contraception Flashcards
contraindiactions to coils
pelvic inflammatory disease
immunosuppression
pregnancy
unexplained bleeding
pelvic cancer
uterine cavity distortion - fibroids
copper coils
99% effective
fertility returns immediately after
can be left for 5-10yrs
can be used as emergency contraception
NOT in Wilsons - excessive accumulation of copper in body + tissues
copper coil mode of action
copper = toxic to ovum + sperm
also alters endometrium + makes it less accepting of implantation
copper coils pros/cons
reliable, effective immediately at any time of cycle
no hormone - safe for VTE, hormone related cancers
may reduce risk of endometrial + cervical cancer
cons
- requires procedure
- can cause heavy or intermentrual bleeding
- pelvic pain sometimes
- increase risk of ectopic pregnancies
mirena coil (IUS) MoA
releases levonorgestrel (progesterone) into local area
- thickens cervical mucus
- altering endometrium + making it less accepting of implantation
- prevents endometrial proliferation
insertion of mirena coil
can be inserted up to day 7 of menstrual cycle without any need for additional contraception
if inserted after - extra protection required for 7 days
benefits / drawbacks of mirena coil
make periods lighter/stop
may improve endometriosis assoc pain
no effect on bone mineral density
no increase VTE risk
aditional uses - HRT, menorrhagia
cons
- can cause spotting - settles 6months
- increased risk of ectopic
- increased incidence of ovarian cysts
- systemic absorption - acne, headaches, breast tenderness
progestogen only implant
last 3 years
99% effective with perfect + typical use
UKMEC4 in ACTIVE BREAST CANCER
MoA of progestogen only implant
inhibits ovulation
thickens cervical mucus
pros / cons of progestogen only implant
can improve dysmenorrhoea - painful menstruation
make periods lighter/stop
cons
- minor operation
- lead to worsening acne
- can cause problemative bleeding
progesterone only injection
given at 12-13wk intervals as IM or SC injection of medroxyprogesterone acetate
99% effective with perfect use, 94% with typical
can take 12months for fertility to return once stopped
- bad for those trying to get pregnant soon
MoA of pogesterone only injection
inhibit ovulation - inhibits FSH preventing development of follicle
thickens cervical mucus
altering endometrium + making it less accepting of implantation
progesterone only injection contraindications
UKMEC4 = active breast cancer
UKMEC3
- ischaemic heart disease + stroke
- unexplained vaginal bleeding
- severe liver cirrhosis
- liver cancer
can cause osteoporosis - old women, steroids
–> due to block of oestrogen
weight gain
benefits of progesterone only injection
improve dysmenorrhoea - painful periods
improved endometriosis-related symtpoms
reduces risk of ovarian + endometrial cancer
reduces severity of sickle cell crisis in patients with sickle cell anaemia
progestogen only pill
99% effective perfect, 91% typical
UKMEC4 active breast cancer
addition contraception required for 1st 48hrs - time takes to thicken mucus
MoA of progestogen only pill
thickening cervical mucus
altering endometrium + making it less accepting of implantation
reducing ciliary action in fallopian tubes
side effects of progestogen only pill
unscheduled bleeding common in first 3 months
increased risk of
- ovarian cysts
- small risk of ectopic pregnancy due to reduced ciliary action
- minimal increased risk of breast cancer, return to normal 10yrs after stopping
“missed pill” POP
> 3hrs (26hrs after last)
12hrs (36hrs) if desogestrel-POP
take pill ASAP, take next pill at usual time (even if taking 2 in 24hrs)
- use extra contraception for next 48hrs
emergency contraception required if had sex since missing the pill or within 48hrs of restarting regular pills
vomiting, diarrhoea = missed pills, extra contraception until 48hrs after settles
combined oral contraceptive pill (COCP)
contains combination of oestrogen + progesterone
licensed for use up to age 50yrs
takes 7 days before protected from pregnancy
COCP MoA
prevents ovulation
progesterone thickens cervical mucus + inhibits proliferation of endometrium, reducing chance of successful implantation
oestrogen+progesterone have neg feedback on hypothalamus + ant pituitary - GnRH, LH + FSH (without LH+FSH ovulation does not occur)
lining of endometrium is stable while taking pill, when stopped - uterus breaks down + sheds
- leads to “withdrawal bleed” - not classed as a menstrual period
side effects of COCP
unscheduled bleeding - common in first 3 months
mood changes + depression
hypertension
VTW
small risk of -
- breast + cervical cancer - risk returns to normal 10yrs after stopping
- MI + stroke
benefits of COCP
rapid return of fertility after stopping
improved menstrual symptoms
reduced risk of endometrial, ovarian + colon cancer
reduced risk of benign ovarian cysts
contraindications (UKMEC4) of COCP
uncontrolled hypertension
migraine with aura - risk of stroke
aged >35 + smoking more than 15 a day
major surgery with prolonged immobility
vascular disease or stroke
ischaemic heart disease, cardiomyopathy or Afib
liver cirrhosis + liver tumours
SLE, antiphopholipid syndrome
BMI>35 = UKMEC3
missed pills COCP
> 24hrs late (48hrs since last pill)
missing 1 pill (<72hrs since last pill)
- take missed pill ASAP
- no extra protection required provided other pills before + after are taken correctly
missing >1 (>72hrs)
- take ASAP
- additional contraception required for 7 days
- if day 1-7 -> emergency contra if unprotected sex
- if day 8-14 -> none needed (if fully compliant 1-7)
- if day 15-21 -> none needed, skip free period
