Clinical Case Studies Week 4 (Contraception) Flashcards
What are enzyme inducing drugs that decrease the effectivness of hormonal contraceptives?
the antiepileptics carbamazepine, oxcarbazepine, perampanel (at doses of more than 8 mg daily), phenobarbital (phenobarbitone), phenytoin, primidone and topiramate (at any dose)
some antiretrovirals used to treat HIV—see the University of Liverpool (UK) HIV Drug Interactions
the antibiotics rifampicin and rifabutin
some complementary medicines (eg St John’s wort)
other drugs (eg aprepitant, modafinil).
Hormonal contraception is traditionally started at the beginning of the next normal menstrual period (within the first 5 days of the menstrual cycle) to avoid the risk that the individual is already pregnant. It also avoids the need for an additional method of contraception for the first 7 days, because hormonal contraception is immediately effective if started at this time.
True or False
True
When to use depot medroxyprogesterone injection?
Safe to use (UKMEC 2) immediately postpartum and during breastfeeding. It can be a useful option for those awaiting IUD insertion after delivery.
When to use progestogen only pills?
Progestogen-only pills (POPs) are commonly prescribed for individuals who are breastfeeding because they do not increase the risk of VTE (unlike combined hormonal contraception). However, the requirement to take the POP within a narrow 3-hour window each day can be challenging at this busy stage of life. The POP can be started immediately after delivery.
When to use combined hormonal contraception?
COC or contraceptive vaginal ring) can generally be used from 6 weeks postpartum, even if breastfeeding. It does not adversely affect breastmilk or neonatal growth when used from 6 weeks.
What age not to use depot medroxyprogesterone injection?
Although depot medroxyprogesterone injection can be used (UKMEC 2) in individuals aged 45 to 49 years, it is generally not started in this age group. It is not recommended for individuals older than 45 years who have cardiovascular risk factors because it has an adverse effect on lipids. It is also associated with a loss of bone mineral density, which may not be regained before the drop in bone mineral density associated with menopause
All combined oral contraceptives (COCs) increase sex hormone–binding globulin and lower serum androgen concentrations, which may reduce acne.
true or false
true
The etonogestrel implant and levonorgestrel-releasing and copper IUDs provide effective contraception in individuals with obesity.
true or false
true
COCs take 7 days to work at other times if not started on day 1 to 5 of a regular menstrual cycle.
True or false
Missed COC
A COC is not considered missed until it is more than 24 hours late. The ‘riskiest’ time to miss a pill is in the first 7 days after the hormone-free interval (inactive pills), when the chance of breakthrough ovulation is highest.
When is COC contraindicated?
Combined hormonal contraception is contraindicated (UKMEC 4) in individuals 35 years or older who smoke 15 or more cigarettes per day
In smokers who have additional risk factors for cardiovascular disease (eg obesity, diabetes, age older than 45 years), use of depot medroxyprogesterone requires expert judgment or referral (UKMEC 3); all other contraceptives except for combined hormonal methods are considered safe.
In smokers who have additional risk factors for cardiovascular disease (eg obesity, diabetes, age older than 45 years), use of depot medroxyprogesterone requires expert judgment or referral (UKMEC 3); all other contraceptives except for combined hormonal methods are considered safe.
Progesterone only pill takes how long to work?
In smokers who have additional risk factors for cardiovascular disease (eg obesity, diabetes, age older than 45 years), use of depot medroxyprogesterone requires expert judgment or referral (UKMEC 3); all other contraceptives except for combined hormonal methods are considered safe.
>immediately effective if started on day 1 to 5 of regular menstrual cycle
Disadvantage of POP?
time the pill is taken each day must not vary by more than 3 hours to ensure effectiveness; therefore, unsuitable if unintended pregnancy would pose medical or psychological harm
Methods of EC?
copper intrauterine contraceptive device (IUD): prevents fertilisation and implantation
>The copper IUD is the most effective method of emergency contraception.
ulipristal or levonorgestrel (oral emergency contraception): prevent or delay ovulation.
Copper IUD for emergency contraception?
The copper intrauterine contraceptive device (IUD) is 99% effective for emergency contraception. It can be inserted up to 5 days (120 hours) after unprotected sexual intercourse
copper IUD is recommended particularly if the individual:
is taking drugs that induce liver enzymes
has a body mass index (BMI) more than 30 kg/m2 or weighs more than 85 kg
wants ongoing contraception with the copper IUD.
