Contraception Flashcards
What are the components of the COCP?
The COCP has two active ingredients:
- ethinyloestrodial (synthetic estrogen)
- levonorgestrel (synthetic progestin)
The MoA is:
✔️ inhibition of ovulation
✔️ thinning of the endometrium
✔️ thickening of the cervical mucus plug, to prevent passage of sperm
There are two formulations:
- 21 active days + 7 inactive days
- 24 active days + 4 inactive days
Identify indications for the COCP?
✔️ contraception (91 to 99% effective) ✔️ acne ✔️ abnormal uterine bleeding (e.g. dysmenorrhea, menorrhagia) ✔️ PCOS ✔️ endometriosis ✔️ PMS
Identify some CONTRAINDICATIONS for the COCP?
✔️ personal or family history of breast cancer
✔️ personal or family history of DVT or PE
✔️ obesity
✔️ 35 years + active smoking
✔️ 35 years + migraine with aura
✔️ impaired liver function
✔️ unexplained vaginal bleeding
What are some common side effects of the COCP?
✔️ nausea + vomiting ✔️ weight gain ✔️ headaches and migraine ✔️ depression / low mood ✔️ breakthrough bleeding ✔️ can take up to 12 months for fertility to return
Explain how the COCP should be implemented?
- It is best to begin the COCP whilst bleeding (days 1 to 5 of cycle).
- Take one pill every day (every 24 hours).
- If a pill is skipped but within 24 hours, take the pill as soon as remembered.
- If a pill is skipped but is greater than 24 hours, take the skipped pill PLUS the required pill (two pills in one day) and use alternative form of contraception for 7 days.
✔️ if < 7 days since most recent inactive pill, EMERGENCY CONTRACEPTION
✔️ if < 7 days since next inactive pill, continue the pack, do NOT take inactive pill - It is possible to run pill packets without a break –> this may cause breakthrough bleeding.
- Seek medical attention if headaches, migraines or visual disturbances occur.
What are the components of the MINI PILL?
Levonorgestrel (synthetic progesterone).
Mechanism of action is NOT inhibition / suppression of ovulation –> very unreliable in doing this. Main MoA is thinning of endometrial lining to prevent implantation of a fertilised egg.
Identify the indications and contraindications for the mini pill.
INDICATIONS
✔️ breast feeding
✔️ post partum
✔️ contraindications to COCP
CONTRAINDICATIONS ✔️ active breast cancer within last five years ✔️ SLE ✔️ unexplained vaginal bleeding ✔️ hepatocellular carcinoma
Explain the implementation of the MINI PILL.
The mini pill has a MoA that lasts ~21 hours. It should be taken within three hours each day.
If missed, alternative contraception should be used for 48 hours.
Identify some common side effects of the MINI PILL.
✔️ irregular menstrual periods ✔️ acne ✔️ weight gain ✔️ mood changes ✔️ breast tenderness
Describe the use of the IMPLANON.
Implanon is a subnormal device that contains a long-acting / slow-releasing synthetic progesterone.
It is inserted using a local anasthetic. The bar can be left in place for 3 years.
Advantages:
✔️ long acting contraception
✔️ 99% effective
✔️ do not need to remember to take every day; good for younger women / girls
✔️ fertility returns immediately after removal
Disadvantages:
✔️ irregular periods (amenorrhea, menorrhagia or light spotting / breakthrough bleeding)
✔️ must be replaced every three years
Compare the COPPER versus PROGESTERONE (MIRENA) IUD.
COPPER IUD
✔️ may be used / inserted as emergency contraception
✔️ left in place for 10 years
✔️ associated with heavier bleeding and cramping
✔️ spermidocidal
MIRENA
✔️ cannot be used as emergency contraception; placed during laparoscopic exploration / caesarian section etc.
✔️ left in place for 5 years
✔️ associated with lighter bleeding, amenorrhea and less cramping
✔️ also indicated in dysmenorrhea or menorrhagia
What are some contraindications to the IUD?
✔️ recent STI / PID
✔️ recent septic ectopic pregnancy / abortion
✔️ gyancaelogical malignancy
✔️ uterine anomaly
Identify some risks of the IUD.
✔️ 99% effective; still a small risk of pregnancy
✔️ perforation
✔️ spontaneous expulsion
✔️ ectopic pregnancy (if pregnancy does occur)
✔️ long-term irregular bleeding
✔️ PID (within first few months)
Describe how the IUD should be inserted.
- The IUD is best inserted during Days 1 to 5 of a woman’s cycle.
- Perform a high cervical / vaginal swab for STIs prior to insertion.
- If screen comes back positive, leave the IUD in place and treat aggressively with antibiotics.
- Review in 4 to 6 weeks for PID / STIs and to check the strings are still in place.
- Annual review after that.
EMERGENCY CONTRACEPTION ✔️active ingredients ✔️ implementation ✔️ mechanism ✔️ risks / disadvantages ✔️ alternatives
ACTIVE INGREDIENTS
Levonorgestrel 1.5g (synthetic progesterone)
This medication can be taken orally within 72 hours of unprotected sexual intercourse –> 99% effective if taken during this time.
IMPLEMENTATION
Oral pill; taken once.
May be prescribe with an anti-emetic to reduce N+V.
Vomiting and diarrhoea reduce effectiveness.
MECHANISM
Levonorgestrel delays ovulation.
Does NOT prevent implantation of an already fertilised egg.
RISKS / DISADVANTAGES ✔️significant nausea and vomiting ✔️ breast tenderness ✔️ may delay next period ✔️ next period may be heavy ✔️ not a sustainable means of ongoing contraception
ALTERNATIVES
The Copper IUD may also be used as a form of emergency contraception.
This can be placed within 5 days of unprotected intercourse and is 99% effective.
It can also be left in for 10 years for ongoing contraception.
