Contraception Flashcards
Main method of action of Depo Provera
The main method of action is by inhibiting ovulation. Secondary effects include cervical mucus thickening and endometrial thinning.
what does the Depo Provera contain
It contains medroxyprogesterone acetate 150mg
How is the Depo Provera injection given
It is given via in intramuscular injection every 12 weeks.
It can however be given up to 14 weeks after the last dose without the need for extra precautions
Adverse effects of the Depo Provera
Adverse effects
* irregular bleeding
* weight gain
* may potentially increased risk of osteoporosis: should only be used in adolescents if no other method of contraception is suitable
* not quickly reversible and fertility may return after a varying time
Contraindication for the Depo Provera
breast cancer: current breast cancer is UKMEC 4, past breast cancer is UKMEC 3
Disadvanatges to the Depo Provera
Disadvantages include the fact that the injection cannot be reversed once given.
There is also a potential delayed return to fertility (maybe up to 12 months)
Amenorrhea may be dividened into:
- primary: defined as the failure to establish menstruation by 15 years of age in girls with normal secondary sexual characteristics (such as breast development), or by 13 years of age in girls with no secondary sexual characteristics
- secondary: cessation of menstruation for 3-6 months in women with previously normal and regular menses, or 6-12 months in women with previous oligomenorrhoea
Causes of Primary Amenorrhea
- gonadal dysgenesis (e.g. Turner’s syndrome) - the most common causes
- testicular feminisation
- congenital malformations of the genital tract
- functional hypothalamic amenorrhoea (e.g. secondary to anorexia)
- congenital adrenal hyperplasia
- imperforate hymen
Causes of secondary amenorrhea
- hypothalamic amenorrhoea (e.g. secondary stress, excessive exercise)
- polycystic ovarian syndrome (PCOS)
- hyperprolactinaemia
- premature ovarian failure
- thyrotoxicosis: hypothyrodysm may cause amenorrhea too
- Sheehan’s syndrome
- Asherman’s syndrome (intrauterine adhesions)
Investigations in amenorrhea
- exclude pregnancy with urinary or serum bHCG
- full blood count, urea & electrolytes, coeliac screen, thyroid function tests
- gonadotrophins: low levels indicate a hypothalamic cause where as raised levels suggest an ovarian problem (e.g. Premature ovarian failure)
raised if gonadal dysgenesis (e.g. Turner’s syndrome) - prolactin
- androgen levels : raised levels may be seen in PCOS
- oestradiol
Management of primary amenorrhea
- investigate and treat any underlying cause
- with primary ovarian insufficiency due to gonadal dysgenesis (e.g. Turner’s syndrome) are likely to benefit from hormone replacement therapy (e.g. to prevent osteoporosis etc..)
Management of secondary amenorrhea
- exclude pregnancy, lactation, and menopause (in women 40 years of age or older)
- treat the underlying cause
After taking ulipristal acetate women should wait……. before starting regular hormonal contraception
After taking ulipristal acetate women should wait 5 days before starting regular hormonal contraception
Common side effect of Nexplanon and management of this
A common side effect of Nexplanon is unscheduled bleeding. This may be managed by a three month course of a combined oral contraceptive
Oestrogen-containing contraceptives should preferably be discontinued………..before major elective surgery and all surgery to the legs or surgery which involves prolonged immobilisation of a lower limb
what contraception can be offered as alternative?
4 weeks
A progestogen-only contraceptive may be offered as an alternative and the oestrogen-containing contraceptive restarted after mobilisation.
