Contraception Flashcards
What does COCP contain and how does it work?
Contains both oestrogen + progesterone.
-ve feedback = suppressing the lncrease of GnRH.
Why can’t COCP be taken on the 1st 21 days postpartum ?
increased risk of VTE esp. while breastfeeding.
What is COCP protective against?
Ovarian and endometrial cancer
What is MoA of COCP?
Preventing ovulation (primary mechanism of action).
Progesterone thickens the cervical mucus.
Progesterone inhibits proliferation of the endometrium, reducing the chance of successful implantation.
What are the RF of COCP?
Unscheduled bleeding in 1st 3 months.
Breast pain + tenderness
Mood changes + Depression
Headaches
Migraines w/ aura = risk of Stroke / VTE
Hypertension
Increase Risk of Breast + cervical cancer
When to take COCP?
1st day of mensural cycle = should after 7 days of use.
Why is POP useful?
Has fewer contraindications + risk compared w/ combined pill
Is POP useful for breastfeeding ?
For breastfeeding women + non-breastfeeding women = POP can be started immediately.
Does not contain oestrogen = less likely to supress milk production.
What is counted as a missed pill when taking POP (Traditional) ?
Cannot be delayed by > 3 hrs.
Taking the pill more than 3 hrs later = missing pills.
MoA of POP?
Traditional: Thickening the cervical mucus.
Destogestrel: inhibits ovulation.
How long does POP take to work?
2 days.
How long does it take for fertility to return after Progesterone Injection ?
12 months. (Not suitable for younger kids).
When is Progesterone Injection started?
Started on 1 - 5 days of menstrual cycle offers immediate protection = injection required every 12 weeks (3 months).
What are the contraindications for Proges Injection?
Active breast cancer. Ischaemic heart disease + stroke. Unexplained vaginal bleeding. Severe liver cirrhosis. Liver cancer.
What is the MoA of progest Injection ?
Inhibits ovulation = inhibiting FSH secretion = stopping development of follicles.
Thickening cervical mucus.
Altering the endometrium and making it less accepting of implantation.
What are the RF for Progest injections?
Bleeding may become heavier + longer = can become irregular. Weight gain - :( Acne Reduced libido Mood changes Headaches Flushes Hair loss (alopecia) Skin reactions at injection sites
Negative cause in using Progest injection?
Can cause osteoporosis = consider in older women, steroids users / inflammatory conditions.
What are the benefits of Progest Injection?
Improvesdysmenorrhoea(painful periods).
Improvesendometriosis-related symptoms.
Reduces the risk ofovarian+endometrial cancer
Reduces the severity ofsickle cell crisisin patients with sickle cell anaemia.
What is Progest Implant ?
Plastic rod placed in the upper arm = above subcutaneous fat (subdermal) non-dominant arm.
How long does the implant Last ?
3 years
Implant cannot be use in pts w/…
Active breast cancer
When does the implant work?
Insertion on day 1 - 3 of menstrual cycle = immediate protection = if after 5 days = require extra protection e.g. condoms.
MoA of Implant?
Inhibiting ovulation.
Thickening cervical mucus.
Altering the endometrium and making it less accepting of implantation.
RF of the Implant?
Worsens Acne
Causes problematic bleeding
Implant can be lost
Coils are contraindicated?
Pelvic inflammatory disease or infection Immunosuppression Pregnancy Unexplained bleeding Pelvic cancer Uterine cavity distortion (e.g. by fibroids) Wilson disease (excessive copper)
How long can copper coil be used ?
5 - 10 yrs
How long does copper coil take to work?
immediatly
MoA of Copper coil ?
Toxic to the ovum + sperm.
Alters the endometrium + makes it less accepting of implantation.
What negatives do some women experience w/ copper coil?
Heavy bleeding + pain
increases risk of Ectopic Preg
LNG-IUS contains what?
progesterone = slowly released into the uterus
How long can IUS be used?
5 years
MoA of IUS?
Thickening cervical mucus
Altering the endometrium and making it less accepting of implantation
Inhibiting ovulation in a small number of women
Benefits of IUS?
It can make periods lighter or stop altogether
Irregular bleeding LATER light / amenorrhea
It may improve dysmenorrhoea or pelvic pain related to endometriosis
What are the 3 types of Emergency Contraception?
Levonorgestrelshould be taken within 72 hours of UPSI
Ulipristalshould be taken within 120 hours of UPSI
Copper coilcan be inserted within 5 days of UPSI
SE of Levonorgestrel?
N + V = MOST COMMON.
If vomiting still occurs within 3 hrs = repeat the pill.
Spotting and changes to the next menstrual period
Diarrhoea
Breast tenderness
Dizziness
Depressed mood
What is the SE of Ulipristal ?
Spotting and changes to the next menstrual period Abdominal or pelvic pain Back pain Mood changes Headache Dizziness
Contraindication for Ulipristal
Breastfeeding = avoided for 1 week after taking ulipristal (milk should be expressed and discarded)
Ulipristal should be avoided in patients withsevere asthma.
