Contraception Flashcards
How do combined contraceptives work
- Inhibit ovulation
- Oest and prog act on HP axis = reduce LH and FSH = no ovulation
- Oest = endometrium proliferates and grows
- Prog = prevents hyperplasia
Amenorrhoeic and starting COC
- Start at any time
- Additional contraception 7 days
Postpartum and COC
- As long as no breastfeeding
- Start day 21 postpartum
- Contraception for 7 days
- If BF = >6 weeks as above
Miscarriage/TOP and COC
- Gestation <24 weeks, start in 5 days of surg/med TOP and no additionals
- > 24w = as for postpartum
No regular contraception and COC start
- Day 1 of menstrual cycle
- No additional needed
(same if 2-5 days) - If other time in cycle = barrier method 7 days
Starting COC after oral emergency
- Levonorgestrel = immediately and 7 days
- Ulipristal acetate = 5 days after and 7 days
Switch from POP to COC
- Any time in cycle and 7 days
Vomit within 3hrs of COC
- Take another pill asap
v/d more than 24hrs
- follow instructions
- barrier for 7 days
starting patch
- day 1-5 cycle
- no additional needed
unscheduled patch detachment for <48hrs
- new patch asap
- That no additional contraception is required if the patch was used correctly earlier in week 1 and the 7 days prior to the HFI.
>48hrs - new patch asap
- barrier for 7 days
Inserting IUS
- days 1-7 cycle = no additional
- any other time in cycle = 7 days
Postpartum IUS
- within 48hrs (no additional) or from 4 weeks (7 days)
IUS after TOP
- Post surgical abortion, insert the LNG-IUS at the end of the procedure.
- Post medical abortion, insert the LNG-IUS any time after completion of the second part of the abortion
- If the device is fitted after day 7 post-abortion additional
IUS emergency contraception
Do not insert the LNG-IUS until pregnancy can be excluded with a pregnancy test performed no sooner than 3 weeks after the last episode of unprotected sexual intercourse.
IUD post partum
- 48hrs or 4 weeks
- no additional for either
IUD post TOP
- no additional needed
IUD post emergency
- Insert the IUD within the first 5 days (120 hours) after the first episode of UPSI or within 5 days of the earliest expected time of ovulation (for example, on day 19 of a regular, 28-day cycle), whichever is later. No additional
- Outside of the above criteria, do not insert the IUD until pregnancy can be excluded with a pregnancy test performed no sooner than 3 weeks after the last episode of UPSI.
POP starting
- Day 1-5 of cycle
- No additional
POP amennorhoea
- 7 days additional
post partum
- up to 21 days post partum = no additional
- Can be started any time after childbirth
- After 21 days = 7 days additional
POP after emergency
Levonorgestrel
- 7 days additional
Ulipristal
- 5 days after
- barrier for 7
Can start straight away
Missed POP
- Take a pill as soon as possible. If more than one pill has been missed, only one should be taken.
- Take the next pill at the normal time. This may mean taking two pills in 24 hours (the missed pill and the next one at the usual time).
- Avoid sexual intercourse or use a barrier method of contraception (such as condoms) for 7 days if taking drospirenone, or 2 days for all other POPs.
Implant insertion
- 1-5 cycle, no additional
- after day 5 = 7 days
Implant postpartum
- Before 21 days = no additional
- After 21 days = 7 barrier
Levonorgestrel
- Take asap
- Within 72 hrs UPSI
- double dose if BMI >26/70kg
- Vomit within 3hrs = repeat
- hormonal contraception can be started immediately after
ulipristal
- 30mg dose no later than 120 hrs after
- may reduce effectiveness of hormonal
- caustion if severe asthma
- delay BF 1 week after taking
Missed COC pill
1 pill missed
- Take the alst pill even if 2 pills in 1 day
2 or more missed
- take last pill
- Missed in week 1 = emergency contraception if UPSI
- Missed in week 2 after 7 days taking = no need emergency
- Missed in week 3 = finish pack and omit pill free interval
Method most associated with weight gain
Depo provera
POP missed pill
- <3hrs late = no action required
- > 3hrs late = take missed pill, continue rest of pack, extra precautions until re-established 48hrs
What contraception is contraindicated in trans men undergoing testosterone therapy
- COC or any containing oestrogen as can antagonize testosterone
