Contraception Flashcards
what are the 3 mechanisms of action of the combined oral contraceptive pill (COCP)
- Prevents ovulation by suppressing LH and FSH
- Progesterone thickens cervical mucus
- Progesterone thins edometrium
give 4 SE of the COCP
- Unscheduled bleeding = common in first 3 mnths
- Breast pain and tenderness
- Mood changes and depression
- Headaches
What advice is given if one COCP is missed (less than 72 hrs since last pill)
-Take missed pill as soon as possible (even if 2 on same day)
-No extra protection required provided other pills before where taken correctly
what should be done if a COCP is missed and MORE than 72 hrs since last pill was taken
-Take most recent missed pill ASAP
-Additional contraception needed until pill has been taken for 7 days straight
-If this was missed on day 1-7 of the packet and they have had unprotected sex they will need emergency contraception
if started within first 5 days of menstrual cycle when does the COCP and POP work ?
immediately
If started after 5 days of menstrual cycle, how many days of extra protection is needed for the COCP and the POP
COCP : seven days
POP : 48 hrs
give 4 SE of the POP
- Unscheduled bleeding
- Breast tenderness
- Headaches
- Acne
what is classed as a ‘missed pill’ with the POP?
-Traditional POP : >3 hrs late (26 hrs from last pill)
-Desogestrel POP >12 hrs late (36 hrs from last pill
what is the advice for a missed POP
- Take pill as soon as possible, taking next pill at usual time
- Use extra contraception for 48 hrs
- Emergency contraception is required if they have had sex since missing the pill or within 48 hrs of restarting the regular pills
what is the progestogen-only injection and when is it given
-Depot medroxyprogesterone acetate (DMPA)
-Given at 12 to 13 wk intervals as IM or Subcut injection
what is a CI to the progesterone only injection
Active breast cancer
how does the projesterone only injection work
Inhibits ovulation by inhibiting FSH secretion
Also thickens cervical mucus and alters endometrium
what are to SE unique to the progesterone only injection ?
weight gain
osteoporosis - oestrogen helps maintain bone mineral density and is produced by the follicles of the ovaries. Suppressing follicle development reduces oestrogen
give 6 CI to the coil
PID or infection
Immunosuppression
Pregnancy
Unexplained bleeding
Pelvic cancer
Uterine cavity distortion (e.g. fibroids)
how does the copper coil work (IUD) and what is a CI
-Copper is toxic to ovum and sperm, licensed for 5-10yrs after insertion
-Wilson’s disease
How does the IUS (mirena coil))work
-Releases levonorgesterel (progestogen) :
-Thicken cervical mucus
-Alter endometrium to make it less acceptive of implantation
-Inhibit ovulation in small no. of women
-Licensed for 5 yrs
what needs to be considered and met when giving contraception to someone under 16
Are they Gillick Competent
Do they meet the Frazer fuidelines
give 3 options for emergency contraception
-Levonorgestrel (take within 72 hrs)
-Ulipristal (within 120 hrs)
-Copper coil (inserted within 5 days of UPSI or within 5 days of estimated ovulation
If a womens cycle was 28 days, when can the IUD be inserted for emergency contracaption
-IUD can be inserted within 5 days after estimated ovulation date
-Estimated ovulation date would be 14 days
-Therefore can be inserted from day 14 to day 19
hoe long should the copper coil be kept in following emergency contraception and what is a complication ??
-Until at least the next period
-PID
how does levonorgestrel work as emergency contraception
-Type of progestogen -> prevents / delays ovulation
-1.5mg as a single dose or 3mg as a single dose in women >70kg or BMI >26
what are common SE of levonorgestrel
-N&V : if occurs within 3 hrs of the pill the dose should be repeated
-Avoid breastfeeding for 8 hrs after dose
What is ulipristal and how does it work as emegency contraception
-Selective prohesterone receptor modulator
-Delays ovulation
-Single 30mg dose
-Wait 5 days before starting combined OCP or progesterone only pill
when should ulipristal be avoided
-Severe asthma
-Breastfeeding should be avoiding for a week
how are the risks of different contraceptions classififed ?
UKMEC 1 : no restriction
UKMEC 2 : benefits generally outweigh risks
UKMEC 3 : risks outweigh benefits
UKMEC 4 : unacceptable risk (CI)
what contraception whould be given in breast cancer
-Copper coil or barrier methods
-Avoid hormonal contraception
what contraception shouldn’t be given in cervical or endometrial cancer
IUS (i.e mirena coil)
what RF would suggest avoiding combined OCP
Uncontrolled HTN
Migraine with aura
History of VTE
>35 y/o smoking >15 cigarettes a day
Major surgery with prolonged immobility
Vascular disease or stroke
IHD, cardiomyopathy or AF
Liver cirrhosis and liver tumours
SLE and antiphospholipid
How long is contraception required after the last period
<50 y/o = 2 yrs
>50 y/o = 1 year
when should the progestogen injection be stopped ?
Before 50 yrs due to osteoporosis risk
what age can the combined OCP be used up to
50
In older / perimenopausal women hormone therapy does no prevet pregnancy
when should amenorrhoeic women taking progestogen-only contaception contunue until
EITHER
-FSH blood test is >30IU/L on two tests taken 6 weeks aprat (continue contraception for 1 more yr)
-55 y/o
give 6 benefits of the combined OCP
-Effective contraception
-rapid return of fertility after stopping
-Improvement in premenstrual symptoms, menorrhagia and dysmenorrhoea
-Reduced risk of endometrial, ovarian and colon cancer
-Reduced risk of benign ovarian cysts
give 3 cancers the combined OCP reduces the risk of
Endometrial
Ovarian
Colon
explain the timing of when the combined OCP will provide protection
-If started on the first day of the cycle = protection straight away
-If starting after day 5 of the cycle, extra contraception is required for 7 days
if switching from the combined OCP to the POP how many days of extra contraception are required
7
However if switching from desogestrel not additional contraception is required
what should be done 4 wks before a major operation if taking the combined OCP
stop the pill to reduce the risk of VTE
what is a complete CI of the POP
Active breast cancer
what are the two types of POP
Traditional - cannot be delayed by more than 3 hrs
Desogestrel-only pil can be take up to 12 hrs late
how does the traditional POP work
Thickens cervical mucus
Alters endometrium making is less accepting of implantation
Reduces ciliary action in fallopian tubes
What does desogestrel work ?
INHIBITS ovulation
Thickens cervical mucus
Alters endometrium
Reduces ciliary action in the fallopian tubes
How long can it take for fertility to return after stopping depot injections
12 mnths
what are the CI to the depot injections
UKMEC 4 : active breast cancer
UKMEC 3 : IHD and stroke, unexplained vaginal bleeding, severe liver cirrhosisn and liver cnacer
what cancers is the depot injection associated with a very small increased risk of
breast an cervical cancer
explain the timing of the depot injection
Day 1-5 of cycle = immediate protection
After day 5 = 7 days of extra protection
give 4 benefits of the depot injection
Improves dysmenorrhoea
Improves endometriosis related sx
Reduces risk of ovarian and endometrial cancer
Reduces severity of sick cell crisis in sickle cell pts
How long does the progestogen-only implant last and how does it work
3 yrs
Inhibits ovulation, thickens cervical mucus and alters endometrium
what is a complete CI to the implant
active breast cancer
Explain the protection given by the implant
On day 1-5 of period = immediate
After day 5 =seven days of extra contraception
what kind of hormonal contraception is mot associated with irregular bleeding
Progesterone only
what can be given to help problematic bleeding with progesterone only contraception >
Taking the combined OCP for 3 mnths
what kind of contraception of coil devices
long-acting reversible contraception
give 6 CI to coils
-PID or infection
-Immunosuppression
-Pregnancy
-Unexplained bleeding
-Pelvic cancer
-Uterine cavity distortion (e.g. by fibroids)
In a women <25 what is done before coil insertion ?
screening for chlamydia and gonorrhoea
what 3 things to need to be excluded when coil threads cannot be seen or palpated
Expulsion, pregnancy and uterine perforation
USS = 1st line
when does the copper coil become effective
immediately
when does the mirena coil become effective
If inserted up to day 7 = immediately
If after day 7, contraception is required for 7 days
what is a female form of sterilisation
Tubal occlusion
Filshie clips occlude the tubes
what is the male sterilisation procedure
Vasectomy -> cutting of the vas deferns
Alternative contraception is require for 2 mnths
Testing of semen to confirm absence of sperm is done at 12 wks
When on the POP, what is the only antibiotic that would require barrier contraception during and for 4 wks after cessation of treatment
Rifampicin
What does the COCP contain and explain its effectiveness ?
- Combination of oestrogen and progesterone
- 99% effective with perfect use
- 91% effective with typical use
What 2 COCP do NICE recommend first line due to lower VTE risk ?
- Levonorgestrel (Microgynon)
- Norethisterone (Loestrin)
What COCP is offered first line for PMS and why ?
- Yasmin (contains drospirenone)
- Has anti-mineralocorticoid and anti-androgen activity which helps with symptoms
What are the 2 common regimes for taking the COCP?
- 21 days on and 7 days off
- 63 days on (three packs) and 7 days off (“tricycling“)
- Continuous use without a pill-free period
Give 4 risks of the COCP
- HTN
- VTE
- Small increased risk of breast and cervical cancer (returns to normal 10 yrs after stopping).
- Small increased risk of MI and stroke
What is a UKMEC 3 for the COCP?
BMI above 35
If started on the first day of the cycle (first day of menstrual period), when does the COCP offer protection ?
Straight away
If the COCP is started after day 5 of the menstrual cycle, how long is barrier contraception required for ?
7 days
When switching from a tradition progesterone only pill to a COCP, how many days of extra protection is required
7 days
When switching from desogestrel to a COCP, how many days of additional contraception is required ?
NON
When should the COCP be stopped prior to a major operation
4 weeks
