Should a woman discontinue the combined oral contraceptive pill (OCP) prior to elective surgery?
Yes. It is prudent to recommend that combined OCP users discontinue use at least four weeks before any surgery which is likely to be followed by a sustained period of reduced activity or immobilization, or before surgery for a malignancy. Combined OCP users who undergo major emergency surgery should discontinue use of combined OCPs and receive prophylactic peri-operative anti-coagulant therapy using subcutaneous heparin. At the same time, it is important to substitute a reliable form of contraception (e.g. a progestin-only method) when oral contraception is withdrawn. When the use of a reliable alternative contraceptive method is doubtful in a given situation, the risk of unintended pregnancy may exceed the risk of venus thombo-embolism. In such circumstances continuation of the combined OCP with addition of peri-operative anticoagulation may be more appropriate. Clinical judgment is important with documentation of the rationale for making an exception in an individual woman.
