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
emergency contraception - Levonrgestrel (Levonelle)
acts to stop ovulation + inhibit implantation
take ASAP - efficacy decreases with time
- must be taken within 72hrs of unprotected sex
1.5mg dose, double dose if BMI >26 or weight of 70kg
if vomiting occurs within 3hrs then dose should be repeated
can be used more than once in a menstrual cycle
hormonal contraception can be started immediately after
emergency contraception - Ulipristal (EllaOne)
selective progesterone receptor modulator - inhibition of ovulation
30mg taken ASAP - no later than 120hr (5hrs) post sex
restart contraception 5 days after taking - barrier method should be used during this period
caution in severe asthma
can be used more than once in same cycle
**breastfeeding should be delayed for a week
emergency contraception - IUD
most effective method of emergency contraception + should be offered to all
must be inserted within 5days of UPSI
- if later, then may be fitted up to 5 days after the likely ovulation date
may inhibit fertilisation or implantation
99% effective regardless of where it is used in cycle
specific risk factors for contraceptives
breast cancer - any hormonal, go for IUD or barrier
cervical or endometrial - avoid IUS
wilsons - avoid copper
COCP UKMEC4 long list (see other card)
how long after last ever period in older ladies is contraception required for?
2yrs in women under 50
1yr in women over 50
HRT does NOT prevent pregnancy - added contraception is required
COCP + progestogen-injection for age 50s?
COCP can be used up to age 50 - can treat perimenopausal symtpoms
progestogen injection should be stopped before 50s - due to osteoporotic risks
when to stop progestogen only contraception if amenorrhoeic? (older)
until either -
- FSH blood test are above 30 on 2 test take 6wks apart - if not, continue for a year
- 55yrs old
contraception in under 20s
- Combined + progestogen-only pills are unaffected by younger age
Progestogen-only implant is a good choice of long-acting reversible contraception (UKMEC1)
- Progestogen-only injection is UK MEC2 due to concerns about bone mineral density
- Coils are UKMEC2 as they have higher rate of expulsion
how long does infertility last for post giving birth?
fertility not considered to return until 21 days after giving birth, and contraception is not required up to this point
- after 21days, will need contraception, including condoms for 7 days when startin the combined pill or 2days for progestogen only pill
lactational amenorrhea
fully breast feeding + amenorrhoeic
98% as effective as contraception for up to 6month after birth
contraception options after childbirth
progestogen only pill + implant safe in breastfeeding + can be started anytime after birth
IUD/IUS can be inserted wither within 48hrs or >4wks after birth
COCP should be avoided in breastfeeding
- UKMEC4 before 6weeks postpartum
- UKMEC2 after
