Contraception 1 Flashcards
give the factors involved in natural family planning and explain each
-Basal body temp
(taken before rising, increase in body temp > 0.2 deg, sustained for 3 days after at least 6 days of lower temp)
Cervical mucous
(thick and sticky post ovulation mucous, for at least 3 days after get thinner, watery, stretchy mucous)
cervical position
(when fertile-cervix is high in vagina, soft and open
When less fertile- cervix low in vagina, firm and closed)
“Standard” days
(in a standard 28 day cycle days 8-18 are the most fertile)
breast feeding
3 criteria: exclusively breast feeding
less than 6/12 post natal
amenorrhoeic
what are the UKMEC categories?
-what must be assessed before prescribing contraception?
they are a series of catagories to determine the risk contraception poses to a patient and whether the benefit outweigh the risk
-Hx: medical conditions fam hx Drug hx potential interactions Recheck annually
LARC/VLARC
-types if each?
long acting reversible contraception/very long acting reversible contraception
-LARC
injectable contraceptive
Depo provera IM (medroxyprogesterone acetate)
Saying press (SC version)
-VLARC
IUD
IUS
Implant
Depo provera/Sayana Press
- primary action?
- works for how long?
- other effects?
- examination?
- start time?
- SE? (4)
- inhibits ovulation
- given every 13 wks, will generally last for 14 wks
- effects cervical mucus (thicker and sticky) and endometrium (thinner)
-Record BP &BMI before first prescription
check smear status if relevant
Consider risk factors for osteoporosis
-can be started up to and including day 5 of the cycle with our need for additional contraception
if not here then need to use additional method for 7 days
-Weight gain
delay in return of fertility
Irregular bleeding
Possible risk of osteoporosis
Risk factors for osteoporosis?
Underweight Anorexia Prolonged steroid use excess alcohol intake immobility family hx smoking low trauma fracture Chronic conditions: hypothyroidism \coeliac disease Rheumatoid arthritis Hyperparathyroidism IBD chronic renal disease
define “reasonably certain” in terms of not being pregnant
no sex since last period
consistently using reliable contraception
<7 days since last normal period
<4 wks post partum not breastfeeding
fully breast feeding, amenorrhoeic and < 6m post partum
Negative preg test AND > 3 wks since UPSI
IUD
- mode of action
- licensed for how long?
- when can it be fitted?
- SE?
-prevention of fertilisation (toxic to eggs and sperm) + inflammatory response in endometrium
T-shaped and non hormonal
ranges in size & shape
made of copper and plastic
-5/10 years
-within the first 7 days of a period OR any time provided not pregnant
up to 5 days after UPSI as EC
5 days after predicated date of ovulation
either within 48 hrs or > 4 weeks post partum
immediately post TOP
-heavy, prolonged menses Pain, infection, PID perforation Expulsion ? ectopic risk
IUS
- what is it?
- brands and doses? (2)
- mode of action?
- when can it be fitted?
- SE?
-T shaped device with elastomers core
-MIRENA
52mg levonorgestrel (synthetic progesterone)
20mcg daily
Decreasing to 10ug per day at 5 yrs
Jaydess
14ug per day for first 24 days
decreasing to 5 ug per day at 5 yrs
-affect on implantation: endometrium unfavourable ,also effects cervical mucous
-within first 7 days of period or any tie provided not pregnant
NOT EC
if fitted out with first 7/7 use condoms for first 7/7
either with in 48 hrs or > 4 wks post partum
immediately post TOP
-lighter, less frequent bleeding Pain, infection, PID perforation Expulsion ?ectopic risk failure
contraindications for IUD/IUS? (7)
-examinations for IUD/IUS?
current pelvic infection? abnormal uterine anatomy pregnancy sensitivity to any of the constituents gestational trophoblastic disease when BHCG levels are abnormal/persistently elevated Endometrial carcinoma cervical Ca awaiting treatment
-PV to check uterine size/position
BP & pulse if condition indicates
Implant
- what is it?
- contains?
- licensed for use for how long?
- mode of action?
- when fitted?
- SE?
-subnormal rod containing
-68mg ENG (etonogestrel), releases 60/70ug per day in wks 5-6
25-30ug per day end of 3rd yr use
-inhibits ovulation
+effects endometrium & cervical mucus
-no precautions: first 5 days cycle up to 5 days post 1st/2nd trim abortion on or before day 21post partum additional precautions: reasonably certain not pregnant "quick start" after EC off-licence
-irregular bleeding
weight gain
Acne
Nerve damage/vascular injury
Deep insertion
does not effect BMD, CV/VTE/MI risk
what drug interactions should be considered?
particularly enzyme inducers
Always check BNF
