[25] Contraception - Combined Hormonal Flashcards
What does hormonal contraction use?
The female steroid hormones oestrogen and progesterone
Is hormonal contraception effective?
Yes, is very effective way of preventing pregnancy
What can hormonal contraception be split into?
- Combined methods
- Progesterone-only
What do combined methods of hormonal contraception contain?
Oestrogen and progesterone
What is the primary action of combined hormonal contraception?
Inhibits ovulation due to the negative feedback effect of the oestrogen and progesterone on the hypothalamic-pituitary axis. This prevents the surge in LH, thus preventing ovulation
What are the additional actions of progesterone in combined hormonal contraception?
- Inhibits proliferation of endometrium, creating unfavourable conditions for implantation
- Increases thickness of cervical mucus, preventing passage of sperm
How is a period free of hormones achieved in combined hormonal contraceptives?
The patient takes a pill-free break or takes placebos
What does the period free of hormones cause when using combined hormonal contraceptives?
A fall in hormone levels, which leads to degeneration of the endometrium and menstrual bleeding
What is the failure rate of combined hormonal contraceptives with perfect use?
0.3%
What is the typical failure rate of combined hormonal contraceptives?
9%
What is the combined oral contraceptive pill (COCP) commonly called?
The pill
What does the COCP contain?
Oestrogen and progesterone
How many tablets are there in a packet of the COCP?
Either 21 or 28
What is the regime of COCP with a packet containing 21 tablets?
Taken consecutively for 21 days, and then a 7-day break when no pills are taken
What is the regime of COCP with a packet containing 28 tablets?
The pills are taken non-stop, and there is no break before starting the next packet
What are the types of COCP?
- Monophasic
- Phasic
What is meant by monophonic COCP?
Every pill contains the same levels of oestrogen and progesterone
What is meant by phasic COCP?
Levels of oestrogen and progesterone in the pills changes throughout the cycle
Other than monophonic and phasic, how can the hormone levels vary between different pills?
Can have varying levels of oestrogen
What is classified as a ‘low oestrogen’ COCP?
Contains 20µg of ethinylestradiol
What is more common, monophasic or phasic?
Monophasic
Give 2 examples of monophasic COCPs?
- Microgynon 30
- Brevinor
Is microgynon 30 and brevinor given in 21 or 28 tablet packs?
21
What are the types of phasic COCPs?
- Biphasic
- Triphasic
- Quadriphasic
What is very important when the patient is taking phasic COCP?
They take them in the correct order
Give 2 examples of phasic COCPs
- Qlaria
- Binovum
What kind of COCP is Qlaria?
Quadriphasic
Is Qlaria given in 21 or 28 tablet packs?
28
How many active pills are there in a pack of Qlaria?
26 (2 inactive)
What kind of COCP is Binovum?
Biphasic
Is Binovum given in 21 or 28 tablet packs?
21
What is the contraceptive patch?
A small 5x5cm patch that can be stuck onto the body to prevent pregnancy
Where can the contraceptive patch be stuck?
- Upper arm
- Abdomen
- Buttock
- Back
What is the brand of contraceptive patch used in the UK called?
Ortho Evra
How often should the contraceptive patch be changed?
Every 7 days over a period of 3 weeks (21 days)
What should happen after the patient has worn the contraceptive patch for 21 days?
It should be removed for 7 patch-free days
What will happen when the contraceptive patch is withdrawn?
The patient will usually experience a withdrawal bleed
How sticky is the contraceptive patch?
Extremely lol
Can the contraceptive patch be worn whilst bathing or swimming?
Yes
What is the brand name for the contraceptive vaginal ring?
NuvaRing
What is the contraceptive vaginal ring?
A plastic ring that is inserted into the vagina and provides hormones
How long is does the contraceptive vaginal ring sit in the vagina once inserted?
21 days
When might women feel discomfort with the contraceptive vaginal ring?
Some women feel uncomfortable inserting or removing the ring
What are the advantages of combined hormonal contraception?
- Non-invasive
- More effective than barrier methods if taken correctly
- Sex doesn’t need to be interrupted to use contraception
- Menses tend to become regular, lighter, and less painful
- Reduced risk of certain medical conditions
- Normal fertility returns immediately after stopping use
What medical conditions does combined hormonal contraception reduce the risk of?
- Cancer of the ovary, uterus, and colon
- Functional ovarian cysts
What is an additional clinical use of combined hormonal contraception?
Can allow for timing over menses
What are the disadvantages of combined hormonal contraception?
- User dependant
- Some temporary adverse effects may be experienced by some women
- Women may experience breakthrough bleeding and spotting for first few months
- Increased risk of VTE
- Small increase in risk of MI and strokes
- Small increase in risk of breast cancer
What temporary adverse effects may be experienced with combined hormonal contraception?
- Headaches
- Breast tenderness
- Mood changes
What are the contraindications to combined hormonal contraception?
- BMI over 35
- Breastfeeding
- Smoking over the age of 35
- Hypertension
- History or family history of VTE
- Prolonged immobility due to surgery or disability
- Diabetes mellitus with complications, e.g. retinopathy
- History of migraines with aura
- Breast cancer or primary liver tumours
