Contraception Flashcards
What are the three things which can be used as emergency contraception?
Levonorgestrel: up to 72h, can be given more than once per cycle
EllaOne: up to 120h, can be given more than once per cycle
Copper coil: up to 120h after UPSI or up to 5d after likely ovulation date
What is UKMEC 4? What are 9 UKMEC 4 conditions for the combined oral contraceptive?
Unacceptable health risk:
> 35y + smoking >15 cigarettes/day
Migraine with aura
Hx of VTE
Hx of stroke or IHD
Breast feeding < 6w post-partum
Uncontrolled HTN
Current breast cancer
Major surgery with prolonged immobilisation
+ve antiphospholipid antibodies (e.g. in SLE)
What is UKMEC 3? List 7 UKMEC 3 conditions for the COCP
Disadvantages generally outweigh advantages:
>35y + smoking <15 cigarettes/day
BMI > 35 kg/m^2*
FH thromboembolic disease in 1st degree relatives < 45y
Controlled HTN
Immobility e.g. wheel chair use
Carrier of known gene mutations a/w breast cancer (e.g. BRCA1/BRCA2)
Current gallbladder disease
Give 3 advantages of the COCP
Effects reversible upon stopping
Makes periods regular, lighter + less painful
Reduced risk of ovarian + endometrial cancer- this effect may last for several decades after cessation
Give 4 disadvantages of the COCP
May forget to take it
Increased risk of VTE
Increased risk of breast + cervical cancer
Increased risk of stroke + IHD (esp. in smokers)
When is additional contraception needed when starting the COCP?
If start COCP in first 5 days of cycle: Not needed
If start COCP at any other point, need condoms for 7 days
What happens if you miss pills on the oral contraceptive?
1 missed pill: Take next pill ASAP, no contraception needed
2 missed pills: Take last missed pill ASAP, no more than 2 in one day, consider additional contraception for 7 days
If missed pills in week 1 of pack + UPSI during pill free interval/ 1st week: Emergency contraception
If missed pills in week 2 of pack + UPSI: no emergency contraception needed
If missed pills in week 3 of pack + UPSI: Finish current pack + start next pack (omit pill free interval)
What is the MOA of the COCP?
Inhibits ovulation
Give 3 side effects of the COCP
Headaches
Nausea
Breast tenderness
What is the MOA of the POP? (excluding desogestrel)
Thickens mucus
When is additional protection needed when starting the POP?
If start POP in first 5 days of cycle: provides immediate protection
Otherwise condoms should be used for the first 2 days
If switching from COCP: gives immediate protection if continued directly from the end of a pill packet (i.e. Day 21)
How should the POP be taken?
At the same time every day, without a pill-free break
What action is required if a patient misses the POP?
Take missed pill ASAP
if < 3h late: continue as normal
if > 3h: continue with the rest of the pack, condoms should be used until pill taking has been re-established for 48h
Which progesterone only pill has a 12h window within which the pill can be taken without extra precautions needed?
Cerazette (Desogestrel)
Give 3 side effects of the POP
Irregular bleeding
Mood swings
Acne
What is the MOA of desogestrel, medroxyprogesterone acetate (Injection) and etonogestrel (Implant)?
Primary: Inhibits ovulation
Also thickens cervical mucus
What are the progesterone-only options?
Mirena coil: 3-5 y
Progesterone depot: given every 3 months. Can’t be given to extremes of reproductive age, will affect fertility for up to a year after cessation
Implant: SC Nexplanon, lasts 3y
Progesterone only pill
How does the copper coil work?
Sterile inflammation of endometrium
Decreases sperm motility + survival
Lasts 5y or 10y
NOT SUITABLE FOR WOMEN WITH HEAVY PERIODS
What is the most effective form of emergency contraception?
Copper IUD (120h, OR within 5 days of the earliest estimated date of ovulation)
What are the hormonal forms of emergency contraception?
Levonorgestrel (72 hours)
Ulipristal acetate (120 hours/5 days)
How long after delivery can a woman get a IUS?
Immediately if no complications (within 48h)
OR
After 4 weeks
How long after birth can a woman get POP?
Immediately after birth up to 21 days, no additional contraception.
If start after 21 days, additional contraception needed for first 2 days
How long after birth can a woman get the COCP?
Breastfeeding: 6w
Not breastfeeding: 3w + need condoms for 7 days
How many days for COCP to start working?
7 days
How long should be the COCP be stopped for elective surgery?
4 weeks pre-operatively
2 weeks post-operatively
How long after taking emergency ulipristal acetate can a woman restart COCP?
5 days
How long after taking emergency levonorgesterol can a woman restart COCP?
Immediately
If a woman takes emergency levonorgesterol and vomits within 3 hours, what should she do?
Repeat dose
If a woman takes emergency ulipristal and vomits within 3h, what should she do?
Repeat dose
Which emergency contraceptive pill if safe whilst breastfeeding?
Levonorgestrel
Which emergency contraceptive is contraindicated in severe asthmatics?
Ulipristal
What emergency contraception is advised in those >70kg or BMI >26?
Ulipristal
If Levonorgestrel, need double dose
Which form of contraception has a reduced efficacy in obese patients?
combined contraceptive transdermal patch
What is the MOA of the mirena coil?
Prevents endometrial proliferation
Prevents implantation
Also: Thickens cervical mucus
What can the IUS be used for in older women?
Endometrial protection for women taking oestrogen-only hormone HTN
Licensed for 4y
How does bleeding change with the IUS?
initial frequent uterine bleeding + spotting.
Later: intermittent light menses with less dysmenorrhoea + some become amenorrhoeic
What are the risks of implantable contraceptives?
Expulsion: 1/20
Infection: small increased risk of PID
Uterine perforation: 2/1000
Ectopic pregnancy: proportion increased, but absolute no. reduced vs. no contraception
Give 2 disadvantages of the injectable contraceptive
Weight gain
Delay in return of fertility: up to 1y
