Contraception Flashcards
Method of action of COCP?
Primary method: Acts on the HPA axis to prevent secretion of FSH and LH - to stop ovulation
Thickens cervical mucus
Reduces endometrial receptivity
COCP problems?
Breakthrough bleeding, breast tenderness and mood swings
VTE risk
MI and stroke risk
Increased breast cancer risk, maybe cervical cancer
Method of action of progesterone only pill?
Ovulation is inhibited to varying degrees
Transport of ovum is delayed
Cervical mucus thickening
Reduces endometrial receptivity
Problems with progesterone only pill?
Can’t miss a pill really at all.
Amenorrhoea & Breakthrough bleeding.
Increased risk of ovarian cysts
Increased risk of breast cancer
Slightly increased risk of ectopic pregnancy
Primary mode of action of progesterone only injectables (e.g. depo-provera)?
Suppress ovulation
Problems with depo injections (progesterone only)?
Not easily reversible
Loss of bone density
- can’t use if under 18, or if any osteoporosis risk
Irregular bleeding, with amenorrhoea eventually
Some weight gain may occur
Possibly risk of breast and cervical cancer
Progesterone only implant mode of action?
Inhibit ovulation
Problems with implant?
Not many,
- Irregular bleeding common for a year
IUD mode of action? How long can it remain/
IUD = device (COPPER)
Toxic to sperm and ova
Thickened cervical mucus
Endometrium gets shit
10 years
Problems with IUD?
Insertion may be unpleasant
Spotting & bleeding in-between periods
Short term increase risk of PID
IUS mode of action, how long can it remain?
Mirena is 5 years
Progesterone t shaped device works by reducing endometrial growth and preventing implantation (local progesterone effects)
Thickens cervical mucus
Does NOT affect ovulation.
Problems with the IUS?
Insertion may be unpleasant
Can get menstrual irregularities for the first year, but them amenorrhoea or no bleeding.
Typical progestogenic side-effects (potentially acne/breast tenderness/headache/mood changes
Difference in a diaphragm and cap?
Diaphragms should lie diagonally between the posterior fornix and behind the pubic bone
Caps are smaller than diaphragms, fitting closely over the cervix
Most effective contraception?
Implant
What dose does the patch release?
20mcg of ethinyl oestradiol and 150mg norelgestromin daily
What do you need to ask in a Hx for IUD?
Fibroids
Pelvic infection
Last menstrual period
Generally everything:
- Menstrual/obstetric/sexual Hx
- Problems in the past
Primary mode of action of the patch?
Suppress ovulation
Benefits of COCP?
Reduced colorectal cancer risk
Reduced risk of ovarian and endometrial cancer
Improved acne
Can you use tampons with the ring?
Yes
How long after expulsion should you re-insert the vaginal ring?
48 hours
What contraceptives can be used with liver enzyme inducing drugs?
IUD, Depo and IUS.
Can use double dose of levonorgestrel EC
What would contraindicate CHC use? (UKMEC 3 & 4)
HTN (even if controlled)
0-6 weeks postpartum and breastfeeding
0-3 weeks postpartum non-breastfeeding
Migraine with aura
>35 and smoker (UKMEC2 if >1 year ago)
Stroke/IHD
High VTE risk
Breast Cancer
Examples of liver enzyme inducing drugs?
St johns wort, Phenytoin, Rifampicin, Carbamazepine, modafinil.
UKMEC 3 & 4 for progesterone only medication?
Depo - R/F for CVD, stroke, IHD
All - current and past breast cancer, hepatocellular Cancer
IUC UKMEC 3 & 4?
48hrs - 4weeks postpartum
Post-abortion sepsis
Long QT
Initiation w/ infection
Risk of intrauterine perforation in IUD insertion?
2 in 1000
How long before a change in IUD should a woman use extra precaution?
5 Days
How long is Levonorgestrel EC licensed for?
72 hours (3 days)
How long after UPSI is UPA EC licensed for?
120 Hours (5 days)
How long after UPSI is IUD licensed for?
120 Hours (5 days)
How does Levonorgestrel affect UPA and vice versa?
If UPA has been taken then can’t take Levonorgestrel in the next 5 days
If Levonorgestrel has been taken then UPA may not work for the next 7 days
