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Genitourinary > Contraception > Flashcards

Contraception Flashcards

1
Q

Name some non-hormonal contraceptives

A

Condoms, diaphragms, cervical caps
Petroleum jelly, baby oil and oil based products can damage barrier methods listed above

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2
Q

List some progesterone only pills (generic name)

A

Levonorgestrel, Noresthisterone, Desogestrel

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3
Q

Main features of Progesterone only pills

A

No pill free period
No additional precaution needed if started in first 5 days of cycle
Need two days precaution if taken after that
Take the same time every day
Desogestrel needs to be taken within 12 hours or considered ‘missed pill’
Other POP’s need to be taken within 3 hours of considered ‘missed pill’

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4
Q

List different types of parenteral progesterone only contraceptives

A
  1. Injections (99.8% effective if correct usage)
    e.g. Depot medroxyprogesterone acetate - every 13 weeks
  2. Implants (99.95% effective if correct usage)
    e.g Etongesterel (nexplanon)
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5
Q

What are side effects of the medroxyprogesterone acetate injections

A

Loss of bone density may occur
Delayed return of fertility for up to one year after treatment cessation

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6
Q

What are the side effects of the implant?

A

MHRA: neurovascular injury and migration of the implant - remove ASAP

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7
Q

How long does the injection and the implant last?

A

Injection: 13 weeks
Implant: 3 years

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8
Q

What methods of combined hormonal contraceptives are there?

A

Tablets, Patches, Vaginal rings

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9
Q

What are the health benefits of the combined oral contraceptive?

A

Reduces risk of ovarian, endometrial and colorectal cancer
Aligns bleeding patterns
Reduces dysmenorrhea and menorrhagia
Manages symptoms of polycystic ovaries, endometriosis and premenstrual syndrome
Improves acne
Reduces menopausal symptoms
Maintains bone density in peri-menopausal females under 50

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10
Q

When should combined Hormonal contraceptives be avoided?

A

Hypertension
Age of 35 years who smoke
Women with multiple risk factors for cardiovascular problems e.g. smoking, hypertensiom, High BMI, dyslipidaemias, diabetes
Migraine with aura
New onset of migraines without aura during the use of CHC

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11
Q

What extra precaution is needed when switching to a combined hormonal contraceptive from….

A

FROM CHC: no additional contraception
FROM POP: 7 days extra precaution
FROM LNG-UD: 7 days extra precaution
FROM COPPER IUD: If CHC started up to day 5 of cycle: no additional contraception
If CHC started after day 5: 7 days extra precaution
OTHER NON-HORMONAL METHODS: same as copper IUD

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12
Q

What extra precaution is needed when switching from a combined hormonal contraceptive to….

A

Week 1 (or day 3-7 of hormone free interval) and NO UPSI since HFI:
- Cu-IUD: no extra precaution
- POP: 2 days precaution
- Others: 7 days precaution

Week 1 (or day 3-7 of HFI) and UPSI since start of HFI:
- Carry on with CHC until 7 consecutive days taken
- Then act as week 2 or 3

Week 2 or 3: no extra precaution needed

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13
Q

Reasons to stop

A
  • Urgent medical review
    o Calf pain, swelling and/or redness (DVT)
    o Chest pain and/or breathlessness and/or coughing up blood (PE)
    o Loss of motor sensory function (stroke)
    o Severe stomach pain (hepatotoxicity)
    o Very high blood pressure (haemorrhagic stroke)
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14
Q

When should you seed advice or a medical review?

A

o Signs of breast cancer (lump, nipple pain/discharge)
o New onset migraine
o Persistent unscheduled vaginal bleeding
o High blood pressure
o High BMI (>35)
o DVT or PE
o Blood clotting abnormalities
o Angina, heart attack, stroke, or peripheral vascular disease
o AF
o Cardiomyopathy
o Includes previous points
 Aged 50+
 Newly developed contraindication

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15
Q

When should the CHC be discontinued before surgery and restarted after surgery?

A
  • Discontinued at least 4 weeks prior for
    o Major elective surgery, any surgery to the legs or pelvis
    o Surgery that involves prolonged immobilisation of a lower limb = DVT risk
  • Use an alternative method of contraception
  • CHC recommenced 2 weeks after full remobilisation
  • If discontinuation is not possible (trauma) / patient is still on CHC:
    o Consider thromboprophylaxis
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16
Q

What are the side effects of hormonal contraceptives?

A
  • Headache
  • Unscheduled bleeding (breakthrough bleeding)
  • Mood change
  • Weight gain
  • Libido change
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17
Q

What is classed as a missed pill when you have diarrhoea or vomit?

A

Missed pill rules apply if a patient omits or has vomited / had diarrhoea within 2 hours of taking COC or POP (unless desogestrel = 12 hours) – take another one ASAP to aim to be within time period

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18
Q

What is considered a missed pill if you dont take it with the POP?

A

Considered missed if >12hours for desogestrel or > 3 hours for rest
Take pill as soon as you remember
Take the next pill at the usual time (can mean 2 in a day)
Need protection up to 48 hours of pills taken correctly (7 days for desogestrel)
Need emergency contraception if UPSI happened between missed pill and 2 days after restarting medication

19
Q

What is considered a missed pill if you dont take it with the CHC?

A

Late start after HFI (>9 days since last active pill)
- Emergency contraception if UPSI has occurred
- Take immediately and use condom till 7 consecutive days taken

1 missed pill (48-72 hours since last active pill)
- Take ASAP – no further action needed (providing consistent use inn previous 7 active pills)

2+ missed pills (72+ hours since last active pill)
- Week 1 of cycle: consider emergency contraception if UPSI happened within HFI and week 1 —- take ASAP and use condom until 7 consecutive doses taken
-Week 2-3 of cycle: no emergency contraception needed — take ASAP and used condom for 7 days
- If 2+ pills missed in 7 days before HFI — carry on taking pill throughout HFI

20
Q

What is the first line emergency contraception?

A

Copper IUD

21
Q

How many hours after UPSI or ovulation can the copper IUD be inserted?

A

up to 120 hours (5 days) after the first UPSI
Up to 5 days after the earliest estimated ovulation date

22
Q

Whats first line oral emergency contraception?

A

Ulipristal 30mg

23
Q

Whats the latest Ella ONE can be taken after UPSI

A

120 hours (5 days)

24
Q

What is the latest Levonorgestrel 1.5mg can be taken after UPSI?

A

72 hours (3 days)

25
Q

When is a second dose needed?

A

If patient has vomited or had diarrhoea in 3 hours

26
Q

If a patient has a BMI over 36 or weighs more than 70kg what contraception should you give?

A

Ullipristal or double the dose of Levonorgestrel

27
Q

Can both oral emergency contraceptives be used more than once in the same cycle?

A

Yes but Levo has more risk of side effects

28
Q

When should regular contraception be reinitiated after Levonorgestrel 1.5mg?

A

Immediately
Use condoms until effective (2 days POP or 7 days CHC)

29
Q

When should regular contraception be reinitiated after Ulispristal 30mg?

A

Wait 5 days after taking ellaone before starting regular hormones again.
Use condoms during the 5 days and until treatment is effective

If during 1 week in females taking regular CHC
it can be reinitiated immediately
Wear condom for 7 days

30
Q

when can patients continue breastfeeding after levonorgestrel?

A

No delay

31
Q

What are the cautions for levonorgestrel?

A

patients with malabsorption

32
Q

What are the side effects of levenorgestrel?

A

Breast tenderness, D+V, fatigue and haemorrhage

33
Q

In what patients should levonorgestrel be avoided?

A

Patients with severe liver impairment

34
Q

when can patients continue breastfeeding after Ulipristal?

A

1 week delay

35
Q

What are the cautions for Ulipristal?

A

Severe asthmatics controlled by glucorticoids

36
Q

What are the side effects of Ulipristal?

A

Cycle irregularities, D+V, altered mood, dizziness

37
Q

In what patients should Ulipristal be avoided?

A

Patients with severe liver impairment.

38
Q

What is the MHRA warning associated with copper coil?

A

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 threads

39
Q

How often should the copper coil be replaced?

A

5 to 10 years
Removed in the first trimester of pregnancy

40
Q

Benefits of progesterone coil rather than copper coil?

A

Reduced pain/bleeding side effects

41
Q

How often should the progesterone coil be replaced?

A

every 3-10 years

42
Q

What is BIG interaction with any Oral contraceptives?

A

CYP ENZYME INDUCERS

43
Q

What are the ages for EllaOne and Levorgestrel OTC

A

Ella one is any age
Levongestrel is 16+

Genitourinary (5 decks)

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