Contraception Flashcards
Name non-hormonal contraceptives
- barrier methods - condoms, diaphragms, cervical cups
- spermicidal contraceptives - in addition only (not alone)
- IUD (Cu-coil) - contraindicated in pelvic inflammatory disease or unexplained vaginal bleeding
What damages latex products
petrolium jelly, baby oil, oil based products
Name progesterone only contraceptives
Levenorgesterel, norethisterone, desogestrel
Progesterone only administration
- no pill free period - take every day
- same time of day for max efficiency
Progesterone only precautions
- no additional precautions if started in first 5 days of cycle
- 2 days precaution if started after that
Progesterone only missed pill rule
- within 3 hours otherwise missed
- desogesterel within 12 hours otherwise missed
Name parenteral progesterone only contraceptives
Injections (99.8% effective), Implants (99.95% effective)
Name a progesterone only injection and side effects
Depot medroxyprogesterone acetate - every 13 weeks
- loss of bone density
- delayed return to fertility for up to 1 year after stopping
Name a progesterone only implant and side effects
- Etonogestrel (Nexplanon)
- lasts upto 3 years
- MHRA: neurovascular injury and migration of implant - remove ASAP
Name types of combined hormonal contraceptives
tablets, patches, vaginal rings
When not to use combined hormonal contraceptives
- in 50 years + as safer alternatives exist
- hypertension
- 35 years plus and smoker
- risk factors for CVD
- migraine with aura
- new onset migraine w/o aura during use of CHC
Health benefits of combined hormonal contraceptives
- reduces risk of ovarian, endometrial and colorectal cancer
- aligns bleeding pattern
- reduces dysmenorrhea and menorrhagia
- manage symptoms of PCOS, endometriosis and premenstrual syndrome
- improves acne
- reduces menopausal symptoms
- maintain bone density in peri-menopausal females under 50
CHC types of preparations
- monophasic - fixed amount of oestrogen and progesterone in each active tablet
- multiphasic - varying amounts of the 2 hormones e.g. diff levels in first 2 weeks compared to last week
- oestrogen - ethinylestradiol, mestranol, estradiol
- on 21 day regimen = monthly withdrawal bleed (doesn’t represent physiological) during 7 day hormone free interval - some come as 21 active 7 dummy to improve coherence
STOP taking CHC if
- calf pain/swelling/redness - DVT
- chest pain/breathlessness/coughing blood - PE
- loss of motor sensory function - stroke
- severe stomach pain - hepatotoxicity
- very high BP - hemorrhagic stroke
Seek advice with CHC if
- signs of breast cancer - lumps/nipple pain
- new onset migraine
- high BP
- persistant unscheduled vaginal bleeding
- high BMI (>35)
- DVT/PE
- blood clotting abnormality
- CVD
- 50 year plus
- newly developed contraindication
CHC surgery rules
- stop 4 weeks before major elective, any surgery to legs/pelvis, if prolonged immobilising of lower limbs
- use alternative method of contraception
- restart 2 weeks after full remobilisation
- if discontinuation not possible (trauma)/still on CHC - consider thromboprophylaxis
CHC side effects
- headache
- unscheduled bleeding (breakthrough bleeding)
- mood change
- weight gain
- libido change
Switching from CHC to a different CHC
no additional contraception needed
Switching from POP to CHC
7 days extra precaution
Switching from levenorgesterel IUD to CHC
7 days extra precaution
Switching from Cu-IUD and other non-hormonal methods to CHC
- if CHC started in first 5 days of cycle - no extra precaution needed
- if started after day 5 - 7 days extra precaution
Switching from CHC to others during week 1 of cycle or day 3-7 of HFI and NO UPSI since start of HFI
- to Cu-IUD - no precaution
- to POP - 2 days precaution
- to others - 7 day precaution
Switching from CHC to others during week 1 of cycle or day 3-7 of HFI and UPSI since start of HFI
- carry on with CHC until 7 consecutive days of other method taken then stop
Switching from CHC to other methods in week 2 or 3 of cycle
No extra precaution required
