contraception Flashcards
Menarche- <18years
(DMPA)
Category 2
- concerns about depoprovera effect on BMD
Postpartum
0-6weeks breastfeeding
(DMPA)
Category 2
- no studies on effect on fetal liver and brain
- concerns of maintenance of breastfeeding
Multiple risk factors for Cardiovascular disease
Progesterone (list for all 3)
Implant : Category 2
DMPA : Category 3
POP: Category 2
Hypertension well controlled
(<140/90)
(DMPA)
Category 2
Others category 1
Risk if VTE with COCP
5-7:10,000 (FSRH)
2:10000 (emq book)
Risk of vte with etonorgestrel containing cocp
6-12: 10000(0.06-0.12%)
Risk of vte with drosperinone/gestodene (3rd generation)
9-12:10000
Benefits of CHC in the perimenopausal period (5)
- regulation of AUB
- reduction in dysmenorrhea and pelvic pain
- reduction in vasomotor symptoms such as menstrual migraines
- protection against bone loss
- reduction in risk of ovarian, colon and endometrial cancer close to time of peak incidence
What is the criteria to discontinue POP, implant or LNG IUS during perimenopause
- method could be stopped at age 55
- testing FSH level of > 30iu then continue x 1 year then discontinue
- FSH <30iu continue for another year and then repeat test
What is the criteria to discontinue DMPA in perimenopause
Women aged 50-55
FSH level checked on day of dosing and 13 weeks later if both >30iu method can be discontinued
What is the criteria to discontinue CHC in the perimenopause
CHC can suppress FSH affecting hormonal testing
- age 50 switch to progesterone only or non hormonal
- discontinue and use barrier method. If no menses in 6 weeks then do FSH 1-2mnths apart
- FSH testing in hormone free interval 6-8 weeks apart
When can CHC be commenced postpartum in non breastfeeding women
> 21days postpartum
Category 2
Risk of expulsion of IUCD within first 3 months
1:20
5%
Risk of uterine perforation with iucd
Up to 0.2%
Risk of ectopic pregnancy if iucd faiils
1:20
