Contraception Flashcards
When can you provide hormonal contraceptives to under 16s?
She understands the doctors advice
She cannot he persuaded to inform her parents
She is very likely to continue having sex
Unless she receives contraception her mental and physical health will suffer
In her best interests to provide treatment
What are the combined oral contraceptives oestrogens?
Ethinylestradiol
Mestranol
Estradiol - zoely with normegestrol, qlaira with diemogest
What are the oral contraceptives progestogen?
Norgestimate Desogestrel Drosperinone Gestodene Norethisterone Dienogest Nomegestrel Levonorgestrel
Which progestogens are best used for acne, depression, headaches, breast symptoms, breakthrough bleeding?
Norgesitmate
Desogestrel
Drosperinone
What are the transdermal contraceptive patches?
Evra - norelgestromin with ethinylestradiol
What are the progesterone only pills?
Desogestrel - cerelle, cerazette
Norethisterone - micronor, noriday
Levonorgestrel - norgeston
What are the parenteral progestogen contraceptives?
Medroxyprogesterone (injection)
Northisterone (injection)
Etonorgestrel (implant)
What hormone is in the IUD?
Levonorgestrel
What are the hormones in the NuvaRing?
Etonogestrel with ethinylestradiol
How do you take the combined oral contraceptives?
One tablet daily for 3 weeks + 1 week pill free interval for withdrawal bleeding
Start any time in menstrual cycle; if started on day 6 or later use protection for 7 days
Not for women above 50 years
What is a monophasic preparation?
Fixed amount of oestrogen and progestogen
What is a phasic preparation?
Varying amount of oestrogen and progestogen
For women who do not have withdrawal bleeding
Or have breakthrough bleeding with monophasic preparations
What is an every day preparation?
Pill free interval replaced with inactive pills
What are the low strength oestrogen preparation?
Risk factor for circulatory disease - 20mg ethinylestradiol
What do you need to be careful of with oestrogens?
Increased risk of VTE
Increased risk of arterial thromboembolism
When do you stop taking contraceptives that contain oestrogen before surgery?
4 weeks before for major surgery and all surgery to the legs or surgery that results in prolonged immobilisation of a lower limb
When should you stop oestrogen containing preparations?
VTE
Stroke
Liver dysfunction
Blood pressure
Prolonged immobility after surgery or leg injury
Detection of a risk factor which contraindicates treatment
How do the progestogen only pills work?
Prevents pregnancy by thickening the mucus in the cervix to stop sperm reaching an egg
Alternative when oestrogens contraindicated
How do you take POPs?
Take one daily on a continuous basis, starting on day 1 of cycle and taken at the same time each day
If started after day 5 of menstrual cycle, additional precaution is required for 2 days
What are the other side effects of hormonal contraceptives?
Combined - increase risk of cervical and breast cancer
Progestogen - increase risk of breast cancer
What are the benefits of combined oral contraceptives?
Reduces risk of ovarian and endometrial cancer
Reduces dysmenorrhea and menorrhagia, premenstrual tension, reduced risk of PID
When is a COC considered missed?
> 24 hours
Zoely/qlaira > 12 hours
What do you do if you miss a COC?
1 missed pill - take one ASAP and one at normal time even if it means taking two together
2+ missed pills - take one pill ASAP + condom for 7 days (9 days if zoely/qlaira)
Omit pill free interval if missed in last 7 days
EHC - if missed in first 7 days and unprotected sex occurs
How many hours is a POP considered missed?
3 hours (desogestrel > 12 hours)
What do you do if you miss a POP?
Take ASAP + condom for 2 days
EHC - unprotected sex occurs before 2 pills are taken correctly
What do you do if you have vomiting/diarrhoea while taking a COC?
Vomiting < 2 hours of taking - take one ASAP
> 24 hours - protection until 7 days after recovery and pill is resumed (9 days if Qlaira)
If it occurs in last 7 days - omit pill free interval
What do you do if vomiting/diarrhoea and taking a POP?
Vomiting < 2 hours of taking = take another ASAP
Severe of if pill not taken within 3 hours of normal time (12 hours if desogestrel) = protection until 2 days after recovery and pill is resumed
What do you do if a transdermal patch is detached for >24 hours or delayed application at beginning of cycle?
Apply new patch ASAP
Start a new day 1 cycle + condom for 7 days
What do you do if a transdermal patch has delayed application in the middle of cycle?
< 48 hours apply new patch and continue as normal
> 48 hours start a new day 1 cycle + condom for 7 days
What are the enzyme inducers that affect hormonal contraception by reducing their effectiveness?
Carbamazepine Phenytoin Phenobarbital St. John’s wort Rifampicin Rifabutin
What reduces the efficacy of ulipristal?
Antacids
H2 receptor antagonists
PPI
How long after sex can the copper IUD be used as EHC?
120 hours (5 days) after unprotected intercourse or up to 5 days after the earliest calculated ovulation
Which EHC do you use if patients BMI > 26 kg/m2
Ulipristal or double dose of levonorgestrel
How does levonorgestrel work?
Prevents ovulation and fertilisation
What is the dose of levonorgestrel for EHC?
1500mg < 72 hours after unprotected sex
If vomiting < 3 hours of taking dose, give replacement dose
What are the cautions with levonorgestrel?
Crohn’s
Past ectopic pregnancy
Ciclosporin
What is the mechani of action of ulipristal?
Progestogen receptor modulator inhibits or delays ovulation
More effective than levonorgestrel
When do you use ulipristal?
30 mg 96-120 hours after unprotected sex
What are the cautions for ulipristal?
Severe asthma treated by oral corticosteroids
Avoid in severe liver impairment
What are the contraindications of ulipristal?
Repeated use within the same menstrual cycle
What are the counselling points for ulipristal?
Reduces effectiveness of regular contraceptives
Wait 5 days before starting regular hormonal contraception
What are the hormonal contraception side effects?
Menstrual irregularities
What are the counselling points for hormonal contraception?
Next periods may be early or late
Use barrier protection until next period
If lower abdominal pain see gp to rule out ectopic pregnancy
If periods are abnormal take a pregnancy test
Why should an IUD not be used in under 25s?
Increased risk of PID
What are the side effects of IUD?
Pain on insertion and bleeding
Uterine perforation
Risk of infection
What is the MHRA warnings for IUDs?
Uterine perforation
Report severe pelvic pain, sudden changes in periods pain during sex, unable to feel threads
When do you remove IUD?
Do not remove mid cycle unless additional contraceptive used for 7 days
If removal is essential and unprotected sex occurs give EHC
If pregnant remove in 1 st trimester
What are the counselling points for medroxyprogesterone injection?
Lasts 2 years
Delay in return to fertility and menstrual irregularities
Osteoporosis risk
How often do you need norethisterone injection?
8 weeks
What is the MHRA warning for etonogestrel implant?
Nexplanon contaceptive implants - reports of device in vasculature and lung
When should spermicidal contraceptives not be used?
At high risk of STIs, high use associated with genital lesions and increased risk of acquiring infections
