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Phase 3a > Contraception > Flashcards

Contraception Flashcards

1
Q

What is the mechanism of the COCP?

A
  1. prevent ovulation (O+P > neg feedback on hypothalamus + pit gland > inhibits GnRH, LH, FSH > inhibits ovulation)
  2. prog thickens cervical mucus
  3. prog inhibits endometrial proliferation
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2
Q

What age is the COCP licensed up until?

A

50

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3
Q

What are the 1st line types of COCP? Why?

A

any containing levogestrel or noresthisterone eg microgynon or loestrin

= lowest risk of VTE

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4
Q

Which COCP is indicated for women with PMS?

A

yasmin - contains drospirenone (anti-mineral corticosteroid + anti-androgen effects > reduces bloating, water retention + mood changes)

can also help to take continuously rather than cyclically

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5
Q

Which COCP is indicated for women with acne?

A

dianette - contains co-cyprindiol (anti-androgenic effects)

HOWEVER only recommended for up to 3m or before if acne clears, 1.5-2x risk of VTE compared to 1st line

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6
Q

Which COCP can be given if women find that a pill-free week disrupts the routine of taking a pill everyday?

A

microgynon

contains 7 inactive pills

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7
Q

What are the 3 possible regimes of COCP?

A

21 days on, 7 days off
63 days on, 7 days off
continuous

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8
Q

What are the SEs/risk of the COCP?

A

unscheduled bleeding initially
HTN, headaches
breast tenderness
mood changes
increased risk of VTE/MI/stroke, cervical + breast ca

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9
Q

Which cancers do COCP increase and decrease the risk of?

A

increase cervical and breast ca
decrease ovarian, endometrial and colon ca

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10
Q

What are the benefits of the COCP?

A

PMS, menorrhagia, dysmenorrhoea
decreases ovarian, endometrial + colon ca risk
rapid return of fertility
reduces benign ovarian cyst risk

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11
Q

What are the UKMEC 4 CI of the COCP?

A

uncontrolled HTN
hx VTE/stroke/vascular disease
migraine with aura
cardiomyopathy, IHD, AF
major surgery with prolonged immobility
liver cirrhosis/tumours
SLE, APS

> 35 + >15 cigs/day
(ukmec 3 = bmi>35)

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12
Q

What additional contraception is needed depending on when in the cycle the COCP is started?

A

day 1-5 > immediate protection
day 6+ > barrier protection for 7 days

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13
Q

What additional contraception is needed if a woman switches type of COCP?

A

none
switch immediately after day 21 and take back-to-back with no pill free week

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14
Q

What additional contraception is needed if a woman switches from a traditional POP to the COCP?

A

switch anytime
need 7 days barrier contraception

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15
Q

What additional contraception is needed if a woman switches from desogestrel to the COCP?

A

switch anytime, immediate protection as desogestrel also inhibits ovulation

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16
Q

What happens if a woman has vomiting and diarrhoea whilst taking the cocp?

A

treat as a missed pill

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17
Q

Which medications can reduce the efficacy of the COCP?

A

rifampicin

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18
Q

How can VTE risk be reduced in women undergoing major surgery who take the COCP?

A

stop 4wks before

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19
Q

What rule should be remembered to work out the impact of a missed COCP?

A

in theory, 7 days on then 7 days off = inhibits ovulation

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20
Q

When is a COCP defined as missed?

A

> 24hrs late (so >48hrs after previous pill)

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21
Q

If 1 COCP is missed (ie within 72hrs of previous one), what steps need to be taken?

A

take missed one asap, even if have 2 in one day
no additional protection if pills before and after are correct

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22
Q

If more than one COCP is missed (ie >72hrs after previous one), what steps need to be taken?

A

take missed one asap, even if 2 in one day
barrier protection until 7 days of COCP taken correctly

if between day 1-7 > emergency contraception if UPSI in this time
day 8-14 > no emergency contraception if day 1-7 was correct
day 15-21 > no emergency contraception if day 1-14 was correct, take next pill packet on day 22 with no pill break

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23
Q

Define contraception % effectiveness

A

average person who uses correctly with a regular partner for 1yr has a 100-% effectiveness chance of getting pregnant

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24
Q

Which contraception should be avoided in women with breast ca?

A

anything hormonal
use barrier or copper IUD

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25
Q

Which contraception should be avoided in women with endometrial or cervical ca?

A

avoid IUS

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26
Q

Which contraception should be avoided in women with Wilson’s disease?

A

copper IUD

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27
Q

How long do post-menopausal need contraception for?

A

after LMP:
2yrs if <50
1yr if >50

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28
Q

Can HRT be used as contraception?

A

no

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29
Q

Which contraception is known to improve perimenopausal sx?

A

COCP

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30
Q

Which contraception is CI in women >50? Why?

A

depot > risk of osteoporosis

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31
Q

If a woman is taking prog only contraception and has become amenorrhoeic due to suspected menopause, for how long should they continue taking it?

A

until FSH is 30+ on 2 tests 6 weeks apart, then continue for 1yr after
OR
until age 55

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32
Q

Which contraception are less preferred in women <20?

A

depot > risk of reduced bone mineral density
coil > higher rate of expulsion

although both ukmec 2

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33
Q

When does fertility return after childbirth?

A

21 days

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34
Q

For how long can lactational amenorrhoea be used as contraception?

A

6mo
IF amenorrhoeic + EXCLUSIVELY breastfeeding

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35
Q

Which contraception can be started any time after birth, irrespective of breastfeeding?

A

POP
implant

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36
Q

When can the COCP be taken after birth?

A

if breastfeeding = CI for 1st 6wks
ukmec 2 after 6wks and breastfeeding

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37
Q

When can a coil be fitted after birth?

A

within 48hrs
or after 4wks

NOT in-between (ukmec 3)

38
Q

What are the 2 types of POP?

A

traditional eg norgeston, noriday
desogestrel only eg cerazette

39
Q

What is the only UKMEC 4 CI of POP, implant and DMPA?

A

active breast ca

40
Q

What is the mechanism of POP?

A

thickens cervical mucus
alters endometrium to prevent implantation
reduces ciliary action in the fallopian tubes

desogestrel = also inhibits ovulation

41
Q

What additional contraception is needed depending on when in the cycle POP is started?

A

day 1-5: immediate protection
day 6+: need 48hrs barrier protection as this is how long it takes for cervical mucus to thicken enough to prevent sperm

42
Q

Can the COCP or POP be taken when there is a risk of pregnancy?

A

COCP = no, rule out pregnancy

POP = yes, do pregnancy test at 3wks, no harm to pregnancy

43
Q

If switching from one type of POP to another, what additional contraception is needed?

A

none, switch anytime

44
Q

If switching from the COCP to POP, what additional contraception is needed?

A

ideal time = during pill free break of COCP > no extra contraception needed

if no sex since last COCP packet > switch and barrier protection for 48hrs
if sex since last COCP > 7 days of COCP, switch and barrier protection for 48hrs
- if not possible eg sudden migraine with aura, use emergency contraception

45
Q

What are the SEs/risk of POP?

A

unscheduled bleeding!! - very unpredictable how a woman will respond, usually settles within 3mo (otherwise exclude other causes)

acne, breast tenderness, headache

small increased risk of breast ca (returns to normal within 10yrs), ectopic pregnancy (with traditional only - reduced ciliary action) + ovarian cysts

46
Q

When are POPs considered missed?

A

traditional = if 3hrs late (ie >27hrs after last)
desogestrel = if 12hrs late (ie >36hrs after last)

47
Q

What action should be taken if a POP is missed?

A

no sex > take missed one and next one at normal time, 48hrs of barrier protection

sex in missed period/within 48hrs of correctly taking > emergency contraception

48
Q

What happens if a woman has D&V whilst taking the POP?

A

= missed pill
need barrier protection for 48hrs after D&V stops

49
Q

What does the prog-only injection contain?

A

DMPA > IM/SC injection of medroxy progesterone acetate

50
Q

How often is the DMPA needed?

A

every 12-13 wks
unlicensed every 10-14 if needed
risk of pregnancy >13wks

51
Q

What types of DMPA are there?

A

depot-provera = IM
sayana press = SC at home

noristerat = contains norethisterone, short-term use for 8wks protection

52
Q

What is the mechanism of a DMPA and implant?

A

inhibits ovulation (inhibits FSH from pit > prevents follicle development in ovaries)

thickens cervical mucus
alters endometrium to prevent implantation

53
Q

What additional contraception is required depending on when the DMPA or implant is started throughout the cycle?

A

day 1-5 = no additional protection
day 6+ = 7 days barrier

54
Q

What are the CI to the DMPA?

A

only ukmec 4 = active breast ca

3 = IHD, severe liver cirrhosis, liver ca, unexplained vag bleeding

55
Q

Which woman should we be careful about giving the DMPA to?

A

anyone taking steroids for asthma/inflammatory disease + older women > risk of OP

avoid in >50

56
Q

What are the risks/SEs a/w DMPA?

A

risks = OP, small risk of breast + cervical ca

takes up to 12m for fertility to return to normal
unpredictable unscheduled bleeding !!
weight gain

57
Q

For how long can irregular bleeding persist with the DMPA? How can this be treated?

A

6m

COCP add-on for 3m
mefanemic acid for 5 days during bleeding

58
Q

For how long can irregular bleeding persist with the DMPA? How can this be treated?

A

6m

COCP add-on for 3m
mefenamic acid for 5 days during bleeding

59
Q

What are the benefits of the DMPA?

A

helps dysmenorrhoea, endometriosis sx, lessens sickle cell crisis
reduces risk of ovarian + endometrial ca

60
Q

How long does an implant last?

A

3yrs

61
Q

What is the implant used in the UK?

A

nexplanon
contains etonogestrel

62
Q

What are the benefits of the implant?

A

can improve dysmenorrhoea
may cause lighter/no periods
lasts 3yrs

no weight gain, CI in obesity, increased risk of VTE, effect on BMD

63
Q

What are the risks of the implant?

A

bent/fractured/impalpable implant
involves minor op

64
Q

What should be done if an implant becomes impalpable?

A

add barrier protection
USS/XR
if not found > CXR

65
Q

When are coils CI?

A

PID/infection
immunosuppression
uterine cavity abnormalities eg fibroids
pregnancy
unexplained bleeding
pelvic cancer

66
Q

What are the risks related to the insertion of a coil?

A

bleeding
pain
vasovagal sx
uterine perforation
PID
expulsion - highest in 1st 3m

67
Q

How long do women need to be protected from pregnancy before coil insertion?

A

abstain/condoms for 7days before

68
Q

What action should be taken if coil threads are non visible?

A

perforation/expulsion/pregnancy

barrier contraception
USS > XR > hysteroscopy/laparoscopic surgery depending on location

69
Q

How does the IUD work?

A

copper toxic to ovum and sperm
alters endometrium

70
Q

How long is the IUD and each IUS licensed for?

A

IUD: 10yrs

Mirena, kyleena + levosert = 5yrs
Jaydess = 3yrs

71
Q

How long is mirena licensed for HRT?

A

4yrs
(5yrs for contraception)

72
Q

Which 2 IUS are licensed for menorrhagia?

A

levosert, mirena

73
Q

How do LNG-IUS work?

A

thicken cervical mucus
alter endometrium

inhibits ovulation in a small number of women

74
Q

When in the cycle can LNG-IUS be inserted and what additional contraception is needed?

A

day 1-7 = no additional protection
post day 7 = exclude pregnancy, barrier protection for 7 days

75
Q

What can be found incidentally on a smear in a woman with an IUD?

A

actinomyces-like organisms
no tx unless sx
if sx > removal considered

76
Q

What are the 3 options for emergency contraception?

A
  1. IUD
  2. ulipristal (ellaOne)
  3. levonorgestrel (levonelle)
77
Q

What is the 1st line emergency contraception?

A

IUD > most effective, no effected by BMI, malabsorption, enzyme-inducing drugs

78
Q

When are oral emergency contraceptives the most effective?

A

the sooner the better

not useful after ovulation but offered anytime during the cycle anyway

79
Q

When can an IUD be fitted as emergency contraception after UPSI?

A

5 days after UPSI OR expected date of ovulation

expected date = shortest cycle length - 14 days

80
Q

For how long should an IUD be kept in that was fitted for EC? What should be given at fitting?

A

until next period
or 10yrs for contraception

give empirical abx if at high risk of infection

81
Q

How long after UPSI can levonorgestrel be given as EC?

A

3 days after

82
Q

Who needs a double dose of levonorgestrel as EC?

A

> 70kg/BMI >26

83
Q

How do the oral EC methods work?

A

prevent/delay ovulation
not known to be harmful to pregnancy

84
Q

What is a common SE of oral EC methods?

A

N&V

if vomit within 3hrs of taking = need another dose

85
Q

Can women who are breastfeeding take the oral EC methods?

A

levonorgestrel = stop for 8hrs after, no known risk

ulipristal = stop for 1wk after taking

86
Q

Can the POP/COCP be taken after oral EC methods?

A

levenorgestrel = can take immediately after
ulipristal = wait 5 days

POP = + barrier contraception for 2 days
COCP = + barrier for 7 days

87
Q

What class if ulipristal?

A

SERM - selective progesterone receptor modulator

88
Q

Which is more effective of the oral EC methods?

A

ulipristal

89
Q

For how long after UPSI can ulipristal be taken?

A

5 days

90
Q

Which women is ulipristal CI in?

A

severe asthma

Phase 3a (11 decks)

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