Contraception Flashcards
What is the failure rate of the COCP
Perfect use 2-3 per 1000
Typical use 9% failure
What is in the COCP
Oestrogens typically ethinyloestradiol, and progestogens e.g. levonorgestrel or dropirenone
Can be monophasic where the dose is constant throughout the pack, or phasic where the hormone doses vary thoughout ( theoretically more physiologic)
How does the COCP work?
Inhibits ovulation, causes thickening of the cervical mucus to prevent sperm penetration and also causes endometrial atrophy to prevent implantation
What are the side effects of the COCP
breakthrough bleeding, weight gain, mood chance, breast tenderness, headaches, bloating, N&V, acne
If the side effects persist, can consider a different dose or a different agent.
List some contraindications to the COCP?
Pregnancy Hypertension and diabetes undiagnosed PV bleeding Thrombophilia Smoker over age 35 BMI >35 Person hx of VTE Migraine with aura Active HPB disease or liver tumours
What affect does the COCP typically have on menstruation?
Regular, lighter and less painful
Improvements in PMS, acne and endometriosis
What are some advantages to using the COCP?
Menstruation + acne
- decreases the risk of colorectal , ovarian and endometrial cancer
What are some disadvantages associated with the COCP?
User compliance is essential
increased risk of VTE
small increased risk of stroke and CVD
Increased risk of breast cancer
What is the risk of VTE with the COCP?
General pop - 5 per 100,000 women /yr
2nd gen COCP risk 10-15
3rd gen 25
Pregnancy 60
How is the COCP taken?
Should be started on the 1st day of bleeding ( but can started up to day 5)
- if started after day 5 - extra precaution for 7 days
- 1 pill per day for 21 days, followed by 7 pill-free days to allow for withdrawal bleed
- take at the same time every day
- there is some variation between different COCPs so always follow the instructions on the leaflet*
What can affect the efficacy of the COCP?
Human error - missed pills
Diarrhoea & vomiting
After taking ulipristal acetate additional precautions should be taken for 14 days
What forms of progesterone only contraceptives are available?
POP
IUDs - mirena, Eloisa, Kyleena, Jaydess
Injectable - Depo-provera
Subdermal implant - Implanon
What is the typical failure rate of the POP
Typical 9-15%, vs less than 1% perfect use
Failure rate decreases with age
What type of hormone is in cerazette?
POP - desogestrel
How does the POP work?
Thickening of cervical mucous to prevent sperm penetration
Endometrial atrophy prevents implantation
inhibits ovulation - newer POP more effective
When would you use the POP?
If the COCP is contraindicated
During breastfeeding
CI to the POP
Pregnancy undiagnosed PV bleeding Severe arterial disease Active breast cancer (or within 5yrs) Active hepatic disease Hx of ectopic pregnancy
Adverse effects of the POP
Menstrual disturbance - 40% stay regular, 40% become irregular, 20% become amenorrhoeic
Mood swings, reduced libido, fluid retention, acne, bloating, breast tenderness ( all usually subside in a few months)
Increased risk of ovarian cysts
Advice on taking the POP
One every day no pill-free period
start on day 1 ( up to day 5 ) of period for immediate effect
Must take at the same time everyday ( 3hr window) for effectiveness - newer pills have a 12hr window ( after hits need additional precautions)
In the case of postpartum contraception, the POP is effective immediately if started within 21 days of delivery
What drugs interfere with the POP?
Anti-epileptics Rifampicin Antiretrovirals St John's wort Ulipristal acetate
How does Depo-provera work?
Injection of progesterone - 150mg given IM every 12wks, effective immediately
Adverse affects - menstrual disturbance, irregular bleeding, weight gain, headache, acne, mood changes.
May take 6-12months for fertility to return after stopping
How does implanon work?
Contains etonogestrel, it is inserted into the arm SC under a LA.
Effective immediately and for 3yrs .
Adverse effects include menstrual disturbance, irregular bleeding, weight gain, headache, acne, mood changes.
May take 6-12months for fertility to return after stopping
( Can cause heavier bleeding in women with already heavy periods )
