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Y3 Patient sem 1 > Contraception 1 > Flashcards

Contraception 1 Flashcards

1
Q

What are the different types of combined oral contraceptive?

A
  • 21 day monophasic (1 daily and 7 day HFI): microgynon/Logynon
  • 28 day monophasic (1 daily): Microgynon ED/Zoely/Lofynon ED/Olaira
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2
Q

What combined hormonal transdermal patch is available?

A

Evra: 1 patch weekly for 3 weeks. 7 day patch-free interval

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3
Q

What combined hormonal vaginal ring is available?

A

Nuvaring: Inserted into the vagina and left for 21 days. 7-day ring free interval

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4
Q

What are the different types of progesterone only combined oral contraceptions?

A

Noriday (norethisterone)
Desogestrel (Cerazette)

  • 28 day - 1 daily
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5
Q

What POC injections are available?

A

DMPA - 8 or 12 weekly: Depo Provera

Norethisterone - 8 weekly: Noriestat

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6
Q

What is the Implant?

A
  • Progesterone only contraception
  • Every 3 years
  • Brand: Nexplanon
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7
Q

What hormonal IUDs are available?

A

Progesterone only:

  • IUD/system, every 3 years: Jaydess
  • Long acting reversible, every 5 years: Mirena
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8
Q

What non-hormonal contraceptive devices are available?

A
  • spermicidal gel (contains chemicals*), for use with barrier methods: Nonoxyl
  • IUD, plastic or copper - replaces every 5-10 years
  • Condoms (barrier): single use male or female
  • Diaphragms (barrier) - must be kept in for 6 hours after sex, silicone, polyurethane single use
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9
Q

What are monophasic pills?

A

Pills that contain equal amount of hormone:
 21-day cycles
• 1 OD for 21 days then 7-day break
• Tailored regimens – irregular bleeding
 28-day cycles
• 21 active pills + 7 ED (sugar) pills
• Zoely 24+4

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10
Q

What are phasic pills?

A 
Pills that contain different doses of hormone:
•	21-day phasic cycle 
•	28-day phasic cycle 
o	Logynon 
o	Qlaira 26 + 2
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11
Q

Is a pill free period required in Progestogen only pills?

A

NO - 28 day cycle of pills

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12
Q

What is the mechanism of action for combined hormonal contraception?

A

o Primary action - inhibit ovulation
o Synthetic oestrogens inhibit FSH release by negative feedback – supressing follicular development.
o Dormancy
o Thickened cervical mucus and altered endometrium – less likely for implantation to occur
o Oestrogen – endometrial proliferation, progestogen opposes proliferation – (can’t have oestrogen alone as it increases cancer risk)

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13
Q

What is the mechanism of action for progestogen only contraception?

A

o Suppression of ovulation
o Thickens cervical mucus, delays ovum transport, renders endometrium hostile to implantation, reduced cilia activity in Fallopian tube – reduces ability for egg to reach the uterus
o Various mechanisms to various degrees

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14
Q

What is the efficacy like for hormonal contraception?

A

• Combined (CHC) and Progestogen only (POC) – similar effectiveness
o 0.3% with perfect use in 12 months – never forgot a pill and took it at the same time every day
o 8% with typical use
• Risk of user failure / user dependent methods
o Pill (COC, POP) 99%/91%
o Patch (CHC) 99%/91%
o Vaginal ring 99%/91%
• Formulations more independent of the user (LARCS)
o Injection 99%/94% - still error as the user has to attend the appointment on the same day every 3 months etc
o Implant 99%/99%
o IUD 99%/99%
o IUS 99%/99%

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15
Q

What is the efficacy of non-hormonal methods?

A
  • Male condom up to 98% effective
  • Female condom up to 95% effective
  • Diaphragm or cap + spermicide up to 96% effective
  • Natural Family Planning: combining two or more fertility indicators new technologies (Persona) up to 98% effective
  • Sterilisation 1/200-500 [F] 1/2000 [M] – most effective form (not 100%)
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16
Q

What is Lactational Amenorrhoea (LAM)?

A

• Breastfeeding (lactation) can be used as a contraceptive method (LAM).
• Efficacy; up to 98 % ONLY if all of the following conditions apply:
o you are fully breastfeeding – (no other liquids or solid food)
o you are nearly fully breastfeeding – (mainly breastfeeding & other liquids infrequently) and
o baby under six months and
o Amenorrhoeic – not started period yet

17
Q

What can increase the risk of pregnancy during LAM?

A

• The risk of pregnancy increases if:
o breastfeeding reduces
o long intervals between feeds – both day and night, or
o night feeds cease and use supplement feeding occurs.
• Risk of pregnancy increases once baby reaches 6 months, regardless of menstrual patterns, level of breastfeeding

18
Q

What are the advantages of Combined oral contraceptives?

A

o Menstrual period regular, lighter, less painful
o  acne, functional ovarian cysts, benign ovarian tumours
o  risk of ovarian, uterine, and colon cancer

19
Q

What are the disadvantages of combined oral contraceptions?

A

o Minor ADRs – nausea, breast tenderness, cyclical weight gain? loss of libido? vaginal discharge, breakthrough bleeding
o increased risk blood pressure (angiotensin), MI, stroke, Venous thromboembolism, breast cancer, cervical cancer

20
Q

What effects can EE (ethinylestradiol) have in the body?

A
  • Increases angiotensinogen and insulin levels
  • EE increases HDL & lowers LDL (opposite for POC)
  • Decreases antithrombin 3 but increases some levels of clotting factors
21
Q

What are the advantages of progestogen only contraceptive?

A

o High efficacy
o Suitable when COC isn’t
o decreased risk of endometrial cancer, benign breast disease, uterine fibroids, anaemia

22
Q

What are the disadvantages of Progestogen only contraceptions?

A

o ADRs – acne, headaches, depression? loss of libido? sustained weight gain? vaginal dryness?
o Menstrual irregularities (oligomenorrhoea and menorrhagia)
o Efficacy – obesity
o increased risk of functional ovarian cyst, ectopic pregnancy, breast cancer

23
Q

What is the definition of a missed pill for COMBINED oral contraceptive?

A

More than 24 hours late

  • so if starting on day 6 or later, add precautions for 7 days
  • critical at end or start of cycle, as pill free period elongated
  • If TWO or more missed (>24hrs) and UPSI occurs –> ovaries will ‘wake up’ and EHC is required
24
Q

What is the definition of a missed pill for PROGESTOGEN only contraception?

A

More than 3-12 hours late

  • continue pills with 2 days extra precautions
  • if ONE or more ACTIVE pills missed (3-12 hours) and UPSI before 2 more tablets were taken correctly - EHC required
25
Q

When is cover compromised due to vomiting or diarrhoea?

A

• Vomiting with 3 hours or persistent diarrhoea – cover compromised

26
Q

How many categories are in the UKMEC?

A

4 (categories of criteria to determine whether HC can be safely prescribed to individual patients)

27
Q

What is category 1 UKMEC?

A

A condition for which there is no restriction for the use of the method

28
Q

What is category 2 UKMEC?

A

A condition where the advantages of using the method generally outweigh the theoretical or proven risks

29
Q

What is category 3 UKMEC?

A

A condition where the theoretical or proven risks usually outweigh the advantages of using the method. The provision of a method requires expert clinical judgement and/or referral to specialist, since the use of the method is not usually recommended unless other more appropriate methods are not available or not acceptable

30
Q

What is category 4 UKMEC?

A

A condition which represents an unacceptable health risk if the method is used

31
Q

What conditions would fit into category 4?

A
  • 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 – lupus

Y3 Patient sem 1 (22 decks)

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