Contraception Flashcards
Describe the COCP
- Stops ovulation, thickens cervical mucus, thins endometrium
- Daily pill, same time every day for 21 days, then 7 days “pill-free” break OR take pill continuously every day with no break OR tricycling
- Will need additional contraception for first 7 days if not started within first 5 days of the cycle
- Reduced efficacy if: vomiting within 2hrs of pill, liver enzyme inducing drugs
- Small risks: blood clots, heart attack/stroke, breast and cervical cancer
What are contraindications to the COCP?
- Smoker >15 cigarettes and >35yrs of age
- <6/52 post partum
- Breastfeeding
- HTN
- CVD
- Current breast cancer
- Liver cirrhosis
- History of VTE
- Migraine with aura
What are the missed pill rules for the COCP?
- 1 missed pill: take the last pill, even if you take 2 in one day, no additional measures needed
- 2+ missed pills: take the last pill, even if you take 2 in one day, but no more than that in a day, continue taking normal thereafter, use condoms or abstain from sex until you have taken the pill 7 days in a row
What are other rules on contraception for COCP?
If pills are missed in:
- Week 1 of packet: need emergency contraception if had unprotected sex in pill free interval or 1st week of packet
- Week 2: no extra contraception indicated if has taken the pill 7 days in a row
- Week 3: omit pill free week
Describe the action of the progesterone only pill
- Increases cervical mucus, thins endometrium
- Take daily at the same time. No pill free breaks.
- Affects periods: May stop periods, make them irregular or more frequent
- Contraindications: liver disease, current/past breast cancer, poor medication compliance, unexplained vaginal bleeding
What are missed pill rules for the progesterone only pill?
- Take as soon as possible (can take two in one day)
- Carry on taking pill normally thereafter
- If >3hrs late (or >12 hrs for others), then use condom for 2 days
- Emergency contraception if had sex 2-3 days before or after missed pill
What are the action and features of the copper IUD?
- Decreases sperm motility and survival
- Reliable immediately following insertion
- Effective for 5-10 years
- Make periods heavier and more painful
- Uterine perforation 2 in 1000
- Small risk of PID 20 days after insertion
- Expulsion risk 1 in 20 – usually within 3 months
- Contraindications: pelvic infection, PID <3 months, gynaecological cancer, small uterine cavity, undiagnosed PV bleeding, copper allergies
What are the action and features of the IUS mirena coil?
- Endometrial and cervical mucous thickening
- Reliable after 7 days
- Effective for 5 years
- Initial spotting, but lighter menses eventually
- Uterine perforation 2 in 1000
- Small risk of PID after insertion
- Expulsion risk 1 in 20 – usually within 3 months
- Contraindications – pelvic infection, PID <3 months, gynaecological cancer, small uterine cavity, undiagnosed PV bleeding, copper allergies
What are the features of implantable contraceptives?
- Nexplanon (previously Implanon)
- Radio-opaque
- Slowly release etonogestrel – progesterone hormone
- Inserted in proximal aspect of non dominant arm, overlying the tricep
- Prevents ovulation and thickens cervical mucus
- Additional contraceptive methods needed for first 7 days if not inserted days 1-5 of cycle
- Can feel it in arm
What are the adverse effects and contraindications of implantable contraceptives?
Adverse effects:
- Irregular/heavy bleeding – so can be used alongside the combined pill to manage this
- Progestogen effects – headaches, nausea, breast pain
- Enzyme inducing drugs can reduced the efficacy of Nexplanon
Contraindications: ischaemic heart disease, stroke, current breast cancer, liver disease, unexplained vaginal bleeding
What are the features of the progesterone injection?
- Same side effects/contraindications as progesterone implant
- 3 monthly injections
- Can take time for fertility to return to normal
What are the surgical options for contraception?
- Not suitable for those who may want children
- Vasectomy for males and Tubal ligation for females
- Some women may have oophorectomy or complete hysterectomy
- Consider surgical risks
- Consider early menopausal symptoms
Describe Levonorgestrel (Levonelle) as emergency contraception
- ?Inhibits ovulation and implantation by delaying or preventing follicle rupture - Levenelle
- Take ASAP – within 72hrs of UPSI
- 1.5mg stat dose – 2x if BMI >26 or weight >70kg
- Disturbance of current menstrual cycle common
- If vomiting within 3hrs, repeat dose
- Can be used more than once in menstrual cycle
- Hormonal contraception can be started immediately
Describe Ulipristal (Ella One) as emergency contraception
- Inhibits ovulation
- Take ASAP – within 120hrs of UPSI, stat dose 30mg
- Can be used more than once in the same cycle
- Hormonal contraception can be started after 5 days
- Delay breastfeeding for a week
Describe the copper IUD as emergency contraception
- Most effective method of emergency contraception
- Must be inserted within 5 days (120 hours) of UPSI OR If a woman presents after 5 days then an IUD may be fitted up to 5 days after the likely ovulation date
- May inhibit fertilisation or implantation
- Can be given with prophylactic abx if high risk of STI
- Can be left in situ (for up to 10 yrs) but if removal required then should be kept in until the next period
