COCP Flashcards
What is Qlaira?
Estradiol Valerate plus Dienogest
26/2 regime
1st two tablets and last 2 tablets are E only
2 other tablet types one with 3mg and one with 2mg of dienogest.
Can you QS Qlaira?
Yes 9 days condoms
It is only effective immediately if D1
What are missed pill rules Qlaira?
> 12 hours is missed pill
take it asap
D25-28 are only days no need extra contraception for 9 days
25 26 are E only 27 28 are placebo
If D18-24 discard pack and start new one
What is point of Qlaira?
better lipid profile, less metabolic impact ? may be better for older/risk cvs
however cycle control is similar to low dose E pills, as is efficacy. 20% will not have withdrawal.
What is the deal with lamotrigine and CHC?
HFI toxicity
CHC reduced seizure contro
Risks could outweigh benefits
Which CHC may have reduced efficacy with increased weight?
Patch > 90kg
Which Cancers does CHC reduce?
Ever use: Ovarian, Endometrial (persists many years) and colorectal
CHC and arterial disease?
current users increased risk but still very uncommon
avoid in those with significant RF
Breast cancer and CHC?
small increased risk reduces with time
Cervical Ca and CHC?
5+ years use increased risk reduces with time and normal after 10 years
What is first line COC and why?
< or = 30mcgEE with LNG or NET (VTE)
Altitude rules?
> 7 days >4500m consider switch
What does 50mcg mestranol equate to?
35mcg EE
What is different about 17B-estradiol?
structure identical to that occurring naturally in humans ? better metabolic profile
What are progestogens?
synthetic steroids designed to have some of properties of progesterone
allow for convenient dosing/potent suppression ovulation/ET
newer ones designed to be less androgenic less glucocorticoid but seem to have increased VTE
What generation is NET?
1st
What generation is LNG?
2nd
What generation are desogestrel gestodene norgestimate
3rd
Etonogestrel is metabolite of desogestrel (ring)
Norelgestromin is metabolite of norgestimate (patch)
What generation are drospirenone dienogest nomegestrol acetate?
4th
What is in the patch?
Norelgestormin and EE
releases 33.9 mcg EE and 203mcg P over 24 hrs
one patch one week
What is in the ring?
etonogestrel and EE
15mcg
one ring 21 days
How do you advise women with very short of variable cycles when starting pill?
<20 days d1 only or 7 days condoms
Switch one CHC to another when effective?
Immed
Switch NET to CHC when effective?
7 days to suppress ovulation
Mucus effect may be maintained however no evidence
DSG/injection/implant when cocp effective if switch?
All suppress ovulation so long as used properly CHC effective immediately as suppression maintained
When is CHC effective if switch from IUS?
7 days. If sex last 7 days leave coil in for 7 days before remove.
What to do if enzyme inducers and wants to continue COC?
20+30mcg
Continuous or extended with short HFI
Exceptionally 70mcg but ??dvt etc
Note not with rifampicin or rifabutin too potent
If short term could use condoms additionally to standard cocp
How many hours within will pill not be absorbed if vomiting or diarrhoea?
Vomit < 3 hours after taking
Severe Diarrhoea > 24 hrs
Follow missed pill rules
When is a coc a missed pill?
> 24 hrs
Most risk ovulation if extend HFI by missing pills either side HFI
What is increase risk VTE with CHC?
3-3.5 times but absolute risk small and lower than preg or post natal
5-12/10,000 pill
2/10,000 no pill
Type of P affects as dose higher dose EE
Conflicting evidence re ctp/cvr…?? Cvr higher risk
Dianette for contraception only?
No due to higher DVT risk
What is Zoely?
24/4 estradiol nomegestrol
How many days do you have to restart pill after HFI?
8 days since last active pill
If > or = 9 days and upsi consider EC
If 1 missed pill anytime in cycle do you need EC?
No
As long as correct earlier pill use
If after HFI must have started pack on time
If 2-7 pills missed week 1?
Consider EC if upsi
If 2-7 pills week 2-3?
No need EC
But omit HFI if leading into
7 days condoms
How many days to restart ring?
Up to 8 days. If 8 completed days or more it’s a late start. Ie 7 days condoms and consider EC if upsi
If ring removed less than 48hrs do you need EC?
No-and no condoms needed (like one missed pill)
If ring removed 48+ hours?
Same as if missed 2+ pills….
If in week 1 consider EC if upsi but any other time no need EC if correct use but 7/7 condoms
If leave same ring in week 3-4 any action needed?
No-this is HFI
If leave same one in up to 5 weeks EC not needed
5+ weeks EC if sex during week 5+ omit HFI and PT/condoms
condoms 7 days if 4+ weeks
What are rules re restarting patch? When is late? When do you need EC?
Same as ring. 8+ completed days consider EC if upsi
What is rules if leave a patch on up to 48hrs post change day? Or detach up to 48hrs?
Like one missed pill. As long as restarted after HFI correct day no EC at any time in cycle needed no additional contraception
If patch detatch or continued use more than 48 hrs what to advise?
Week 1- EC if UPSI
Any other week if correct use 7 days prior no EC
Condoms 7 days
Why difference in days to restart after HFI?
Cocp is not late unless 9+ days
CVR/CTP is 8+days
Difference is due to fact with patch/ring HFI is considered to start immediately on removal
Eg mon 9am have until wed 9am to start by if pill but Tues 9am if ring or patch.
