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Contraception - Management
How should I advise a woman taking combined oral contraceptives (COCs) about surgery and immobilization?
- Stop the combined oral contraceptive (COC) 4 weeks before any major surgery, surgery to the legs, or surgery with prolonged immobilization of a lower limb.
- If emergency surgery or immobilization (e.g. fractured leg) is necessary, the COC should be stopped and treatment to prevent thromboembolism should be given.
- Advise the use of another method of contraception that will minimize the risk for venous thromboembolism.
- No precautions are necessary for minor surgery where the duration of anaesthesia and immobilization is short (e.g. laparoscopic sterilization, varicose vein surgery, and tooth extraction).
- The COC should normally be recommenced at the first menses occurring at least 2 weeks after full mobilization.
- To restart the COC, take the COC on day 1 of the first menstrual period that occurs at least 2 weeks after full mobilization. If the woman has used a progestogen-only injectable in the interim, the COC can be restarted before the next injection would be due.
In depth
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