Contraception Flashcards

1
Q

IBD and contraception

A

malabsorption reduced efficacy of oral contraception

do not give Dep-Provera in <18y/o due to increased risk of osteoporosis

use combined patched, progesterone-obly injectables and implants, intrauterine and vaginal ethods

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2
Q

Breastfeeding and contraception

A

No EC = UPSI before day 21 postpartum

COCP = avoid before 6 weeks postpartum, and relatively contraindicated 6wks - 6 months postpartum (affects breast milk volume)

Progesterone-only = no effect on milk production, can be used in first 6 wks postpartum and thereafter

IUD = inserted from 4 wks postpartum

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3
Q

Contraeption and menopause

A

women <50 = continue contraception for 2 years after last period

IUD and IUS good

COCP also good in non-smoking women with no other RFs

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4
Q

3 types of hormonal contraception

A
  1. progestogen tablet = POP
  2. progestogen as a depot = nexplanon, depo-provera or IUS
  3. COCP, transermal patch, vaginal ring
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5
Q

COC timetable

A

every day for 3 weeks and then stopped for 1 week

vaginal bleeding at end of pill packet as a result of withdrawal of hormonal stimulus on endometrium -> cycle then restarted

can be taken back to back to reduce frequency of withdrawal bleed althoguh increased irregular spotting may occur

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6
Q

Common side effects of sex hormones

A
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7
Q

uses of COC

A

teenage (in conjunction with condoms)

older woman (no cardiovascular risk factors until age of 50)

useful for: menstrual cycle control, menorrhagia, PMS, dysmenorrhoea, acne/hirsutism and pevention of recurrent simple ovarian cysts

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8
Q

issues with COC: missed pill rules, abx, anti-convulsants, D+V, surgery

A

reduced pill absorption when D+V = continue taking pills but follow missed pill instructions for each day of illness

  • V within 2 hours of taken pill -> take another pill or follow rules of missed pills
  • taking BS abx -> continue pills but use condoms during and for 7 days after abx course
  • liver enzyme-inducing drugs (e.g. anticonvulsants) -> increase oestrogen dose

Missed pill:

  • forgotten pill taken ASAP, packet continued as normal
  • if more pills missed = packet continued as normal + condoms used for 7 days
  • <7 pills in packet = next packet started straight after last (avoid pill-free break)

Surgery = pill stopped 4 wks before major surgery as prothrombotic risks, but risks of pregnancy should also be considered. Not discontinued prior to minor surgery.

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9
Q

counselling the woman starting on the COC

A
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10
Q

Major complications and minor side effects of COC

A

Complications:

  • VTE + MI
  • smoking, increased age and obesity (increases risk)
  • contraindication: BMI >40, or age >35 amd smokes >15 cigarettes per day
  • relative: BMI 35-39 and <15 cigarettes per day
  • other problems = CVS, focal migraine, hypertension, jaundice, and liver, cervical and breast carcinoma

Minor:

  • nausea, headaches, breast tenderness
  • breakthrough bleeding common in first few months but ettles after 3 months
  • lactation partly suppressed so pill contrainidcated during the first 6 wks of breastfeeding
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11
Q

Advantages of COC

A

Contraceptive = effective

Non-contraeptive = regular less painful lighter periods. Protects against simple ovarian cysts, benign breast cysts, fibroids, endometriosis. Hirsutism and acne may improve. PID risk reduced. LT reduction in incidence of ovarian, endometrial and bowel cancer.

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12
Q

Contraindications to COC (including oral) contraception

A
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13
Q

Combined transdermal patch (Evra)

A

ethinyloestradiol + norelgestromin

weekly for 3 consecutive weeks followed by patch free week

efficacy, contraindications and side effects similar to COC

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14
Q

Combined vaginal ring (nuvaring)

A

ethinyloestradiol and etonogestrel

worn for 3 week and removed for 7-day ring free break and a withdrawal bleed, new ring inserted

better tolerated than COC due to lower systemic oestrogenic side effects

not recommended to remove during SI but can be for maximum of 3 hrs.

Same metabolic and coagulation effects as other combined hormonal methods

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15
Q

POP

A

counselling before using the mini-pill:

  • advise woman about bleeding patterns
  • emphasize the importance of meticulous time-keeping

low dose norethisterone/micronor

every day without a break and at the same time +/- 3 hrs

side effects: vaginal spotting, weight gain, mastalgia and PMS-like symptoms, functional ovarian cysts can occur

less effective than combined pill and need for timing

good for those with contraindication for combined ill

if pill missed by more than 3 hours, another should be taken asap and condom used for 2 days

not affected by BS abx

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16
Q

LARCs

A

not user dependent and high efficacy rates

more cost-effetive than COC after 12 months of use

current usage rates are low

17
Q

Depo-Provera, Noristerat and Sayana Press

A

DP

  • IM every 3 months
  • irregular bleeding first weeks, followed by amenorrhoea
  • prolonged amenorrhoea may follow cessation
  • bone density reduction first 2-3 years of use then stabilised and regained after stopping

Noristerate

  • IM every 8 weeks
  • short-term interim contraception e.g. whilst waiting for vasectomy to become effective

Sayana press

  • SC for self-administeartion
  • cover for 13 weeks

All 3 may be used in breastfeeding women

18
Q

Nexplanon

A

Rod-contianing progestogen (etonogestral) inserted into upper arm subdermally with local anaesthetic

lasts 3 years

irregular bleeding in first year, no drop in bone density, removal easy and rapid resumption of fertility

simple and long acting so may have a particular role in the developing world

19
Q

EC: morning after pill

A

Levonelle = best taken within 24 hours and no later than 72 hours after UPSI. Vomiting can occur plus menstrual disturbances in the following cycle

Ullipristal (EllaOne) = SPRM (e.g. mifepristone). Can be used up to 120 hours after UPSI. Will reduce effectiveness of progesterone-contianing contraceptives so women should use condoms or avoid UPSI until the next period

20
Q

EC: IUD

A

inserted up to 5 days after either the episode of UPSI or expected day of ovulation (so if intercourse occurened 2 days before expected ovulation, the IUD could be inserted 7 days later).

abx prophylaxis usually given at the time of insertion

21
Q

diaphragms and caps

A

fitted before intercourse and must remain in situ for at least 6 hours afterwards

cervical caps fit over cervix whilst spring of latex dome of diaphragm holds it between the pubic bone and sacaral curve covering the cervicx

PID protection but less protection against HIV

some find in inconvenient so best suited for woman with good motivation

22
Q

Cooper IUD, IUS (mirena coil)

A

IUS = Jaydess/Levosert replaced every 3 years, Mirena every 5 years

reduced menstrual loss and pain

systemic side effects lower than POP

irregular light bleeding is main probelm

return of fertility after removal is rapid and complete

lack of user dependence

23
Q

IUD/IUS complications

A

Pain/cervical shock complicate insertion

device being expelled

perforation of uterine wall at insertion

heavier or more painful menstruation can occur

lapraoscopy to remove IUD if within abdomen

if pregnancy occurs despite presence of IUD -> likely to be ectopic

if ectopic pregnancy excluded -> remove IUD early to reduce risk of miscarriage and particularly mid-trimester loss

24
Q

contraindications to the IUD

25
Q

counselling before inserting an IUD

26
Q

Female sterilisation

A

Commonly used are clips via laparoscope

high efficacy

indications:

  • doctor and woman must be satisfied that there will be no regret
  • usually used on older woman whose family is complete, or when disease contraindicates pregnancy

Complications

  • visceral damage on laproscopy
27
Q

Male sterilisation

A

vasectomy more effective than female sterilisation

sterily not assured until azoospermia is confirmed by two semen analyses and may take up to 6 mmonths to achieve

complications = failure, post-op haematomas and infection, chronic pain

28
Q

contraception at a glance

A

continued…