What is the perioperative management of oral contraceptives?

Updated: Jan 09, 2018
  • Author: Nafisa K Kuwajerwala, MD; Chief Editor: William A Schwer, MD  more...
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Answer

Answer

Patients taking oral contraceptives have an increased risk of postoperative venous thromboembolism because of the combined effects of hormones and the hypercoagulable state, which accompanies surgical stress and postoperative immobility. Controversy focuses on whether to stop or continue combined oral contraceptive pills (OCPs).

The recommendation of the British National Formulary and manufacturers of combined OCPs is that for major surgeries, the patient should switch to alternative contraceptive methods 4-6 weeks prior to surgery and then restart OCPs after the first menses occurs at least 2 weeks after regaining full mobility following surgery. Other groups suggest that insufficient evidence is available to recommend interrupting the routine schedule for elective major procedures and that this places the patient at risk of unwanted pregnancy. Thus, the patient is faced with a choice of continuing combined OCPs and receiving thromboprophylaxis in the perioperative period (ie, subcutaneous LMWH and graduated elastic compression stockings) or stopping the pill 4-6 weeks prior to surgery and using another form of contraception (eg, a progesterone-only pill).

In case of unprotected intercourse during this period, pregnancy must be excluded before the operation.


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