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Y4 - GOSH > Combined Contraception & Consent > Flashcards

Combined Contraception & Consent Flashcards

1
Q

What are the 3 ‘Cs’ of under 16 consultations?

A
  • confidentiality
    • everything remains confidential unless there is a threat to their or another person’s wellbeing
  • consent
  • competence
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2
Q

How is the competence of a young person determined?

A

Fraser competence

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3
Q

What are the 5 key points involved in determining Fraser competence?

A

UPSIS (UnProtected Sex Is Silly)

  • the young person Understands the advice given
  • Parental involvement is encouraged (but not enforced)
  • the young person is likely to continue having Sexual intercourse
  • it is in their best Interest to supply contraception
  • their mental and physical health is likely to Suffer without contraception
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4
Q

When is sex in a young person deemed illegal and what is done?

A

sex under the age of 13 years is illegal

  • they are deemed incapable of consenting
  • this MUST be reported to authorities
    • could be police
    • could be safeguarding / social services if it is both young people involved
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5
Q

What guidelines are used to ensure contraception provision is safe?

A

UK MEC guidelines

  • give guidance on who can use which methods safely
(cautious use = risks generally outweigh the benefits / seek specialist advice)
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6
Q

What are the 3 different categories of contraception?

A

shorter acting contraceptive methods:

  • POP & COCP
  • combined contraceptive patch
  • combined contraceptive ring
  • barrier methods

longer acting contraceptive methods (LARC):

  • injectable methods (Depo Provera / Sayana Press)
  • subdermal implants (Nexplanon)
  • intrauterine devices (copper IUD & levonorgestrel IUS)

irreversible contraception:

  • male / female sterilisation
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7
Q

What contraceptive methods are the most effective against pregnancy?

A
  • the implant (Nexplanon) is the most effective method
  • this is followed by the IUS and then IUD
  • in general, LARCs have a much lower failure rate than other methods
    • they are less user dependent
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8
Q

What are the 3 options for combined contraception?

A
  • pills
  • patches
  • rings
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9
Q

What age is the COCP licensed for use up to?

A

up to 50 years

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10
Q

In what 3 ways does the COCP act to prevent pregnancy?

A
  • it prevents ovulation (primary mechanism of action)
  • progesterone thickens the cervical mucus
  • progesterone prevents proliferation of the endometrium, reducing the chance of successful implantation
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11
Q

How does the COCP prevent ovulation?

A
  • progesterone + oestrogen have a negative feedback mechanism on the anterior pituitary + hypothalamus
  • this suppresses release of GnRH, LH & FSH
  • without LH + FSH, ovulation cannot occur
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12
Q

How is the COCP typically taken?

How does this affect the lining of the uterus?

A
  • typically, pills are taken every day for 3 weeks** followed by a **pill-free week
  • the endometrium is maintained in a steady state whilst taking the COCP
  • during the pill-free week, the endometrium breaks down and sheds
  • this produces a withdrawal bleed
  • breakthrough bleeding can occur with extended use without a pill-free period
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13
Q

What is meant by “extended use” of the COCP?

A
  • a pill is taken every day continuously
  • at some point, spotting will occur
  • this is a breakthrough bleed that signals the endometrium needs to shed
  • stop taking the pills** when the **breakthrough bleed occurs
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14
Q

What is meant by “tricycling” of the COCP?

A
  • 3 packets of pills are taken back to back
  • this is followed by a withdrawal bleed
  • this results in around 4 bleeds a year and is usually done when someone has aggressive, heavy periods
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15
Q

On what day of the cycle should the COCP be started?

A
  • if it is started on day 1 - 5 of the cycle, it provides contraception immediately
  • if it is taken after day 5, condoms should be used for the initial 7 days
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16
Q

What advice is given to people about the length of the breakthrough bleed?

A
  • there is contraceptive cover whilst not taking the pill for 7 days
  • after 7 days, hormone levels will rise and there is a risk of ovulation
  • the breakthrough bleed should not be more than 7 days, and can be shorter than this
17
Q

When does a COCP count as missed?

A
  • there is a 24 hour window to take the pill
  • it only counts as missed if it is more than 24 hours late
18
Q

What advice is given if one pill is missed?

A
  • if 1 pill is taken > 24 hours late, take the pill and continue as normally
  • EC may be required if other pills were missed earlier in the pack or in last week of previous pack
19
Q

What advice is given if more than one pill is missed?

A
  • take the most recent missed pill and continue the others (even if multiple pills are taken on the same day)
  • use condoms for the next 7 days
  • EC** is required if there was UPSI in the **hormone-free interval** or **first week of pill
  • there is no need for EC in week 2
  • if missed in week 3, EC is not required but omit the hormone-free interval
20
Q

What are the 2 different types of COCP?

A

monophasic pills:

  • contain the same amount of hormone in each pill

multiphasic pills:

  • contain varying amounts of hormone to match the normal cyclical hormonal changes more closely
21
Q

How do different COCPs vary from each other?

A
  • they ALL** contain **ethinylestradiol (oestrogen)
  • they contain different amounts of ethinylestradiol
  • and they contain different types of progesterone
22
Q

What type of pills are everyday COCP formulations?

A

monophasic pills

  • the pack contains 7 inactive pills, which makes it easier for women to keep track as they can take 1 pill every day
23
Q

What are the 2 first line COCPs?

A

Microgynon:

  • contains ethinylestradiol and levonorgestrel

Loestrin:

  • contains ethinylestradiol and norethisterone
  • these are used first-line as they have a lower VTE risk
24
Q

What type of COCP is used first-line in premenstrual syndrome and why?

A
  • pills containing drospirenone (e.g. Yasmin)
  • drospirenon has anti-androgen + anti-mineralocorticoid activity
  • this reduces the symptoms of bloating, water retention + mood changes
  • pills should be taken continuously, opposed to cyclical use
25
Q

What type of COCP is used in the treatment of acne + hirsutism?

A
  • pills containing cyproterone acetate / co-cyprindiol (e.g. Dianette)
  • co-cyprindiol has anti-androgen effects
26
Q

What is the risk associated with use of pills containing cyproterone acetate?

A
  • there is a 1.5-2x greater risk of VTE compared to first-line pills
  • it should be stopped after 3 months once the acne is controlled
27
Q

What should women be told about bleeding when first starting the COCP?

A

unscheduled bleeding is common in the first 3 months after starting the pill

this should settle with time

28
Q

What are the side effects associated with the COCP?

A
  • breast pain / tenderness
  • mood changes / depression
  • headaches
  • hypertension
  • nausea
  • acne
  • increased risk of VTE
  • small increased risk of MI / stroke
29
Q

How does taking the COCP effect cancer risk?

A
  • increased risk of breast + cervical cancer
  • reduced risk of ovarian, colon + endometrial cancer
  • this risk returns to normal within 10 years of stopping the pill
30
Q

What are the benefits of using the COCP?

A
  • effective contraception
  • rapid return to fertility after stopping
  • improvement in menorrhagia + dysmenorrhoea
  • improvement in premenstrual symptoms
  • reduced risk of benign ovarian cysts
31
Q

What are the contraindications to using the COCP (UKMEC 4)?

A
  • uncontrolled HTN (particularly if >160 / >100)
  • migraine with aura (risk of stroke)
  • history of VTE
  • age > 35 and smoking > 15 cigarettes daily
  • major surgery with prolonged immobility
  • vascular disease / stroke
  • liver cirrhosis / tumours
  • ischaemic heart disease / AF / cardiomyopathy
  • systemic lupus erythematosus (SLE) + antiphospholipid syndrome
32
Q

How does BMI affect use of the COCP?

A

a BMI > 35 is ranked UKMEC 3 for combined contraception

(the risks generally outweigh the benefits)

33
Q

What advice should be given to women switching to the COCP from a POP?

A
  • use condoms for 7 days after switching
  • ensure there is no risk of pregnancy before switching (pill use has been consistent)
  • no additional contraception is required if switching from desogestrel as this inhibits ovulation
34
Q

What advice is given to the patient about vomiting / diarrhoea?

A
  • if vomiting / diarrhoea, this counts as a “missed pill” day
  • illness may affect the absorption
  • some medications (rifampicin) can also reduce the effectiveness of the pill
35
Q

What advice is given regarding taking the pill prior to surgery?

A
  • COCP should be stopped 4 weeks prior to a major operation
  • this is any surgery lasting for > 30 mins or that requires immobilisation of the lower limb
  • this is to reduce the risk of thrombosis
36
Q

What is the regime for combined transdermal patches?

A
  • a patch is worn for 7 days each
  • this is continued for 3 weeks, followed by a patch-free week + withdrawal bleed
  • the patch can be placed anywhere on the body except for the breasts
37
Q

Why might a transdermal patch be chosen over the COCP?

A
  • contains the same hormones so risk profile is identical
  • patches may be preferred where there is malabsorption (e.g. colostomy / bowel condition)
38
Q

What is the regime for the combined vaginal ring?

A
  • a soft, flexible ring is left in for 21 days
  • a ring-free interval for 7 days then induces a withdrawal bleed
the ring does not have to be in a certain position, just inside of the vagina

Y4 - GOSH (62 decks)

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