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A - MSRA Gynaecology [8] > [25] Contraception - Combined Hormonal > Flashcards

[25] Contraception - Combined Hormonal Flashcards

1
Q

What does hormonal contraction use?

A

The female steroid hormones oestrogen and progesterone

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2
Q

Is hormonal contraception effective?

A

Yes, is very effective way of preventing pregnancy

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3
Q

What can hormonal contraception be split into?

A
  • Combined methods

- Progesterone-only

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4
Q

What do combined methods of hormonal contraception contain?

A

Oestrogen and progesterone

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5
Q

What is the primary action of combined hormonal contraception?

A

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

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6
Q

What are the additional actions of progesterone in combined hormonal contraception?

A
  • Inhibits proliferation of endometrium, creating unfavourable conditions for implantation
  • Increases thickness of cervical mucus, preventing passage of sperm
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7
Q

How is a period free of hormones achieved in combined hormonal contraceptives?

A

The patient takes a pill-free break or takes placebos

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8
Q

What does the period free of hormones cause when using combined hormonal contraceptives?

A

A fall in hormone levels, which leads to degeneration of the endometrium and menstrual bleeding

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9
Q

What is the failure rate of combined hormonal contraceptives with perfect use?

A

0.3%

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10
Q

What is the typical failure rate of combined hormonal contraceptives?

A

9%

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11
Q

What is the combined oral contraceptive pill (COCP) commonly called?

A

The pill

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12
Q

What does the COCP contain?

A

Oestrogen and progesterone

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13
Q

How many tablets are there in a packet of the COCP?

A

Either 21 or 28

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14
Q

What is the regime of COCP with a packet containing 21 tablets?

A

Taken consecutively for 21 days, and then a 7-day break when no pills are taken

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15
Q

What is the regime of COCP with a packet containing 28 tablets?

A

The pills are taken non-stop, and there is no break before starting the next packet

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16
Q

What are the types of COCP?

A
  • Monophasic

- Phasic

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17
Q

What is meant by monophonic COCP?

A

Every pill contains the same levels of oestrogen and progesterone

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18
Q

What is meant by phasic COCP?

A

Levels of oestrogen and progesterone in the pills changes throughout the cycle

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19
Q

Other than monophonic and phasic, how can the hormone levels vary between different pills?

A

Can have varying levels of oestrogen

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20
Q

What is classified as a ‘low oestrogen’ COCP?

A

Contains 20µg of ethinylestradiol

21
Q

What is more common, monophasic or phasic?

A

Monophasic

22
Q

Give 2 examples of monophasic COCPs?

A
  • Microgynon 30

- Brevinor

23
Q

Is microgynon 30 and brevinor given in 21 or 28 tablet packs?

A

21

24
Q

What are the types of phasic COCPs?

A
  • Biphasic
  • Triphasic
  • Quadriphasic
25
Q

What is very important when the patient is taking phasic COCP?

A

They take them in the correct order

26
Q

Give 2 examples of phasic COCPs

A
  • Qlaria

- Binovum

27
Q

What kind of COCP is Qlaria?

A

Quadriphasic

28
Q

Is Qlaria given in 21 or 28 tablet packs?

A

28

29
Q

How many active pills are there in a pack of Qlaria?

A

26 (2 inactive)

30
Q

What kind of COCP is Binovum?

A

Biphasic

31
Q

Is Binovum given in 21 or 28 tablet packs?

A

21

32
Q

What is the contraceptive patch?

A

A small 5x5cm patch that can be stuck onto the body to prevent pregnancy

33
Q

Where can the contraceptive patch be stuck?

A
  • Upper arm
  • Abdomen
  • Buttock
  • Back
34
Q

What is the brand of contraceptive patch used in the UK called?

A

Ortho Evra

35
Q

How often should the contraceptive patch be changed?

A

Every 7 days over a period of 3 weeks (21 days)

36
Q

What should happen after the patient has worn the contraceptive patch for 21 days?

A

It should be removed for 7 patch-free days

37
Q

What will happen when the contraceptive patch is withdrawn?

A

The patient will usually experience a withdrawal bleed

38
Q

How sticky is the contraceptive patch?

A

Extremely lol

39
Q

Can the contraceptive patch be worn whilst bathing or swimming?

A

Yes

40
Q

What is the brand name for the contraceptive vaginal ring?

A

NuvaRing

41
Q

What is the contraceptive vaginal ring?

A

A plastic ring that is inserted into the vagina and provides hormones

42
Q

How long is does the contraceptive vaginal ring sit in the vagina once inserted?

A

21 days

43
Q

When might women feel discomfort with the contraceptive vaginal ring?

A

Some women feel uncomfortable inserting or removing the ring

44
Q

What are the advantages of combined hormonal contraception?

A
  • 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
45
Q

What medical conditions does combined hormonal contraception reduce the risk of?

A
  • Cancer of the ovary, uterus, and colon

- Functional ovarian cysts

46
Q

What is an additional clinical use of combined hormonal contraception?

A

Can allow for timing over menses

47
Q

What are the disadvantages of combined hormonal contraception?

A
  • 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
48
Q

What temporary adverse effects may be experienced with combined hormonal contraception?

A
  • Headaches
  • Breast tenderness
  • Mood changes
49
Q

What are the contraindications to combined hormonal contraception?

A
  • 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

A - MSRA Gynaecology [8] (52 decks)

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