Starting Dose of Contraception for a 43-Year-Old Female Taking Zopiclone and Lorazepam
For a 43-year-old female taking Zopiclone 7.5 mg and lorazepam 1 mg BID, a combined hormonal contraceptive (CHC) starting with a monophasic pill containing 30-35 μg of ethinyl estradiol is recommended as there are no significant drug interactions with these medications.
Contraceptive Options and Considerations
Combined Hormonal Contraceptives (CHCs)
- Many experts recommend starting with a monophasic pill containing 30-35 μg of ethinyl estradiol and a progestin such as levonorgestrel or norgestimate for women without contraindications 1
- CHCs can be started at any time if it is reasonably certain that the woman is not pregnant 1
- If started >5 days after menses began, she should abstain from sexual intercourse or use barrier methods (e.g., condoms) for 7 days 1
- Blood pressure measurement should be performed before initiation 1
Medication Interactions
- Neither zopiclone (Imovane) nor lorazepam have clinically significant interactions with hormonal contraceptives that would affect contraceptive efficacy 1
- Psychotropic medications, including benzodiazepines like lorazepam, are classified as Category 1 (no restriction on method use) for all contraceptive methods 1
- While some benzodiazepines may have altered pharmacokinetics with oral contraceptives, these changes are not clinically significant enough to affect the dosing of either medication 2
Age-Related Considerations
- At 43 years old, all contraceptive methods are considered U.S. Medical Eligibility Criteria category 1 or 2 (no restriction, or advantages generally outweigh theoretical or proven risks) based on age alone 1
- Women approaching menopause should continue contraception until menopause or at least until 50-55 years of age 1
- The noncontraceptive benefits of CHCs include decreased menstrual cramping, reduced blood loss, and protection against endometrial and ovarian cancers 1
Administration Guidelines
Starting the Method
- CHCs can be initiated immediately (same-day start) if reasonably certain the woman is not pregnant 1
- If starting >5 days after menses began, use backup contraception for 7 days 1
- Take one pill at approximately the same time each day 1
Missed Pill Management
- If one pill is missed (<24 hours late): Take the missed pill as soon as possible and continue regular schedule 1
- If two or more consecutive pills are missed (>48 hours late): Take the most recent missed pill immediately, continue taking remaining pills as scheduled, and use backup contraception for 7 days 1
- If pills were missed in the last week of hormonal pills: Omit the hormone-free interval and start a new pack immediately 1
Monitoring and Follow-up
- Blood pressure should be measured before initiation 1
- No pelvic exam is required to prescribe oral contraceptive medications 1
- Follow-up to assess tolerance and address any side effects is recommended
Potential Side Effects and Management
- Breakthrough bleeding: If it occurs, NSAIDs for 5-7 days may help manage this common side effect 1
- Nausea: Taking the pill with food or at bedtime may reduce this symptom 1
- Headaches: Evaluate pattern and severity; migraine with aura would be a contraindication 1
Alternative Options
- If CHCs are not desired or contraindicated, other options include:
- Progestin-only pills (POPs): Can be started at any time; if >5 days after menses started, use backup contraception for 2 days (norethindrone/norgestrel) or 7 days (drospirenone) 1
- Long-acting reversible contraception: Such as intrauterine devices or implants 1
- Vaginal ring: Releases 15 μg ethinyl estradiol and 120 μg etonogestrel; provides comparable efficacy with simpler regimen 1