradiol is now the usual first choice. A 50mg pill may be recommended for women on some anti-epileptic drugs (Q16.20).
If a friend has recommended her brand of pill to you there is unlikely to be a reason why you should not try it. Similarly, if you are about to recommence oral contraception and have been happy with one preparation in the past, it would seem reasonable for you to try it again.
Medical opinion varies as to how often patients on the combined oral contraceptive pill should be checked.
At your first visit the doctor will need to review your medical history and to undertake a general and pelvic examination.
A further review will be undertaken about three months later to ensure that the chosen pill is acceptable.
Many family planning clinics have specialist nurses to undertake some of these routine assessments.
The blood pressure is checked at each subsequent visit to the clinic, which will probably be at three to six monthly intervals. A persistent blood pressure of 160/100mm Hg or more would be an indication to stop the combined oral contraceptive pill and to consider medication to reduce your blood pressure.
Pelvic examination and cervical smears every three years are probably ade quate unless you develop symptoms. More frequent monitoring may be indicated for those with risk factors.
Product information for oral contraceptives currently includes the recommendation that all women should have breast and pelvic examination before starting the combined oral contraceptive pill and at regular intervals whilst taking it.
The Committee on Safety of Medicines and the Faculty of Family Planning and Reproductive Health Care in the UK now believe that it is unnecessary for all women taking the combined oral contraceptive pill to have routine breast and pelvic examinations either before or whilst taking the combined oral contraceptive pill.
Blood pressure should always be measured but other physical examination should only be performed if considered appropriate by the clinician.
Thromboembolism may occur during immobilisation particularly after a major operation. If your relative had a thromboembolism in such circumstances we would not anticipate that you are at increased risk.
Some families have disorders of the blood clotting mechanism, which predisposes them to thrombosis (thrombophilia). If several of your relatives have been affected, particularly when the blood clots have occurred spontaneously without an obvious cause, we would need to consider thrombophilia. There are blood tests that may detect these abnormalities but they are extremely expensive. In these circumstances, it may be appropriate to seek advice from a haematologist (blood disorder specialist).
Modern commercial aeroplanes are pressurised. The increased risks of venous and arterial thrombosis associated with high altitude are therefore eliminated.
There have been reports of circulatory complications after a flight but this is e qually true for those not taking the combined oral contraceptive pill. Underlying dehydration, following sunbathing, alcohol or a gastro-intestinal upset increases the risk.
Many airline stewardesses take the combined oral contraceptive pill. They know the importance of ensuring ade quate fluid intake and they will take a little walk every hour or so to keep their circulation going.
It has been suggested that Aspirin 75mg daily should be considered before the flight and for a few days afterwards.
There is one concern about flights for women taking Marvelon particularly if they are travelling West as they may inadvertently take a pill late. It may be prudent to keep one watch set at the time of your home and use this to guide you on when you should be taking your pills.
Yes, there are times when a patient has medical problems such that the combined oral contraceptive pill can be prescribed but only with special caution. More careful monitoring is required. Examples are:
Varicose vein problems are not a contraindication for Marvelon. Varicose veins are more frequently found in association with obesity and this would be a reason for caution. The pill should be stopped if you need injection treatment.
When a woman has a medical problem that may be affected by Marvelon, the doctors involved in her care will usually liaise to ensure consistency of advice. Ultimately it is for the doctors caring for the woman to provide her with the information that she requires to make an informed choice.
The more common contraindications to Marvelon include:-
Nowadays, we recommend that it should be started on thefirst day of a period as this provides immediate contraceptive cover. The next period will occur after 23 days but subsequent periods will be at 28 day intervals.
Following childbirth, the combined pill can be taken if the baby is not being breast-fed; breast feeding combined with progestogen-only pills provides excellent contraception. During pregnancy and for the first two weeks after childbirth there is an increased risk of thromboembolism (blood clot problems - surgery risks) and this may be further increased by Marvelon (Q15.14).
If periods are absent or infrequent, and this problem has been appropriately investigated (Q6.6), a course of progestogen tablets will usually provide a withdrawal bleed and Marvelon can be commenced on the first day of bleeding.
Marvelon is likely to reduce the quantity and quality of your milk which will contain a relatively large amount of hormones. If oral contraception is required the combination of a progestogen-only pill with breast-feeding will provide highly effective contraception for you.
This means that the amenorrhoea may recur and fertility medication may be required if a pregnancy is planned.
Absence of periods (amenorrhoea) needs to be investigated (Q6.6). Provided that both pregnancy and a problem requiring treatment have been excluded, amenorrhoea is not a contraindication to Marvelon.
A withdrawal bleed ('period' whilst taking Marvelon) does not have to occur with every pill-free interval.
Provided you have taken Marvelon correctly, a pregnancy is very unlikely.
If you do not see a withdrawal bleed it usually means that the lining of your womb is not building up sufficiently to result in a bleed. This reflects the way that the womb is responding to the combined oral contraceptive pill and does not indicate what will happen when Marvelon is stopped if you wish to have a baby.
From the medical point of view there is no reason to change Marvelon if the problem continues and there is no need to run any tests.
If you are unhappy that you do not see a withdrawal bleed, a different pill may suit you better. One of the phasic pills could be tried if you are on a monophasic variety
A girl of 13 had extremely heavy and painful periods which were controlled for two years with a monophasic pill (Microgynon). At the age of sixteen she returned to my clinic as she kept missing withdrawal bleeds. She had not started sexual activity but was worried that she would lose her fertility. We reassured her that medically there was no anxiety. After discussion she was started on a phasic pill (Trinovum) and withdrawal bleeds occurred.
Some women find that when they stop the combined oral contraceptive pill they do not see their periods. Until twenty years ago this was called 'post-pill amenorrhoea'. Research then showed that, with few exceptions, patients with amenorrhoea after discontinuing the combined oral contraceptive pill had infrequent or absent periods before they commenced the combined oral contraceptive pill. The pill had simply masked an underlying problem and was not the cause.
The simplest guide is that the current combined oral contraceptive pill should be taken until the course is completed and the new pill should commence on the first day of the withdrawal bleed; no additional contraception is required but the first cycle on the new pill will be just 23 days.
The first course of action is to check that there is no cause for the bleeding other than Marvelon preparation. A missed pill, antibiotics or gastro-intestinal upset may have occurred. There may be a local cause such as vaginitis (inflammation of the vagina), a cervical polyp (cervical polyps) or other cervical disease. These can be assessed by medical examination. A bleed early in pregnancy can be mistaken for break-through bleeding.
Light breakthrough bleeding may be acceptable for perhaps three months and is likely to settle. Otherwise a change of pill preparation is appropriate. If the oestrogen content is very low increasing this may be the first line of approach. Increasing the progestogen content (Table 16.1) or changing from a monophasic to a bi-phasic or tri-phasic pill (Table 16. 2) are other possible remedies.
If a pill packet is commenced on a Sunday, the withdrawal bleed should occur on weekdays. When starting Marvelon for the first time, if you delay to the next Sunday rather than commence on the first day of the period, additional contraception is required for the first seven days. For those on monophasic pills (Table 16.1) who wish to convert to a Sunday start, it is probably best to take two packets back-to-back and then finish the second packet on the Saturday. The third packet is commenced on the following Sunday. The other option would be to continue taking Marvelon from a spare pack until the next Sunday. This spare packet can be kept in reserve for similar cycle adjustments when required.
From the medical point of view, there is no benefit in having the gap, and if you are taking a fixed, rather than a phasic pill, you can take Marvelon back-to-back without pill free days. This may avoid a bleed during a social event or a vacation.
The bleed that occurs during the gap we call a withdrawal bleed and not a period. The pharmaceutical companies produce the packaging with the combined oral contraceptive pill-free interval as women understandably feel that it is normal to have a monthly bleed. The only real advantage is that it provides an indication that there is no pregnancy. The phasic pills do not readily lend themselves to a pill-free interval although your doctor can usually provide appropriate advice (Q16.2)
If a pill is missed less than seven days before the combined oral contraceptive pill-free interval, Marvelon-free interval should be avoided (Q16.18).
The pill-free interval can be avoided for social convenience such as a vacation.
Some women have cyclical symptoms around the time of the combined oral contraceptive pill-free interval. If there are problems with headaches, heavy or painful periods the combined oral contraceptive pill can be taken back-to-back. We generally recommend three packets at a time leading to a withdrawal bleed every ten weeks. Marvelon is a treatment option for endometriosis and we may recommend avoiding the combined oral contraceptive pill-free interval for several months (21).
Related Medical Abstracts - Click on the paper title:-
If a pill is taken more than 12 hours late we regard it as missed. The missed pill can be taken and the course continued at the appropriate time. Additional precautions (usually condoms) should be used for the next seven days. If there are less than seven pills remaining in the course, the next packet should be commenced without a seven-day gap; if you are on an ED (every day) regimen, the seven inactive pills should be omitted. The risks of pregnancy are highest when the missed pill is at the beginning or end of a cycle.
There are few failures associated with the combined oral contraceptive pill provided that the combined oral contraceptive pill has been taken correctly.
Ideally, Marvelon should be taken at the same time each day.
There is a maximum safety limit of 12 hours.
If Marvelon is taken more than 12 hours late additional precautions are essential (Q16.18). The seven pill-free days allow the natural hormone cycle to begin.
If the gap is inadvertently increased, ovulation (egg release) can occur and pregnancy may ensue.
During a gastro-intestinal upset (vomiting or severe diarrhoea) Marvelon may not be absorbed and additional precautions are required. The additional precautions should be continued for at least seven days after the bowel has settled. Similarly, some antibiotics reduce the absorption of the combined oral contraceptive pill and the same precautions would apply.
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 Marvelon.
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.
The short answer is no.
At one time it was thought that the combined oral contraceptive pill could cause 'post-pill amenorrhoea (absent periods after stopping the combined oral contraceptive pill - birth control pill) and this was associated with anovulatory (failure of egg release) infertility. Subsequent studies showed that those who developed post-pill amenorrhoea had similar cycle problems before commencing the combined oral contraceptive pill. The pill was not the cause but it had been masking the underlying problem.
It seems likely that, if anything, the combined oral contraceptive pill may conserve fertility by reducing the incidence of pelvic inflammatory disease (Q 20.2) and endometriosis (Q9.11). Pregnancy termination (abortion), which should be prevented by Marvelon, can have complications leading to infertility (Q19.14).
Modern contraceptive methods are extremely effective. There is a danger that
one can assume that when Marvelon is discontinued a pregnancy will occur
quickly. With increasing age, fertility decreases if you want a child, you
should not leave it too long (Q9.6).
Related Medical Abstracts - Click on the paper title:- There is no medical advantage in taking a break from Marvelon. All too
frequently, an unplanned pregnancy will occur. The concept that the combined
oral contraceptive pill should only be taken for five or ten years at a time is
based in mythology.
One of the potential complications following an operation is a blood clot in
one of the veins in the legs or pelvis (surgery
risks) and we surgeons try to reduce the risk as far as possible. As the combined pill is also associated with a tiny risk of blood clot
problems (Q15.14)
we need to consider whether Marvelon should be stopped before we operate. Ideally, Marvelon should be discontinued four weeks before major surgery or
any operation on the legs. The pill can be recommenced on the first day of
the next period provided that this occurs at least 14 days after the
operation. If there is need for a major operation when Marvelon has not been
discontinued, your surgeon may recommend injections of heparin for a few days to
thin the blood a little. There is no reason to discontinue Marvelon for minor operations or
intermediate operations such aslaparoscopy. There is no recommendation to stop progestogen-only pills or other
progestogen contraception for surgery.
The official recommendation for women with no risk factors is that there is
no upper age limit for taking the combined oral contraceptive pill. Women who smoke should stop Marvelon by the age of 35 years as they are at
increased risk of heart disease. The best medical advice is to stop smoking. As we get older the risks of heart disease increase and fertility falls. If
you are taking the combined pill and wish to continue with oral contraception,
it is probably advisable to change to a progestogen-only pill at the age of 50.
The pill does not change the time of the menopause. Each egg appears to
behave as if it has a timer which determines when it will go into an active
phase (Q
2.3). If the hormone environment is not appropriate, the active phase is cut
short and that egg fails to develop. One of the important ways that Marvelon
works is that it creates a hormone environment that prevents further development
of the eggs that are going into the active phase. The pill does not stop eggs
from going into the early active phase (otherwise the menopause would be delayed
in pill users).
As you approach the age of 50 there is an increasing chance that you will be
reaching your menopause but withdrawal bleeds will continue for however long the
combined oral contraceptive pill is taken. There is no test that can absolutely
define when the menopause has occurred even for a woman who is not taking the
combined oral contraceptive pill and seems to have stopped her periods although
a blood test for FSH and oestradiol levels (Q
26.14) can be a useful guide. If you want to know if you are likely to have
reached your menopause, the blood test should be scheduled for the last day of
the combined oral contraceptive pill-free interval. Related Medical Abstracts - Click on the paper title:- The pill should be discontinued and urgent medical advice sought if any of
the following occur:-
Many women experience mild symptoms that are a nuisance or inconvenience
although they are not damaging to their general health. Many of these symptoms occur frequently amongst non-pill takers so the
combined oral contraceptive pill may not be responsible. Anxiety that the
combined oral contraceptive pill may be causing major problems frequently leads
the patient back to her doctor. The more common symptoms include
After checking that all is well, your doctor will probably only need to
reassure you. frequent change of pill prescription is rarely indicated.
Migraine involves a headache with visual disturbance. If severe migraine
starts, Marvelon should be stopped immediately and not recommenced. The
progestogen-only pill is not contraindicated. If mild migraine occurs, Marvelon
should be stopped but it may be tried again later with careful monitoring and
advice from your doctor. Headaches by themselves are not a contraindication to Marvelon. If they occur
around the time of the combined oral contraceptive pill-free interval, the
combined oral contraceptive pill may be taken for nine weeks without a break
before a pill-free interval reducing the symptom from 13 to 5 times each year.
Varicose veins are not a contraindication against taking Marvelon.
If you have taken a pill within two hours and you do not think that another
will stay down, you should recommence Marvelon as soon as possible and use
additional contraception until seven days after the vomiting has settled. The
pill should be continued rather than omitted for the seven pill free days if
they would occur during this time. Mild to moderate diarrhoea does not interfere
with pill absorption.
There is no evidence of any increased risk of abnormality for the baby in
women who conceive soon after stopping the combined oral contraceptive pill. The
underlying risk of congenital abnormality (a structural defect of one or more
parts of the body present at birth) is 2% of all babies. Even when pregnancy
occurs accidentally in women taking the combined oral contraceptive pill, the
risk of congenital abnormality is not increased above this 2% level. At one time, one of the most common problems facing obstetricians was
determination of the duration of pregnancy.
There is some evidence that folic acid supplementation reduces the risk
of the spina bifida group of defects when taken before pregnancy and for a
few weeks after conception. We now recommend folic acid supplements to all
women contemplating pregnancy. Taking breaks from Marvelon.
Surgery and Marvelon.
Until what age can I take Marvelon?
Marvelon and the menopause.
I am taking Marvelon. How will I know if I have reached my menopause?
In what circumstances should Marvelon be stopped immediately?
What symptoms are commonly associated with taking the oral contraceptive pill?
Should Marvelon be discontinued if I develop headaches?
Varicose veins and Marvelon.
Vomiting and diarrhoea. How does this affect my oral contraceptive pill taking?
Starting a pregnancy - When should I stop taking Marvelon?
