Paper II
2025 March (Supplementary (SAY)) (2019 Scheme) · 100 marks · 180 min

Question

Contra indications and drug interactions of oral contraceptive pills.

Q134 marksShort Answers

Answer

Contraindications

  • Smokers over 35 years (markedly elevated thromboembolic/cardiovascular risk)
  • History of venous thromboembolism, stroke, or ischemic heart disease
  • Migraine with aura (elevated stroke risk)
  • Uncontrolled hypertension
  • Known or suspected breast cancer (estrogen-sensitive malignancy)
  • Active liver disease
  • Pregnancy

Drug interactions

  • Enzyme inducers (Rifampicin, Phenytoin, Carbamazepine) — accelerate estrogen/progestin metabolism, reducing contraceptive efficacy and risking breakthrough pregnancy.
  • Broad-spectrum antibiotics — can reduce enterohepatic recirculation of estrogen (via disruption of gut flora that normally deconjugate and allow reabsorption of the hormone), theoretically reducing efficacy, though this effect is more historically emphasized than robustly evidenced for most antibiotics.
  • Anticoagulants (Warfarin) — OCP-associated changes in clotting factor synthesis can alter anticoagulant response, requiring closer INR monitoring.
  • Increased risk with other pro-thrombotic drugs — additive thromboembolism risk when combined with other agents that independently increase clotting tendency.

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