contraception Flashcards
Combined hormonal contrace
oestrogen and a progesterone
tablets(COC) , transdermal patches (CTP) and vaginal rings (CVR)
health benefits of Combined hormonal contrace
reduced risk of ovarian endometrial and colorectal cancer
predictable bleeding patterns
reduced dysmenorrhoea and menorrhagia
management of symptoms of PCOS endometriosis and prementsrual syndrome
improved acne
reduced menopausal symptoms
maintain bone density in peri menopausal females under age of 50
what age should cop not be continued after
beyond age of 50 as there are safer options
monophasic vs multiphase
monophasic has a fixe amount of oestrogen and progesterone
multiphasic has varying amount of both hormones
most common oestrogen component in COC
ethinyestradiol ranging from 20-40micrograms
first line COC
monophasic containing 30 micrograms or less of ethinyestradiol with levonrgesterol or norothistherone
when are non oral CHC advised
concerns of absorption
what advise is given to patients weighing 90kg or more
consider non topical options or additional precautions with transdermal patches
regimen choice for CHC
traditional vs tailored
traditional
21 days with a monthly withdrawal bleed during 7 day hormonal free interval (HFI)
examples of tailored regimens
only used with monophasic CHC containing ethinyestradiol
shortened HFI : 21 days followed by 4 day HFI
extended use tricycling : 9 weeks of continuous use followed by a 4/7 day HFI
flexible extended use : continuous use for 21 days followed by 4 day HFI when breakthrough bleed occurs
continuous use with not HFI
withdrawal bleeds vs normal mesturation
not the same - can’t prove patient isn’t pregnant
when should CHC be discontinued before surgery
4 weeks before
major elective surgery
surgery to the legs or pelvis
surgery involving prolonged immobilisation to a lower limb
condoms should be used and CHC can be recommenced 2 weeks after full remobilisation
what should be done if CHC can’t be stopped before surgery e.g. after trauma
thromboprophylaxis should reconsidered
