Contraception Flashcards
how does COCP work?
inhibits ovulation
risks of COCP?
increases VTE risk
increases risk of breast and cervical cancer
how does progesterone only pill work?
thickens cervical mucus
side effects of POP?
irregular bleeding
how does depot work?
primary = inhibits ovulation
also thickens cervical mucus
how long does depot last?
12 weeks
how does implant work?
primary = inhibits ovulation
also thickens cervical mucus
side effects of implant?
irregular bleeding
weight gain
how long does implant last?
3 years
how do copper intrauterine device work?
decreases sperm motility and survival
how does mirena coil work?
primary = prevents endometrial proliferation
also thickens cervical mucus
children under what age are considered unable to consent to sexual intercourse in all cases?
under 13
what guidelines are used to assess ability to consent to sexual activity?
fraser guidelines
advise for STI testing after unprotected sex?
advise young people to have STI test 2 and 12 weeks after intercourse
when can COCP be started?
start within first 5 days of cycle
if taken after day 5 then additional contraception such as condoms need to be used for 7 days
how is COCP taken?
same time every day for 21 days then a 7 day break
is intercourse safe during pill free week?
yes but only if next pack is started on time
when might efficacy of COCP be reduced?
vomiting within 2 hrs of taking pill
taking meds causing liver enzyme inducing drugs (eg some anticonvulsants)
advise if 1 pill (COCP) is missed at any time in the cycle?
take the last pill (even if that means taking 2 pills in one day) then continue taking pills normally
no additional contraceptive needed
advise if 2 or more pills (COCP) are missed in week one of cycle?
take last pill even if it means taking two pills in one day
leave any other missed pills
then continue normal daily pills
need emergency contraception if she had unprotected sex during pill free week or week 1 of cycle
is emergency contraception needed if 2 more COCP are missed in week 2 of cycle?
no need for emergency contraception as long as there had been 7 consecutive days of taking the COCP
is emergency contraception needed if 2 or more COCP are missed in week 3 of cycle?
not as long as they had taken pills for 7 consecutive days before
should finish pills in current pack then start new pack immediately (omitting pill free week)
which is most effective form of contraception?
implant (nexplanon)
what hormones in implant and how does this affect risks?
no oestrogen, only progesterone
so doesnt increase VTE risk so can be used if PMH of thrombosis, migraine etc
when should implant be inserted?
day 1-5 of cycle
if not inserted within days 1-5 then 7 days additional contraceptive measures are needed
can also be inserted immediately after a termination of pregnancy
types of IUD?
copper
mirena (levonorgestrel)
what else are IUDs used for?
menorrhagia
fibroids (if uterus not too distorted)
how long does copper IUD last?
5-10 years (think its 10 generally)
how quickly is copper IUD effective?
immediately after insertion?
how long does mirena IUD last?
5 years
how quickly is mirena IUD effective?
7 days after insertion (need 7 days of additional contraception)
when can copper IUD be inserted?
any time in menstrual cycle
when can mirena be inserted?
within first 7 days of cycle
if inserted after day 7 then extra barrier contraception is required for 7 days
when can copper coil be inserted after unprotected sex as emergency contraception?
up to 5 days after
does either type of coil affect VTE risk?
no
therefore can be used in obese people, people at risk of VTE etc
which coil helps dysmenorrhoea and pain related to endometriosis?
only mirena
adverse effects of coils?
can cause heavy or intermenstrual bleeding but this usually settles
can increase risk of ectopics
can fall out
no STI protection
3 types of emergency contraception?
levonorgestrel (ellaOne)
ulipristal acetate
copper coil
levonorgestrel must be taken within how long of unprotected intercourse?
72 hrs
when are two doses of levonorgestrel needed?
BMI>26 or weight >70kg
or if vomiting occurs within 3 hrs of taking it
how quickly can hormonal contraception be started after levonorgestrel?
immediately
how quickly must ulipristal acetate be taken after unprotected intercourse?
120 hrs
how many doses of ulipristal acetate?
only 1 generally
how quickly can hormonal contraception be started after ulipristal acetate?
not until 5 days after ulipristal acetate (as it reduces effectiveness of hormonal contraception)
barrier methods should be used during these 5 days
how does emergency contraception affect breastfeeding?
levonorgestrel has no effect
should delay breastfeeding for 1 week after ulipristal acetate
which emergency contraception can be used more than once in a single cycle?
levonorgestrel
for how long is it normal to have some intermittent bleeding after insertion of IUD?
6 months
women require contraception from how many days following birth?
21 days
when can POP be started after giving birth?
anytime postpartum (regardless of whether they are breastfeeding)
when can COCP be started after giving birth if breastfeeding?
6 weeks after birth at the earliest (if patient requests it) but not really recommended until 6 months after
(would still need barrier contraception from 3 weeks after birth)
when can COCP be started after birth if not breastfeeding?
3 weeks
when can IUD be inserted after birth?
immediately after delivery of placenta or within 48 hrs of birth
can be done immediately at time of C-section after delivery of placenta
if IUD not inserted within 48 hrs of birth, how long must you wait before inserting it?
delay insertion until 4 weeks after birth
when can implant be inserted following birth?
immediately or anytime really
if inserted before 3 weeks then no extra contraception is needed
