Contraception Flashcards
COCP mechanism and use
• Oestrogen and progesterone
o Inhibit LH and FSH
o Prevent ovulation
- Start on day 1 of the menstrual cycle
- 21 days consecutively with 7 days breaks
COCP indications
Contraception Menorrhagia Dysmenorrhea PMS Acne
COCP contraindications
35 + yrs old Migraine DVT HTN DM with complications Breast cancer or primary liver CA < 6 weeks post partum BMI < 35 Breastfeeding Smoking over 35 yo FHx of VTE Prolonged immobility or surgery
COCP side effects
Initial temporary: o Nausea o Headache o Breast tenderness o Menstrual irregularities
- No STI protection
- MI, stroke, VTE and HTN
- Risk of breast cancer
- Mood changes – depression
Missed COCP or POP dose
Take the missed pill immediately and the next pill as usual (2 pills in 1 day)
• If 2+ pills are missed, abstain from intercourse until finishing 7 days of pill or extra contraception should be used
- Vomits 3hrs after taking pill, take another
- If illness occurs during last 7 days, omit pill free interval
Which contraception, when stopped, returns fertility immediately
COCP POP Progesterone implant IUS IUD
Progesterone only pill mechanism and use
Progesterone only o Prevents ovulation o Thick, acidic cervical mucus o Prevents implantation o Reduces cilia activity
- Taken with no break at the same time each day
- Start on day 1 -5
Indications for POP
- Contraception
* Dysmenorrhea
POP contraindications
- Breast cancer
- Liver cirrhosis or tumours
- Lower efficacy in women over 70kg
- Stroke or CHD
POP side effects
Menstrual irregularities Breast tenderness Ovarian cysts Ectopic pregnancy Increased risk of breast cancer
COCP patch use and indications
Use: • Only 1 patch worn at one time • Applied to clean dry arm • Change weekly for 3 weeks • Patch free interval on week 4
Indication:
COntraception
If COCP patch detached for 48+ hrs
- Abstain for 7 days
* Barrier contraception
Vaginal ring mechanism, use and indication
Mechanism:
Oestrogen and progesterone:
• Inhibits FSH and LH
• Inhibits ovulation
Use:
• 21 days, new ring inserted after 7 days
• Insert day 1 – 5 of menstruation cycle
Indication:
• Contraception
When does fertility return after using patch
May have a delay of few months
Side effects of vaginal ring
Initial temporary: o Higher chance of headache o Vaginal discharge o Breast tenderness o Menstrual irregularities
- No STI protection
- MI, stroke, higher risk of VTE and HTN
- Risk of breast cancer
If 8 days since last removal of vaginal ring
Abstain or use barrier contraception
Emergency pill
Insert ring as soon as possible
When does fertility return after using vaginal ring
May have a delay of few months
Progesterone Implant mechanism and use
Increased progesterone: • Inhibits ovulation • Thickens cervical mucus • Thinning of endometrium preventing implantation • Works for 3 years
Indication: contraception
Side effects of progesterone implant
- Irregular menstruation
- Increased risk of breast cancer
- Can bend or break in situ
- Acne
- Pain and bruising when inserted
Progesterone Injection
Increased progesterone • Inhibits ovulation • Thickens cervical mucus • Prevents implantation by thinning endometrium • Lasts 3 months
Indication: contraception
Contraindications and side effects of progesterone injection
Contraindications: • Breast cancer • Pregnancy • PMHx of arterial disease or RF • DM with complication
Side effects: • Irregular menstruation • Weight gain • Increased risk of breast cancer • Loss of bone density
If longer than 3 months before getting next progesterone injection
If longer than the time specified for next injection use:
• emergency contraception
• bridging methods e.g. POP
• Avoid intercourse for 7 days
When does fertility return after not taking progesterone injection
Delay of up to 1 year
Menstruation can take several months to return to normal
Intrauterine system mechanism
5 years
- Progesterone that inhibits implantation due to thickened cervical mucus and endometrial thinning
- Can still ovulate
- Inserted day 1 – 7 of the menstrual cycle
- Use barrier contraception for first 7 days
IUS indication
Contraception
Menorrhagia
Dysmenorrhea
IUS contraindications
Internal pelvic examination is needed to check suitability
- Pregnancy or 4 wks post partum
- Distorted uterine anatomy
- Unexplained vaginal bleeding
- Pelvic infection or STI
IUS sie effects
- Acne and headaches
- Irregular bleeding in first 6 months
- Perforation of uterine walls (rare)
- Expulsion
- Ectopic pregnancy
- Ovarian cyst
- Hypersensitivity
- Depression
- Weight gain
- Decreased libido
Intrauterine device mechanism
- Copper – spermicide
- 5 – 10 years
- Internal pelvic examination is required
IUD indication
Contraception
Emergency contraception – within 5 days
IUD contraindications
Pregnancy or 4 wks post partum Distorted uterine anatomy Unexplained vaginal bleeding Pelvic infection Wilson’s disease Allergy to copper STI Uterine fibroids PID
IUD side effects
Copper can make periods heavier and painful
• Uterine perforation
• PID
• Expulsion
• Ectopic pregnancy
• Unscheduled bleeding – common during 3 – 6 months
Methods of sterilisation
• Vasectomy (male):
- Prevent sperm entering semen by blocking vas deferens
• Tubal occlusion (women)
- clip inserted to block fallopian tubes
Emergency contraception
Levonorgestrel
Ulipristal Acetate
Copper IUD
Levonorgestrel
Synthetic progesterone inhibits ovulation for 5 – 7 days
Efficacy may be reduced with diseases of malabsorption e.g. Crohn’s and enzyme inducing drugs e.g. rifampicin
Ulipristal Acetate
Selective progesterone receptor modulator:
• Inhibition of ovulation for 5 days
• If given before ovulation – prevents follicular development
• If LH surge started, delays follicular rupture
Contraindications for ulipristal acetate
- Crohn’s
- Hypersensitivity
- Severe hepatic dysfunction
- Rifampicin and other enzyme inducing drugs
- Breast feeding
- Asthma that is not controlled by corticosteroids
- Drugs increasing gastric pH – omeprazole, ranitidine
- Avoid breastfeeding for 1 week after taking
Contracepetive assessment
UKMEC - ensure no contraindications
- comorbidities
- DHx
-Age
STI risk - Competency
- Measure BMI and BP
Fraser guidlines
If a girl younger than 16 requests emergency contraception without parental consent:
- Reassure consultation is confidential
- Emotional and physical implications of intercourse
- risks of pregnancy and STI
- Assess competence
Fraser criteria
Understands advice Cannot be persuaded to inform parents Likely to begin or continue intercourse Physical and mental health will suffer if doesn't receive contraception Autonomy
Learning disability capacity
Understand information
Retains information
Use info to weigh up options
Communicate decision
Gillick competency
Person under the age of 16 wishes to receive treatment without their parents’ or carers’ consent
Gillick competency criteria
- child’s age, maturity and mental capacity
- understanding of the issue and what it involves - including advantages, disadvantages and potential long-term impact
- understanding of the risks, implications and consequences
- how well they understand any advice or information they have been given
- understanding of any alternative options, if available
- ability to explain a rationale around their reasoning and decision making.
When should ulipristal acetate be given?
Within 120 hours (5 days) of unprotected sex
How long do you have to take the POP for before it becomes effective?
After 48 hours
Provides immediate effective contraception if started on the first to the fifth day of menstruation.
If started at any other point in the cycle, or if the patient is unsure, then additional contraceptive measures, such as condoms or abstinence, should be utilised for the first 48 hours.
Time until effective if not taken within first 5 days of period
Instant - IUD
2 days - POP
7 days - COCP, injection, implant, IUS
