Contraception Flashcards
Why is Depo-Provera contraindicated in adolescents and IBD?
Reduces bone density (IBD has risk of osteoporosis)
NB can also not use pills in IBD.
How long does breast feeding work as contraception?
If fully breastfeeding and amenorrhoeic it is 98% for 6months.
What contraception can be used while breastfeeding? (and what is contraindicated)
If breastfeeding - COCP is contraindicated <6wks postpartum as it affects breast milk volume, and relatively contraindicated 6wks - 6months postpartum.
If not breastfeeding, COCP cannot be used in first 21 days due to VTE risk.
Progestogen only methods have no effect on milk production and can be used whenever.
IUD can be inserted from 4weeks postpartum.
Which contraception can be used after birth and from when?
No contraception required in first 21 days (earliest date of ovulation is 28 days after birth and sperm can survive for 7 days).
- POP can start anytime.
- COCP absolutely contraindicated if breastfeeding 6wks-6m (reduces milk production) and not used in first 21 days due to VTE.
- Coils inserted within 48hrs of childbirth or after 4 weeks
- EC: Levonelle and Ulipristal can be used after day 21.
When is a women considered infertile (i.e., how long should you consider contraception after last period)?
<50 - continue contraception 2yrs after last period
>50 - continue contraception 1yrs after last period
Name 6 absolute contraindications (UKMEC4) for COCP
> 35yrs old and a smoker of >15cigs/day
Migraine w/ aura
Personal Hx of DVT or PE
Personal Hx of stroke or IHD
Uncontrolled HTN
Breast cancer
Recent surgery w/ prolonged immobilisation
Breastfeeding and <6wks postpartum
COCP - 1 pill missed any point in the cycle, what do you do?
Take last pill, even if taking 2 pills in one day.
No additional contraceptive protection needed
COCP - 2+ pills missed, what do you do if missed in week 1, 2 and 3
Take the last pill, even if taking 2 in one day (no more than 2 though, ignore other missed pills).
Use condoms/abstain until taken pills 7 days in a row (may be over-zealous in weeks 2 and 3 but safer)
Week 1 (days 1-7), missed 2 pills = emergency contraception if sex in pill-free interval/week 1
Week2 (days 8-14) = after 7 days of consecutive contraception, no need for EC
Week 3 = finish pills in current pack and start a new back the next day (thus omitting the pill free interval).
If >7 consecutive pills missed, take EC and restart as new pill user.
When should you stop pill before surgery?
COCP stopped 4 weeks before major surgery.
Which cancers is COCP a RF for?
Breast and cervical (remembered as the ones we screen for)
It decreases ovulation and endometrial thickening so protective for ovarian, endometrial cancer (also bowel)
POP missed pill rules?
Take the pill ASAP, if outside the window condoms should be taken for 2 days (12hr window, or 3hrs with some)
2 consequences of Depo-Provera
Reduced bone density (relative contraindication in teenagers
Weight gain
Levonelle (Levonorgestrel) window, MoA and hormonal restart
No later than 72hrs after unprotected sex, but best within 24hrs
Affects sperm function and endometrial receptivity, may also prevent ovulation
Hormonal contraception can be restarted immediately
Ulipristal (ellaOne) window, MoA and hormonal restart, 1 contraindication
Can be used 120hrs after intercourse
It is a selective progesterone receptor modulator (SPRM), like mifepristone and prevents/delays ovulation.
Since it blocks the action of progesterone, women should use condoms/avoid sex for 5 days prior to restarting normal hormonal contraceptive (COCP, minipill)
Contraindicated in severe asthma due to anti-glucocorticoid effect of ulipristal
What is the window where copper coil works as EC, what are contraindications to copper coil insertion?
Effective if either 5 days after the episode of unprotected intercourse
Within 5 days after estimated date of ovulation, e.g. if intercourse occurred 2 days before expected ovulation, could be inserted 7 days later.
Contraindicated if signs of active infection/STI as PID.
