Contraception Flashcards
What is the MOA of COCP?
Inhibition of ovulation
What is the MOA of POP (except desogestrel)?
Thickens cervical mucous
What is the MOA of desogestrel?
Inhibition of ovulation
What is the MOA of the injectable contraceptive (medroxyprogesterone acetate)?
Main MOA:
- Inhibits ovulation
Other MOAs:
- thickens cervical mucous
What is the MOA of the implantable contraceptive (Nexplanon)?
Main MOA:
- Inhibits ovulation
Other MOAs:
- thickens cervical mucous
What is the MOA of IUD (copper coil)?
Decreases sperm motility and survival
What is the MOA of IUS (Mirena coil)?
Main MOA:
- Prevents endometrial proliferation
Other MOAs:
- Thickens cervical mucous
What is the MOA of levonorgestrel emergency contraception?
Inhibits ovulation
What is the MOA of ulipristal acetate emergency contraception?
Inhibits ovulation
What is the MOA of IUD emergency contraception?
Main: toxic to sperm and ovum
Other: inhibits implantation
What are the UKMEC 4 contraindications to COCP?
- > 35 years old and smoking >15 cigarettes/day
- Migraine with aura
- History of thromboembolic disease or thrombogenic mutation
- History of stroke or ischaemic heart disease
- Breastfeeding < 6 weeks post-partum
- Uncontrolled hypertension
- Current breast cancer
- Major surgery with prolonged immobilisation
- Positive antiphospholipid antibodies (e.g. in SLE)
What are the UKMEC 3 contraindications to COCP?
- > 35 years old and smoking <15 cigarettes/day
- BMI > 35 kg/m^2*
- Family history of thromboembolic disease in first degree relatives < 45 years
- Controlled hypertension
- Immobility e.g. wheel chair use
- Carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
- Current gallbladder disease
What are UKMEC2 contraindications to COCP?
Breastfeeding 6 weeks to 6 months post-partum
What are the benefits of the COCP?
- Less strict “missed pill rules” than the progestogen-only pill
- May make periods more regular, lighter and less painful
- May reduce the risk of ovarian, endometrial and bowel cancer
What are the limitations of COCP?
- Side effects may include headaches, nausea, breast tenderness and mood swings
- Vomiting and diarrhoea may affect the effectiveness
- Certain drugs including anti-epileptic drugs may affect the effectiveness
- Increases the risk of VTE and stroke
- Potentially increases the risk of breast cancer while using the COCP
What are the indications for COCP use besides preventing pregnancy?
- Hyperandrogenism (PCO/PCOS)
- Menorrhagia
- Dysmenorrhoea
- Endometriosis
- Leiomyomas
What is the Pearl Index?
A statistical estimate of the number of unintended pregnancies in 100 woman-years of exposure
- 100 women over 1 year of 1
- 10 women over 10 years of use
What is the Pearl index score of COCP?
9%
- Out of 100 women using COCP over 1 year period, 9 would have unintended pregnancy
What should a woman do if she has missed 1 COCP in week 1?
- EC not required
- take the missed pill ASAP
- continue remaining pill at same time (2 pills in 1 day)
- no additional precautions
What should a woman do if she has missed 1 COCP in week 2 or 3?
- EC not required
- take missed pill ASAP
- continue remaining pill at same time (2 pills in 1 day)
- no additional precautions
What should a woman do if she has missed 2-7 COCPs in week 1?
- Consider EC if UPSI has taken place during hormone-free interval or week 1
- take most recent pill ASAP
- continue the remaining pills at the same time
- condoms/avoid sex until pill has been taken for 7 consecutive days
- consider follow-up pregnancy test
What should a woman do if she has missed 2-7 COCPs in week 2 or 3?
- EC not required
- take most recent pill ASAP
- continue the remaining pills at the same time
- Omit the hormone-free interval if 2+ pills missed in the 7 days before it was supposed to occur
- condoms/avoid sex until pill has been taken for 7 consecutive days
What should a woman do if she has missed >7 COCPs in any week of pill taking?
- Consider EC if UPSI at any point
- Manage as new start contraception
- Consider immediate pregnancy test
- Quick start new COC packet
- Condoms/avoid sex until pill has been taken for 7 consecutive days
- Consider follow-up pregnancy test
What are the benefits of the POP?
- Suitable for patients where oestrogen is contraindicated or those who are intolerant to oestrogen
- Taken without breaks so don’t have to remember to start and stop pills
