contraception Flashcards
what is the cocp patch
how long is a cycle and how does it work
if patch delayed longer than 48 hours
evra patch
lasts 4 weeks
patch changed every weeks and not worn 4th week to allow for bleed
if longer than 48 hours between changing patches then 7 days contraception required
advantage and disadvantage of cocp
A- effective, reversible effects, decreases risk of endometrial and ovarian cancer and colorectal cancer and good for acne
D- forget to take
increases risk of breast and cervical cancer
lot of se- headaches n+v
increases risk of vte
UKMEC 4 contraindications
UKMEC 3 (JUST READ)
more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)
UKMEC3-
Examples of UKMEC 3 conditions include
more than 35 years old and smoking less than 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
when should we strat taking cocp
WHEN
WITHDRAWAL BLEED?
WHEN MAY EFFICACY BE REDUCED
if the COC is started within the first 5 days of the cycle then there is no need for additional contraception. If it is started at any other point in the cycle then alternative contraception should be used (e.g. condoms) for the first 7 days
SAME TIME EVERYDAY
AFTER 21 DAYS STOP TO HAVE A WITHDRAWAL BLEED
Discussion on situations where efficacy may be reduced*
if vomiting within 2 hours of taking COC pill
medication that induce diarrhoea or vomiting may reduce effectiveness of oral contraception (for example orlistat)
if taking liver enzyme-inducing drugs
MISSED PILL
IF ONE MISSED ANY TIME
IF 2 MISSED
If 1 pill is missed (at any time in the cycle)
take the last pill even if it means taking two pills in one day and then continue taking pills daily, one each day
no additional contraceptive protection needed
2 MISSED
take the last pill even if it means taking two pills in one day, leave any earlier missed pills and then continue taking pills daily, one each day
if pills are missed in week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1
if pills are missed in week 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception*
if pills are missed in week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval
COCP BENEFITS IN MEOPAUSE
DEPOPROVERA DISADVANTAGES
COCP use in the perimenopausal period may help to maintain bone mineral density
COCP use may help reduce menopausal symptoms
a pill containing < 30 µg ethinylestradiol may be more suitable for women > 40 years
DEPOPROVERA DISADVANTAGE
women should be advised there may be a delay in the return of fertility of up to 1 year for women > 40 years
use is associated with a small loss in bone mineral density which is usually recovered after discontinuation
MOA
CONDOMS
COCP
POP
MEDOCYPROGESTRONE ACETATE (INJEC)
IMPLANTABLE - ETONOGESTREL
INTRAUTERINE CONTRACEPTIVE DEVICE
IUS- LEVONORGESTREL
PHYSICAL BARRIER
COCP- INHIBITS OVULATION
POP THICKENS CERVICAL MUCUS
INECTABLE- Primary: Inhibits ovulation
Also: thickens cervical mucus
IMPLANTABLE SAME- Primary: Inhibits ovulation
Also: thickens cervical mucus
IUD- DECREASES SPERM MOTILITY AND SURVIVAL- (levonorgestrel) IUS-Primary: Prevents endometrial proliferation
Also: Thickens cervical mucus
OBESE PATIENTS AND COCP
UKMEC 2: BMI 30-34 kg/m²
UKMEC 3: BMI >= 35 kg/m²
COCP TRANDERMAL LESS AFFECTIVE IN OVER 90KG
Patients who have had a gastric sleeve/bypass/duodenal switch cannot have oral contraception ever again due to lack of efficacy, including emergency contraception.
WHEN SHOULD A YOUNG PERSON BE ADVISED TO HAVE STI CHECK
young people should be advised to have STI tests 2 and 12 weeks after an incident of unprotected sexual intercourse (UPSI)
EMERGENCY CONTRACEPTON
LEVONORGESTREL
ULIPRISTAL
IUD
LEVONORGESTREL- STOP OVULATION AND INHIBIT IMPLANATION- 72 HOURS OF UPSI
DOSE DOUBLED IF OVER 26BMI
IF VOMITED WITHIN 3 HOURS RETAKE
ULLIPRISTAL- ELLAONE- INHIBIT OVULATION NO MORE THAN 120 HOURS. CAUTION IN ASTHMA, BREAST FEEDING DELAYED FOR A WEEK
IUD- must be inserted within 5 days of UPSI, or
if a woman presents after more than 5 days then an IUD may be fitted up to 5 days after the likely ovulation date
if someone on antiepileptics what contraception should they take
For women taking phenytoin,carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine:
UKMEC 3: the COCP and POP
UKMEC 2: implant
UKMEC 1: Depo-Provera, IUD, IUS
For lamotrigine:
UKMEC 3: the COCP
UKMEC 1: POP, implant, Depo-Provera, IUD, IUS
what is the implantable contraceptive
ukmec
disdvantage
neplaxon
UKMEC 3*: ischaemic heart disease/stroke (for continuation, if initiation then UKMEC 2), unexplained, suspicious vaginal bleeding, past breast cancer, severe liver cirrhosis, liver cancer
UKMEC 4**: current breast cancer
heravy bleeding
any day other than 1-5 then additional contraceptives needed
name me the injectable contracptive
depo provera contains medroxyprogestrone acetate- im injection every 12 weeks
becomes weffective after 7 days
irregular bleeding
weight gain
may potentially increased risk of osteoporosis: should only be used in adolescents if no other method of contraception is suitable
contraindicated in breast canc3r
IUD
MOA
how long use
problems?
copper intrauterine device-
decreases perm motility and survival
effective fior 5 years, effective immediately
make periods longer and infection
IUS
MOA
