Contraception Flashcards
What is the effect of estrogen on fertility?
They suppressh FSH meaning a dominant follicle isn’t formed.
It also stimulates endometrial proliferation (uterus wall thickening)
Name 3 side effects of estrogens
Nausea and vomiting
breast tenderness
fluid retention
change in libido
chloasma
What happens to HDLs and LDLs with estogens? Is this good or bad?
HDLs increase and LDLs decrease. This is good because HDLs are a good cholesterol and LDLs are bad
Does a patient with estrogens have blood which has lower or higher coagulability?
higher
What happens to bone resorption with estrogens?
it decreases
What are triglycerides? Do they increase or decrease with estrogens?
A type of fat, also known as lipids. They increase
Are progestogens synthetic or natural?
Synthetic
What is the difference in VTE risk between 2nd generation progestogens and a third generation progestogen such as gestodene?
higher generations have a higher risk of VTE
What does progestogen do? (4)
Suppresses the LH surge and blocks ovulation
suppresses endometrial proliferation and thickens the uterus wall
thickens cervical mucus making it impermeable
produces secretory endometrium which prevents endometrium cancer
When does a withdrawal bleed occur when a patient is on COCs?
during the 7 pill free days or placebo days
What are 3 side effects of progestogen?
menstrual irregularity
nausea
bloating/weight gain
breast tenderness
acne
change in libido
mood changes
What happens to HDLs and LDLs with progestogens? Is this good or bad?
decrease HDL and increase LDL This is bad because HDLs are a good cholesterol and LDLs are bad
What is a monophasic COC?
same amount of estogen and progestogen for 21 days
Who should you give progestogen only tablets to?
women who can’t take estrogens and people who are breast feeding
Name an example of an emergency contraceptive?
Levonorgestrel and ulipristal
How many days after unprotected sex is ulipristal effective for?
5
What are two side effects of emergency contraception?
Nausea and vomiting
If a patient had Levonorgestrel and then vomited 30 mins after, do they need to repeat the dose?
yes
How does a vaginal ring work? (3)
insert in vagina for 21 days
releases estrogen and progestogen slowly
take ring out for 7 days
How does COCs werk? (2)
inhibit ovulation
inhibits endometrium development and therefore corpus luteum
How do progestogen only tablets work?
thickens cervical mucus so sperm penetration is unlikely
What are three dose forms of progestogen?
tablet, subdermal implant, IUD and IM depot injection.
What are 5 adverse effects for COCs?
breakthrough bleeding, nausea, breast enlargement, tenderness, headache, fluid retention, chloasma, VTE, allergy, hypertemsion, jaundice, pancreatitis, liver, cervical and breast cancer and stroke.
What are 3 adverse effects for progestogen only tablets?
menstrual irregularities, depression and weight gain
What are three things which COCs can prevent?
- ovarian and endometrial cancers
- ovarian cysts
- pelvic inflammatory disease
Name 3 examples of drugs which interact with estrogen?
CYP3A4 inducers e.g. rifampicin, phenytoin, carbamazepine
Orlistat
St John’s Wort
What should I do if i give a patient on carbamezapine a COC?
Increase the dose
Name an example of a progestogen only tablet?
levonogestrel and norethisterone
When do you start a progestogen only tablet?
first day of menstruation or 21 days postpartum
How long do you need to use extra contraception if you have a progestogen only tablet on the 5th day of menstruation?
48 hours
If I wanted to change from one COC to another, what do I do?
Start day after old ones
If I wanted to change from progestogen only tablets to a COC, what do I do?
Start day after old ones and use extra contraception
Do you start with a low or high dose of a COC?
Low
What is trycycling and what type of COCs can you do this with?
taking three packets of monophasic pills without taking an inactive tablet
If you are taking COCs, what class of drugs do you need a high dose with?
antiepileptics
If you start you first active COC pill on day 4 of the menstrual cycle, do you need extra protection?
yes, for 7 days after
What is the most dangerous dose of a COC to miss?
those at the beginning or end of the active pill cycle
Is contraception affected if you forget a COC dose after 6 hours?
no
What do you do if you missed a COC pill in the first 7 days of active pills and sexual
intercourse occurred?
Get emergency contraception
What do you do if you missed a COC dose for 30 hours?
take a pill when you remember and then take the next when it is due
continue pill and use another form of contraception for the next 7 active pill doses
If you vomit 3 hours after taking a COC, what do you do?
Take another ASAP and use extra contraception
My patient took their progestogen tablet yesterday at 1400hrs, when should they have it today?
1400 hrs- 1700hrs at the absolute max
How long is the maximum contraceptive effect after administration?
3-20 hours after
What are 4 issues to consider when choosing contraception?
effectiveness, best protection against STIs, life stages, medical hx, personal/ethical/religious
beliefs, risk vs benefit.
