Contraception 1 Flashcards
What are the different types of combined oral contraceptive?
- 21 day monophasic (1 daily and 7 day HFI): microgynon/Logynon
- 28 day monophasic (1 daily): Microgynon ED/Zoely/Lofynon ED/Olaira
What combined hormonal transdermal patch is available?
Evra: 1 patch weekly for 3 weeks. 7 day patch-free interval
What combined hormonal vaginal ring is available?
Nuvaring: Inserted into the vagina and left for 21 days. 7-day ring free interval
What are the different types of progesterone only combined oral contraceptions?
Noriday (norethisterone)
Desogestrel (Cerazette)
- 28 day - 1 daily
What POC injections are available?
DMPA - 8 or 12 weekly: Depo Provera
Norethisterone - 8 weekly: Noriestat
What is the Implant?
- Progesterone only contraception
- Every 3 years
- Brand: Nexplanon
What hormonal IUDs are available?
Progesterone only:
- IUD/system, every 3 years: Jaydess
- Long acting reversible, every 5 years: Mirena
What non-hormonal contraceptive devices are available?
- 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
What are monophasic pills?
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
What are phasic pills?
Pills that contain different doses of hormone: • 21-day phasic cycle • 28-day phasic cycle o Logynon o Qlaira 26 + 2
Is a pill free period required in Progestogen only pills?
NO - 28 day cycle of pills
What is the mechanism of action for combined hormonal contraception?
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)
What is the mechanism of action for progestogen only contraception?
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
What is the efficacy like for hormonal contraception?
• 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%
What is the efficacy of non-hormonal methods?
- 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%)
What is Lactational Amenorrhoea (LAM)?
• 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
What can increase the risk of pregnancy during LAM?
• 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
What are the advantages of Combined oral contraceptives?
o Menstrual period regular, lighter, less painful
o acne, functional ovarian cysts, benign ovarian tumours
o risk of ovarian, uterine, and colon cancer
What are the disadvantages of combined oral contraceptions?
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
What effects can EE (ethinylestradiol) have in the body?
- Increases angiotensinogen and insulin levels
- EE increases HDL & lowers LDL (opposite for POC)
- Decreases antithrombin 3 but increases some levels of clotting factors
What are the advantages of progestogen only contraceptive?
o High efficacy
o Suitable when COC isn’t
o decreased risk of endometrial cancer, benign breast disease, uterine fibroids, anaemia
What are the disadvantages of Progestogen only contraceptions?
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
What is the definition of a missed pill for COMBINED oral contraceptive?
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
What is the definition of a missed pill for PROGESTOGEN only contraception?
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
When is cover compromised due to vomiting or diarrhoea?
• Vomiting with 3 hours or persistent diarrhoea – cover compromised
How many categories are in the UKMEC?
4 (categories of criteria to determine whether HC can be safely prescribed to individual patients)
What is category 1 UKMEC?
A condition for which there is no restriction for the use of the method
What is category 2 UKMEC?
A condition where the advantages of using the method generally outweigh the theoretical or proven risks
What is category 3 UKMEC?
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
What is category 4 UKMEC?
A condition which represents an unacceptable health risk if the method is used
What conditions would fit into category 4?
- 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
