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
Oral contraceptives vomit/diarrhoea
if vomit/diarrhoea within 2 hours of COC/POP - take another ASAP
POP misses doses and protection
- missed if >12 hours desogesterel, >3 hours other, take ASAP, next pill at usual time
- protection until 48 hours taken right (7 days desogesterel)
- emergency contraception if UPSI between missed pill and 2 days after restarting
COC missed doses and protection
- late start after HFI (>9 days since last active pill) = emergency contraception if UPSI, take ASAP and use condoms 7 days
- 1 missed pill = take ASAP - no further action if consistent use in last 7 pills
- 2 + missed pills:
week 1 = emergency contraception if UPSI within HFI + week 1, take ASAP and use condom 7 days
week 2-3 = no emergency contraception, take ASAP, 7 days condom
if 2+ missed pills in 7 days before HFI - carry on taking pill through HFI
Name the different emergency contraceptions
Cu-IUD, ulipristal 30mg, levonorgestrel 1.5mg - taken ASAP
Cu-IUD emergency contraception details
- first line
- within 120 hours
- can be inserted up to 5 days after the earliest estimated date of ovulation
Levonorgestrel emergency contraception details
- within 72 hours - 2nd dose if DV in 3 hours
- BMI > 26 or weight > 70kg = ulipristal or 2 x levonorgestrel
- can be used more than once in same cycle but increases risk of side effects
Ulipristal emergency contraception details
- within 120 hours - 2nd dose if DV in 3 hours
- ulipristal more effective than levonorgestrel
- BMI > 26 or weight > 70kg = ulipristal or 2 x levenorgestrel
- can be used more than once in same cycle
Reinitiating regular contraception after levenorgestrel
start hormonal contraception immediately - condoms until effective
Reinitiating regular contraception after ulipristal
- wait 5 days before starting regular hormones again - use condoms in those 5 days
- if during week 1 in females taking regular CHC - can restart immediately but use condom for 7 days
Levonorgestrel 1.5mg side effects and cautions
- breastfeeding: no delay
- caution if malabsorption
- cause breast tenderness, DV, fatigue and haemorrhage
- avoid in severe liver impairment
- interaction: CYP inducers e.g. rifampicin
Ulipristal 30mg side effects and cautions
- Breastfeeding: 1 week delay
- caution in severe asthmatics controlled by glucocorticoids
- cause cycle irregularities, DV, altered mood, dizziness
- avoid in severe liver impairment
- interaction: CYP inducers e.g. rifampicin
Cu-IUD MHRA warning
risk of uterine perforation (severe pelvic pain after insertion, sudden change in period, pain during intercourse, unable to feel threads- check up if can’t feel)
Cu-IUD replacement requirements
- replace every 5-10 years
- remove in first trimester of pregnancy if not worked
Levenorgestrel IUD (not emergency contraception) details
- risk of uterine perforation
- remove in first trimester of pregnancy if not worked
- reduced pain/bleeding side effects
- replace every 3-10 years
