Contraception Flashcards
when can the POP be started and when is patient protected from
up to day 5: immediate protection
day 5 onwards: use condoms for 2 days
how is the patch used
change every week for 3 weeks, then one week break
if someone has a patch change delay >48 hours in week one or two, or end of patch free week
use condoms for 7 days
the COC pill carries an increased risk of
cervical cancer
breast cancer
the COC pill carries a decreased risk of
endometrial cancer
ovarian cancer
bowel cancer
OBE
how long is the Mirena Coil licensed for use
5 years
how long is the copper coil licensed for use normally
5 or 10 year use
how long is the copper coil licensed for use if fitted >40yo
until 1 year after LMP
first line COCP for >40
<30ug ethinylestradiol (lower risk strokes, VT, CVD)
how long after childbirth can a contraceptive implant be inserted
immediately
failure rate of female sterilisation
1 in 200
if the POP is late
> 3 hours: take missed pill ASAP, continue pack and use condoms for 48 hours
Missed pill rules COCP
1 pill: continue as normal
2 pills: condoms for 7 days
in week 1: emergency contracpetion
in week 2: crack on
in week 3: finish the pills and start a new pack immediately (miss pill free interval)
After giving birth, when do women require contraception
After day 21
When can women start the POP post party
any time, after day 21 normal rules regarding condoms for 2 days
COCP UKMEC score in breastfeeding <6 weeks
UKMEC 4 - may reduce breast milk production and cause increased VT risk
COCP UKMEC score in breastfeeding 6 weeks-6months
UKMEC 2
When can the IUD or IUS be inserted after childbirth?
within 48 hours, or after 4 weeks
UKMEC 1
no restriction for the use of the contraception
UKMEC 2
benefits outweigh the risks
UKMEC 3
risks outweigh the benefits
UKMEC 4
unacceptable health risk
UKMEC 3 conditions
> 35 and smoke (less than 15 a day)
BMI >35
family hx of thromboembolic disease in 1st degree relative <45
controlled hypertension
immobility
carrier of BRCA gene
current gallbladder disease
UKMEC 4 conditions
> 35 and smoke more than 15 a day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding <6 weeks postpartum
uncontrolled hypertension
current breast cancer
positive antiphospholipid antibodies (SLE)
which contraceptive may decrease bone mineral density in women?
depo provera
delayed return to fertility after the injection
up to 12 months
Levonorgestrel must be taken within __ of unprotected sex
72 hours
a single dose of levonorgestrel is ___mg and should be ___x for a BMI of >__ or weight over ___kg
1.5
2
26
70
more UPSI can occur within __ hours of levonorgestrel with no need to take more
12
how long does nexplanon last for
3 hours
management of bleeding after the implant
<3 months: add 3 month course of COCP to control bleeding pattern
>3 months: cervix exam and STI screen
depoprovera can be _ weeks late with no extra precaution
2 weeks
most suitable contraception for young people
Long Acting Reversible Contraception LARCs: nexplanon implant
COCP weight UKMEC scores
BMI 30: UKMEC 2
BMI >35: UKMEC 3
Patch becomes less effective in patients over __kg
90
safest form of contraception for breast cancer or BRCA gene
copper coil
Ulipristal (EllaOne) can be used up to __ hours post UPSI
120 (5 days)
Levonorgestrel should be used up to __ hours post UPSI
72 hours (3 days)
Contraception for patients with epilepsy
UKMEC 2: implant
UKMEC 1: depo-provera, IUD, IUS
UKMEC 2 conditions
being a smoker under 35
first degree relative with VTE aged 45 or above
when can COC be started after abortion >24 weeks
immediately
primary mode of the contraceptive implant
inhibition of ovulation
time until copper coil effective
immediately
time until injection and implant effective
7 days
time until COC effective
7 days
time until POP effective
2 days
mechanism of desogestrel (cerazette)
inhibits ovulation
expulsion rate of IUD (copper coil)
occurs in 1 in 20 women and more likely in the first 3 months
management of smear test positive for actinomyces organisms with symptoms vs no symptoms
symptoms: remove IUD and penicillin therapy
no symptoms: no action needed
management of nexplanon if patient is on enzyme-inducing drugs
cover with depo-provera
how effective is lactational amenorrhoea if woman is fully breastfeeding and under 6 months postpartum
98%
contraception needed if IUS inserted on day 1-7 of cycle
no additional contraception needed
COC can be used up to __ years of age
50
why is migraine with aura contra-indicated?
significantly increased risk of ischaemic stroke
what is the COCs effect on BMD
help maintain
how long is Mirena licensed for for endometrial protection in women taking oestrogen only HRT
4 years
undiagnosed breast mass UKMEC category
UKMEC 2
does the progesterone implant cause increased risk of VTE, stroke, MI, BMD
NO
time until mirena coil effective
days 1-7: immediately
days 7+: 7 days
how long should a woman wait after taking ulipristal acetate (EllaOne) before returning to hormonal contraception
5 days (ulipristal acetate can reduce hormonal contraceptive)
COCP effect on perimenopausal symptoms
may ease
What UKMEC is past breast cancer
UKMEC 3
what age can contraception be stopped without risk of pregnancy?
55
how many months postpartum does LAM method stop working
6 months
Which contraceptives must be stopped at 50 years old
COCP, depoprovera
most common adverse affect of POP
irregular vaginal bleeding
most common adverse affect of depo provera
weight gain
BMI 30-35 UKMEC score
2
best contraceptive option for BMI>35
mirena IUS
what contraceptive is impacted by enzyme inducing drugs
nexplanon, the patch
most appropriate place for the implant
subnormal, non dominant arm
management of bleeding >3 months on COCP
cervical exam, STI screen, high vaginal and endocervical swab
UKMEC for COCP with positive antiphospholipid antibodies
UKMEC 4
VTE risk in dianette is around __x that of other COCP
twice
types of coils hormone content in order
Jadess
Kyleena
Mirena
which pill is indicated in obesity
cerazette
difference between nexplanon and implanon
implanon less likely to be inserted too deep
radiopaque and so easier to locate
IUD and ectopic pregnancy risk
overall pregnancy risk decreased, but if a woman gets pregnant, it is more likely to be ectopic
how is the copper coil used as emergency contraception
must be inserted within 5 days of UPSI or 5 days after ovulation date
how is the copper coil used as emergency contraception
must be inserted within 5 days of UPSI or 5 days after ovulation date
UKMEC BRCA gene carrier
UKMEC 3
what is the increased risk of PID with an IUD
increased risk in first 20 days then back to normal
which contraceptives take 7 days to work
IUS, injection, COC, implant
how much ethinylestradiol is recommended for first time COCP
30ug
EllaOne is contraindicated in patients with
severe athsma
