contraception 1 Flashcards
when was the first synthetic contraception?
1974
when is day 1 of the cycle?
- no contraception day 1 is the first day of the period
- with contraception day one is the first day you take the pull
what is HFI?
hormone free interval, you have a week without the hormone can sometimes be given placebo pills
what are the types of the combined oral contraception/
all contain oestorgen and progesteron • Monophasic pills o 21-day cycles 1 OD for 21 days/7-day break (FHI) Tailored regimes o 28-day cycles 21 active + 7 ED pills Zoely 24+4 • Phasic pills o 21-day phasic cycle o 28-day phasic cycle Logynon Qlaira 26+2
what are the types of the progesterone only pill?
no free pill period 28 days of taking the active form • Traditional POPs o Norethisterone (at low doses – 350mcg) • Newer POPs o Desogestrel More commonly used • Progesterone only you do not have a FHI, same amount of each hormone throughout the 28 day cycle. Typically find women who have these have very light / no periods.
do women get periods on POP?
typically no
they may experience light bleeding but often no peruod
what is a tailored regime?
may be used for another reason other than contraception - often used for irregular bleeding
21 pills active and 7 placebo pulls which do not contain any hormones.
what are examples of non oral combined contraception?
contain oestrogen and progesteron
- patches which release the hormones. 1 patch evry 7 days for 21 days and then 7 day break
- vaginal ring releasing the hromones, have the ring for 3 weeks then have a week free
what are examples of non oral progesterone contraception?
- injection needed between 8-12 weeks
- implant lasts for up to 3 years
- IUS intra uterine system .- slowly releases the hormone which thickens preventing implantation
what is the mechanism of action of a COC?
primary - inhibit ovulations and make the ovaries dormant.
thickens the cervical mucus
the oestorgen causes endometrial proliferation whilst progesterone opposes proliferation
are women protected during there 7 days off?
provided the woman has taken it effectively she is covered for her 7 days - if any long the ovaries will no longer be dormant
what is endometrial proliferation?
overgrowth and this can lead to the production of cancerous cells and this would affect fertility - this is why there is not an oestrogen only pil
what is the mechanism of action of a progestron only?
- suppresses ovulation
- thickens cervical mucus, delays ovum transport and renders endometrium hostile to implantation
- reduced cilia activity
why is ovum transport important?
the egg needs to move down the fallopian tube, if you reduce the cilia activity then it would slow down how quickly the egg can reach the uterus.
can you get pregnant at any time of the cycle/
yes
what is the efficacy of the COC and POP?
- perfect use is 99.7%
- typical use is 92%
what is perfect use?
used it exactly how it is meant to be and never miss anything
what is typical use?
people make some mistakes but still use it how they should
how effective is the male condom/
98% - mainly influenced by user failure
how effective is the female condom?
95% as they are much harder to use
how effective is the diaphragm?
96% but it has to be left in for 6 hours after sexual intercourse in order for it to be effective - if taken out before it would be effective
what are the condtions for lacation to be used as a contraception method?
- fully breastfeeding (no other liquids or solid foods)
- you are nearly full breastfeeding ( mainly breastfeding but you may be using some other types of nutrition) AND
- baby is under 6 months old
- you have NOT started periods yet
how does the risk of pregnancy increase with LAM?
- breastfeeding reduces
- long intervals between feeds
- night feeds ceases and you use supplementing feeding
what determines the patients contraceptive choice/
- Patient choice
- Medical conditions ?
- Medication ? DDI?
- UKMEC* categories for contraindications
- Advise on other suitable methods and offer if appropriate
- Discuss advantages, disadvantages, risks, efficacy, adverse effects and when to seek advice
- Advise on how to start HC
- CHC regimens – standard and tailored
- Advise on missed/late pill/use of vaginal ring
- Need for ‘Quick-starting’ contraception
what are the advantages of combined oral contraception?
- Menstrual period regular, lighter, less painful
- decrease in acne, functional ovarian cysts, benign ovarian tumours
- decrease the risk of ovarian, uterine, and colon cancer
what are the disadvantages of combined oral contraception?
- Minor ADRs – nausea, breast tenderness, cyclical weight gain?, loss of libido?, vaginal discharge, breakthrough bleeding
- increase risk blood pressure (angiotensin), MI, stroke, Venous thromboembolism, breast cancer, cervical cancer
what are the advantages or progesterone only contraception?
- High efficacy
- Suitable when COC isn’t
- decrease risk of endometrial cancer, benign breast disease, uterine fibroids, anaemia (as they cut down periods or stop them altogether)
what are the disadvantages of progesterone only contraception?
- ADRs – acne, headaches, depression?, loss of libido?, sustained weight gain?, vaginal dryness?
- Menstrual irregularities (oligomenorrhoea and menorrhagia)
- Efficacy – affected by patients weight. Less affected in obesity
- increase risk of functional ovarian cyst, ectopic pregnancy, breast cancer
what is the defintion of a missed pill for COC?
> 24 hours
• If starting on day 6 or later, add precautions for 7 days
• Critical at end or start of cycles as PF period elongated
• If 2 or more missed (>24 hrs) and UPSI occurs EHC indicated
• COC - Zoely/Qlaira missed pill = >12 hours
what is the defintion of a missed pill for POP?
- > 3/12hrs LATE
- Continue pills with 2 days extra precautions
- If 1 or more ACTIVE pills missed (>3/12hrs) [and UPSI before 2 more tablets taken correctly] then EHC indicated
- POP – Cerazette missed pill = >12 hours
what are the 4 catergoies for UK MEC health risk with COC?
1 - condition for which no restriction for the use of methods
2- condition where there is advantages of using method outweigh the risks
3 -ncondtion where the risks outweigh the advantages, so you need to refer and try another acceptable method
4 - unacceptable health risk if the method is used
what is a catergory 4 condition?
- Breast feeding women < 6 weeks post partum
- Women>35 + 15 cigarettes a day
- Multiple CVS risks
- Consistently elevated BP
- Vascular disease & history of VTE (inc thrombogenic mutations), IHD and stroke
- Migraine WITH aura
- Current breast cancer
- DM with nephropathy, retinopathy or neuropathy
- Benign hepatocellular adenoma and malignant hepatoma
- SLE
