As usual, I am not suited for this profession and I did quite badly again. The drug I got was progestrone only OC so I never prepared at all about the estrogen. And tadaa.. patient told me that she was initially on combined OC so what the switch was for? I was like "Ow crap!". The actual answer was that estrogen reduced breast milk (and this patient was lactating). I would never ever thought of that because based on the info I found out, progesterone caused breast milk reduction too!! I was thinking about some severe adverse effects but could not think of any so I just said I didn't know. Bleah..
I also don't know that when someone is breastfeeding, there will be no menses.. Neither I know that full-time and part-time breastfeeding also differ. Gosh.. I told the patient to start taking on first day of the next period and I was stunned when she said "I have no period". I thought she was pregnant again!! Bleah.. Then she asked me "then why are you giving me OC? are you sure this is the correct drug for me??". Alamaks.. completely gone case..
Oh well.. at least I learnt a few new things:
- breastfeeding causes menses to stop.. and lactation amenorrhea is some sort of "natural contraceptive" a.k.a you won't get pregnant (no need OC) if full-time lactating
- estrogen causes less breast milk.. so if need OC while breastfeeding, use progesterone only
- if have DVT/embolism/etc, estrogen is a big no no... still can choose some progesterone carefully
- progesterone alone is quite lousy as it only provides 40% protection