1 Contraceptives Flashcards
MOA of combined oral contraceptives
Suppression of ovulation; cervical mucus thickening; endometrial thinning
0.1-0.3% per 100 women years
Failure rate of COC
Reasons for failure rate of COC
Poor compliance, reduced absorption, increased metabolism
Reduced incidence of these things on COC
Carcinoma of ovary, carcinoma of endometrium, benign breast disease, benign ovarian cysts, fibroids, ectopic pregnancy, pelvic infection.
Side effects of COC
Weight gain, acne, not good for bones in long term use.
Increase in VTE risk on COC
3-4x (but normal risk only 7 in 100,000)
Lamotrigine
The levels of this are reduced by the CHC, so, in the pill free week the symptoms worsen and fit control worsens. Sodium valproate is okay to use.
Levonelle
Levonorgestrel
ellaOne
Ulipristal acetate. Selective progesterone receptor modulator
After levonelle, need to use condoms for…
2 days for POP
7 days for COC
9 days Qlaira
After ellaOne, need to use condoms for…
9 days for POP
14 days for CHC
16 days Qlaira
After emergency contraception do not use (2)
IUS or dianette
Copper coil MOA
Inhibits fertilisation due to direct toxicity.
<1%
Failure rate of copper coil
300mm2, preferably 380mm2
How much copper should be in the copper coil if using it for long term use
The Fraser guidelines
1 understands the advice 2 cannot be persuaded to inform rents 3 likely to online having UPSI 4 if she does not receive treatment her physical/mental health will suffer 5 in is in her best interests
20%
Percentage of women who become amenorrhoeic on cerazette
DMPA
Depot medoxyprogesterone acetate injection. Aqueous suspension 150mg/ml given every 12 weeks. Most common
NET EN
Norethisterone Oenanthate, known as noristerat. Oily 200mg given every 8 weeks. Rarely used
Guidance for DMPA use
In adolenscense, use only 1st line if other methods unsuitable or unacceptable. All women re-evaluate risks/benefits at 2 years. in women with lifestyle and/or medical risk factors for osteoporosis consider other methods
Norplant
Subdermal implant in 1993, no longer available
Implanon
Subdermal implant from 1999.
Nexplanon
Almost 100% effect implant.
Mirena
Levonorgestrel Intra Uterine System
30-50%
% of women who get breakthrough bleeding in first few months of starting oral contraceptives
Nuva-ring
Medium acting contraceptive.
Evra
20cm2 transdermal patch.
Zoely
Nornegestal acetate/estradiol.
The 2008 white paper on pharmacy services in England states that pharmacies should be involved in:
promotion/access condoms Sexual Heath prescribing/PGDs Advice&EHC STI awareness raising Chlamydia testing Supply contraceptive pill
18-29
Age group when most unplanned pregnancies occur
90%
Percentage of teenage pregnancies in England that are unplanned
Potential barrier method failure
Due to: condom rupture, dislodgement or misuse, incorrect insertion of diaphragm/cap, removed too early, torn or dislodges during intercourse
Potential IUD failure
Complete or partial expulsion, mid cycle removal
Qlaira
A COC which has a complex quadraphasic dosage regime designed to provide optimal cycle control. It has a continuous 28 day cycle with 26 active and 2 placebo tablets. It has different missed pill rules to other COCs. A pill is considered to be missed if taken more than 12 hours late. If this missed pill is in days 1-24 of the cycle, additional precautions are required for 9 days.
MOA of EHC if taken after ovulation has occurred
affects the motility of the fallopian tube to prevent the sperm meeting the ovum, it affects the patency of the endometrium to proven implantation
16 years
Minimum age for P supply of levonelle
18
Minimum (licensed) age for POM supply of elleOne
Methods of contraception ok if on enzyme inducing drugs
POP, copper bearing IUDs or the levonrgestrel containing IUS
Short term EID
On this, should have CHC with at least 30mcg EE, and use addition contraception. Use tricycling regime
Long term EID
on this, should have CHC with at least 50mcg EE and use tricycling regimen. Increase if bleeding.
Breakthrough bleeding indicated…
low serum EE concentrations. If other causes, e.g. chlamydia have been excluded, the dose of EE can be increased up to a max of 70mcg
3mg levonelle within 120 hours (unlicensed). Not UPA
EC treatment for people on EID
After UPSI and EC do preg test….
No sooner than three weeks after
IUD is made of
Copper
Qlaira pill is late if over
12 hours
Qlaira what to do for missed pill
1-17: take pill & use extra con(9 days)
18-24: start new pack & use extra(9 days)
25-26: take pill, no extra
27-28: placebo
elective surgery (with immobility) suggest…
COC discontinue 4 weeks prior/ use LMWH
POP is fine
emergency surgery suggest…
LMWH & stockings
Stop COC if long period of immobility
past history of DVT suggest…
CuIUD (UKMEC1)
POP/IUS (UKMEC 2)
Circumstaces where you consider referring a woman requesting EC for IUD?
All
History of migraine suggest…
POP
Risk to the foetus with EC?
Levonelle - no risk
EllaOne - unknown
IUD - risk ectopic preg
Contraceptives reduced by EI
COC, POP, patches, vag rings
EI will effect for what time frame
while taking and until 4 weeks after
Tricycling means
3 packs on the trot followed by 4 day PFI
