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A - MSRA Gynaecology [8] > [26] Contraception - Progesterone Only > Flashcards

[26] Contraception - Progesterone Only Flashcards

1
Q

What does progesterone only hormonal contraception use?

A

The female steroid hormone progesterone

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2
Q

What is the failure rate of progesterone only contraceptives with perfect use?

A

0.3%

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3
Q

What is the typical failure rate of progesterone only contraceptives?

A

9%

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4
Q

What are the different types of progesterone only contraceptives?

A
  • Pill (POCP)
  • Implant
  • Injection
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5
Q

What are the types of POCP currently available in the UK?

A
  • Femulen
  • Norgeston
  • Noriday
  • Micronor
  • Cerazette
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6
Q

What is the primary mechanism of action of POCP?

A

Thicken cervical mucus due to high levels of progesterone, which prevents the entry of sperm and therefore fertilisation of the oocyte

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7
Q

What are the secondary mechanisms of POCP?

A
  • Suppression of ovulation (to varying degrees)

- Thinning of endometrium, inhibiting implantation

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8
Q

What does the degree to which the POCP suppresses ovulation vary based on?

A

The form of progesterone given

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9
Q

What are the advantages of the POCP?

A
  • More effective than barrier methods when taken correctly
  • Sex doesn’t need to be interrupted to use contraception
  • Can be used in many patients for whom the COCP is contraindicated
  • May reduce risk of endometrial cancer
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10
Q

What are the disadvantages of the POCP?

A
  • User dependant, and has to be taken at same time every day
  • Can produce irregular menstruation or amenorrhoea
  • Some adverse effects
  • Increased risk of ovarian cysts
  • Small increased risk of breast cancer
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11
Q

What proportion of women taking the POCP experience irregular mensuration?

A

4 in 10

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12
Q

What proportion of women taking the POCP experience amenorrhoea?

A

2 in 10

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13
Q

What are the adverse effects of POCP?

A
  • Headaches
  • Breast tenderness
  • Skin changes
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14
Q

By how much does POCP increase risk of ovarian cysts?

A

30%

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15
Q

What are the contraindications to POCP?

A
  • Current or past history of breast cancer
  • Liver cirrhosis or tumours
  • Stroke or coronary heart disease
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16
Q

In whom does the POCP have a lower efficacy?

A

Women over 70kg

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17
Q

What is the brand name for the progesterone only implant linseed for use in the UK?

A

Nexplanon

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18
Q

What is the progesterone only implant?

A

A small, flexible tube about 40mm long that is inserted into the upper arm

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19
Q

What does the progesterone only implant contain?

A

68mg steroidal progestin

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20
Q

How long does the progesterone only implant last?

A

3 years

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21
Q

What is the failure rate of the progesterone only implant with perfect use?

A

0.05%

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22
Q

What is the typical failure rate of the progesterone only implant?

A

0.05%

23
Q

What is the main mechanism of action of the progesterone only implant?

A

Inhibition of ovulation

24
Q

What are the additional mechanisms of action of the progesterone only implant?

A
  • Causes thinking of cervical mucus, which inhibits the passage of sperm
  • Causes thinning of endometrium, preventing implantation if the egg were fertilised
25
Q

What are the advantages of the progesterone only implant?

A
  • Extremely effective
  • Can be used in some women for whom the COCP is contraindicated
  • Users don’t have to think about contraception for 3 years
  • Can be used when breastfeeding
  • Normal fertility returns as soon as implant is removed
  • Effective in woman of all BMIs
  • May reduce risk of endometrial cancer
26
Q

What is recommended in women using the progesterone only implant with a high BMI?

A

Earlier replacement

27
Q

What are the disadvantages of the progesterone only implant?

A
  • About 50% of women experience changes in menstrual bleeding
  • Fitting and removing the implant may cause pain, bruising, and irritation
  • Small increased risk of breast cancer
  • Implant can break or bend in situ
28
Q

Are bleeding patterns likely to remain irregular if a woman with the progesterone only implant experiences changes in menstrual bleeding?

A

Yes

29
Q

What are the contraindications to the progesterone only implant?

A
  • Pregnancy
  • Unexplained vaginal bleeding
  • Liver cirrhosis or tumours
  • History of breast cancer
  • Stroke or transient ischaemic attacks whilst using implant
30
Q

What is the progesterone only injectable contraceptive?

A

A long lasting contraception where synthetic progesterone is slowly release into the systemic circulation

31
Q

How does the progesterone only injectable contraceptive administered?

A

IM or IV

32
Q

What are the currently available progesterone only injectable contraceptive in the UK?

A
  • Depo-Provera
  • SAYANA PRESS
  • Noristerat
33
Q

What is the most commonly used progesterone only injectable contraceptive in the UK?

A

Depo-Provera

34
Q

Is Depo-Provera licensed for long-term use?

A

Yes

35
Q

How often is Depo-Provera given?

A

Every 12 weeks

36
Q

How is Depo-Provera administered?

A

IM injection

37
Q

Is SAYANA PRESS licensed for long-term use?

A

Yes

38
Q

How often is SAYANA PRESS given?

A

Every 13 weeks

39
Q

Is Noristerat licensed for long term use?

A

No, only 2 sets of injections

40
Q

How often is Noristerat given?

A

Every 8 weeks

41
Q

How is Noristerat administered?

A

Deep IM injection

42
Q

What is the failure rate of the progesterone only injectable contraceptive with perfect use?

A

0.2%

43
Q

What is the typical failure rate of the progesterone only injectable contraceptive?

A

6%

44
Q

What is the mechanism of action of progesterone only injectable contraceptive?

A
  • Inhibition of ovulation
  • Thickening of cervical mucus
  • Thinning of endometrium, making it unfavourable for implantation if fertilisation was to occur
45
Q

What are the advantages of progesterone only injectable contraceptive?

A
  • Very effective
  • Users don’t have to think about contraception for as long as the injection lasts
  • No known interactions with any drugs
  • Can be used when hormonal contraceptives are not recommended, such as in women with migraine or who are breastfeeding
  • Can be used in women <35
  • May reduce risk of endometrial cancer
46
Q

What are the disadvantages of progesterone only injectable contraceptive?

A
  • Not rapidly reversible
  • Up to 50% of women stop using within a year
  • Increase in body weight
  • May be slightly increased risk of breast cancer
  • Loss of bone mineral density with long-term use
47
Q

How long does it take for fertility to return with progesterone only injectable contraceptive?

A

Up to a year

48
Q

How long does it take for menstruation to return to normal with progesterone only injectable contraceptive?

A

Several months

49
Q

Why do 50% of women stop using the progesterone only injectable contraceptive within a year?

A

Due to altered bleeding patterns, including persistent bleeding

50
Q

How much can body weight increase with progesterone only injectable contraceptive?

A

2-3kg/year

51
Q

What constitutes long term use with progesterone only injectable contraceptive?

A

Over a year

52
Q

Does the loss of bone mineral density with progesterone only injectable contraceptive increase the risk of fracture?

A

No evidence for this

53
Q

What are the contraindications to progesterone only injectable contraceptive?

A
  • Breast cancer within past 5 years, or currently
  • History of severe arterial disease or very high risk factors
  • Pregnancy
  • Diabetes with any vascular disease, e.g. retinopathy
  • People who will want to return to fertility in the near future

A - MSRA Gynaecology [8] (52 decks)

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