contraception Flashcards
main barrier contraception Is condoms
daily is oral contraceptive pill
what are the LARCS
injections
implants
IUD
IUS
vasectomy and tubal ligation are irreversible methods
what types of barrie methods
advantage and disadvantage
male and female codnoms ( 8 hours before)
cerivcal caps - 3 hours before
diaprhagms - 3 hours before
preven sperm from contact into female ovum
adv- protective against UTIs
Dis- high chance of human error
24 yr old attends sexual health clinic to discuss. PMH of acne and PCOS( polycystic ovary syndrome) . heavy periods and irregular and would prefer light and regular periods. She wants to avoid any methods that cause her to gain weight
Which is the most suitable method
COCP -prefered option for women with PCOS
can also help with acne
IUD - periods to become heavier
implant - irregular periods
injection linked to weight gain
POCP - weight Gain
COCP inhibits ovulation it is good for immediate return of normal fertility but increased risk of VTE ( VENOUS THROMBO-EMBOLISM)
increased risk of breast cancer but reduce the risk of ovarian and womb cancer
what are the two types
monophonic - same amount of oestrogen and progesterone taken for 21 days
phasic - varying amount of progesterone and oestrogen - taken every 28 days back to back - placebo pills at the end to allow bleed
Uk medical eligibility criteria
UKMEC4
over 35 year old and smoking over 15 a day
migraine with aura
history of thrombogenic mutation or thromboembolic disease , stroke or ischaemic heart disease
breastfeeding under 6 weeks postpartum - UKMEC4 \
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
POCP thickens the cervical mucus - is is good alternative to COCP
however requires a daily commitment
increase risk of ovarian cysts
what is it contradiction
breast cancer
live cirrhosis or tumours
ischaemic heart disease
long acting reversible contraception LARCs
progesterone only implant inhibits ovulation but should not be used in breast cancer what are the side effects
acne , implanted too deeply
benefits are that it improves dysmenorrhoea and no weight gain , no effect on bone mineral density , no VTE risk, no restriction of use in obese patients
lasts 3 years
nexplanon - licensed between ages 18-40 years old
progesterone only injection two types
deep-provera (IM) and saying press (SC) - women can do themselves
it is given 12-13 week intervals between day 1-5 menstrual cycle
inhibts ovualtion
however should not be used in breast cancer , liver cirrhosis or OP in over 50 year olds
what are the side effects
irregular bleeding
weight gain
acne
slow return of fertility
IUD - copper coil - toxic to ovum and sperm
why is this so good
when should it not be used
immediately effective and used in emergency contraception up to 5 days
avoid in Wilsons disease ) cooper accumulation)
side effect including heavy bleeding, pelvic pain and ectopic risk
LNG-IUS - MIRENA MOST COMMON
5 years of contraception and 4 years for HRT
this thickens cervical mucus and inhibits ovulation
benefits and side effects
immediately effective fi inserted
light periods , amenorrhea and menorrhagia, no OP
SE- irregular bleeding , ectopic risk and ovarian cysts
contraindications of IUD and IUS
risk of stiff pregnancy unexplained vagianl bleeding pelvic cancer fibroids
problematic bleeding - first 6 months
takes pill every day so a phasic COCP
If she misses this what happens
the missed and continue with daily and no extra
if missed more than 1 pill take immediately one and take next normal but contraception is re-established after 7 days
if missed 2 or more in first 7 days then emergency needed
if in week 2 menstrual cycle then no action
if week 3 just finish pill and then immedaielty start again so no pill interval
21 days 7 days monophonic COCP or progesterone only
MECK 4 criteria so would be on progesterone only pill
if she missed this what do you do
within 3 hours no action Is needed, if taking cerazette can extend to 12 hours
beyond this no longer effective - take next pill at time and contraception re-estabilished after 48 hours
emergency contraception is given within a specific time period after unprotected sex or wishing number of day of estimated ovulation
if you have a 22 day cycle what is the estimated ovulation on day
8
what are the emergency contraceptives
IUD - inserted put to 5 days UPSI - coil should remain until next periods - or within 5 days of estimated ovulation
Ulipristal -LO1
selective progesterone modulator
this delays ovulation and is 30mg up to 120 hours after UPSI
SE N+V spotting and abode pain and mood changes but avoid in breastfeeding and sever asthma.
Levonorgestrel
progesterone
prevents or delayed ovulation
15mg single dose up to 72 hours UPSI
diarrhoea dn depressed modd for this
this is safe with breastfeeding but avoid after 8 hours of dose
