Contraception Flashcards
Name an example of a Combined oral contraceptive pill (COCP)
Microgynon (Ethinylestradiol + Levonorgestrel)
Yasmin (Ethinylestradiol + Drospirenone)
Name an example of a Progesterone only pill (POP)
Cerazette (Desogestrel) «_space;12 Hour pill
Norethisterone also used (3 hour pill though???)
Name an example of a contraceptive patch used in the UK
Evra
Name a contraceptive vaginal ring
Nuva ring
How do Combined hormonal contraceptives work?
Negative feedback to the pituitary = prevents release of LH + FSH = Inhibits ovulation
Effects on endometrium = Prevents implantation
Effects on cervical mucus = Prevents sperm penetration
What are the 4 types of regimens for Combined hormonal contraceptives?
Extended use (3 pill packs taken back to back / 3 months on pill followed by 7 day break)
Shortened pill-free interval (3 weeks of CHC use then 4 days taken between pill pack)
Extended use with shortened pill-free interval (use for >=21 days; CHC-free period omitted until breakthrough bleeding occurs then 4 day break)
Extended use with regular pill-free interval (use for >=21 days; CHC-free period omitted until breakthrough bleeding occurs then 7 day break)
When is patch CHC preferred to oral CHC?
Patch preferred when PMHx of VTE
What are the benefits of Combined Hormonal Contraceptive use?
Reduces:
- Menstrual bleeding
- Menstrual pain
- Ovarian cancer risk
- Endometrial cancer risk
- Colorectal cancer risk
What are the risks associated with Combined Hormonal Contraceptive use?
Breast cancer (risk increased)
Cervical cancer (risk increased)
VTE (DVT/PE)
Cardiovascular disease + Stroke
What is the name of the criteria for CHC contraindications
UK MEC Criteria
Outline the UK MEC Criteria
Age >35 + Smoking >15/day
Hypertension (sBP >=160; dBP >=95)
VTE (current or previous)
Migraine with aura
Current breast cancer
CHD/IHD/Stroke
Name 2 drugs which effect the efficacy of COCP
Anti-epileptic (eg Phenytoin)
Rifampicin
Certain HIV drugs
What are the side effects of POP?
Headaches,
Breast pain,
Acne,
Nausea,
Changes in libido
When are POP contraindicated?
DO NOT USE IN CURRENT BREAST CANCER
What drug is used in the POP injectable? (eg in Depo provera)
Medroxyprogesterone acetate
What are the risks associated with POP injectables (Depo provera)
Osteoporosis,
Weight gain,
Delayed return of fertility
What is a contraindication for the Depo provera?
Current breast cancer
What are the benefits of the subdermal progesterone only implant? (eg Nexplanon)
LARC (less likely to fail due to user reasons)
No adverse effects on BP, risk of VTE or CV disease
BMD – no effect
Rapid return of ovulation»_space; fertility following removal
What are the risks associated with the subdermal progesterone only implant (eg Nexplanon)
Procedure-related» Infection. Bleeding/Bruising. Scarring.
First 3 months»_space; Irregular bleeding is common.
Long term:
- 2 in 10 = Amenorrhoea
- 3 in 10 = Infrequent bleeding
- 2 in 10 = Prolonged bleeding
What is a contraindication for the subdermal progesterone only implant (eg Nexplanon)
COMPLETE CONTRAINDICATION = CURRENT BREAST CANCER
What are the side effects associated with intra-uterine contraceptive device insertion? (IUS/IUCD)
Pain/Discomfort at insertion.
Infection/PID.
Bleeding.
Perforation (of the uterus – 5/1000).
Expulsion (use threads to check or Speculum examination – 1/1000).
Failure + Ectopic pregnancy.
Note: the IUCD can be fitted at the time of caesarean section - if not fitted at the time then have to wait 6 weeks until insertion
What are the specific side effects associated with IUCD usage?
Dysmenorrhoea and/or HMB
What are the specific side effects associated with IUS usage?
Hormonal side effects: (less than systemic progesterones)
- Breast tenderness
- Acne
- Headaches
Irregular bleeding
Give 3 UKMEC Category 4 criteria for IUD/IUS insertion
Initiation of intrauterine methods:
o Pregnancy.
o Current PID or Symptomatic CT or NG
o Pelvic tuberculosis
o Postpartum sepsis
o Immediate post-septic abortion
Initiation of the method in women with unexplained vaginal bleeding:
o Malignant Gestational Trophoblastic Disease
o Cervical cancer
o Endometrial cancer
What is a contraindication for IUS insertion (eg Mirena)?
Breast cancer
Name 3 emergency contraceptives
Levonorgestrel
Ulipristal acetate (EllaOne)
Copper intrauterine device (IUD)
How long is Levonorgestrel licensed for emergency contraceptive use?
Licensed for use up to 72 hours after unprotected sexual intercourse or contraceptive failure
How long is Ulipristal acetate (EllaOne) licensed for emergency contraceptive use?
Licensed for use up to 120 hours after unprotected sexual intercourse or contraceptive failure
How long is the IUD licensed for emergency contraceptive use?
Can be used up to 5 days following first unprotected sexual intercourse anywhere in cycle.
OR
Within 5 days from the earliest estimated day of Ovulation.
What patient information is provided following Levonorgestrel use?
o Emergency contraception can fail.
o Pregnancy test in 3 weeks if abnormal period
o Nausea, Headaches, Breast tenderness or Abdominal pain
o If patient vomits within 2 hours Repeat dose
o Continue or quick start regular contraception + use condoms
o Repeated use of emergency contraception within same cycle is OK
What patient information is provided following Ulipristal acetate (ellaOne) use?
o CHC or POP may interfere with action of ellaOne»_space; commence CHC/POP 5 days after administration
o Breast feeding NOT recommended for 7 days after intake
o Repeated use of emergency contraception within same cycle is OK
When is Ulipristal acetate (ellaOne) especially more effective than Levonorgestrel?
Ulipristal acetate may be more effective than Levonorgestrel in those with BMI >26 or Weight >70kg
* First line (for BMI >26 or BW >70kg) = Cu-IUD (but patients may prefer second line drugs)
* Second line = Ulipristal acetate (or 3mg Levonorgestrel)
