Contraception Flashcards
Give examples of LARCs (long-acting reversible contraceptive methods)
Progesterone-only subdermal implant
Copper IUD
Progestogen- only IUS
Progestogen-only injection
What is the progrestogen-only subdermal implant?
flexible rod containing 68 mg of progestogen etonogestrel
How does the progrestogen-only subdermal implant primarily work?
suppressing ovulation by preventing LH and FSH surge
How does the copper IUD work?
preventing fertilisation as copper is toxic to sperm
inflammation on endometrium prevents inflammation
What is in the progestogen-only IUS?
progestogen levonorgestrel
How does the progestogen-only IUS work?
prevents pre-fertilisation by thickening cervical mucous
prevents implantation by thinning endometrial lining
What does progestogen-only injection contain?
depot medroxyprogesterone acetate (DMPA) - available as Depo Provera and Sayana Press
How often are Depo Provera and Sayana Press injections given?
every 13 weeks
How do Depo Provera and Sayana Press injections work?
suppressed ovulation
What is the combined oral contraceptive pill?
oestrogen and progestogen
What are types of combine hormonal contraception?
Combined oral contraception (COC)
Combined vaginal ring (CVR)
Combined transdermal patch (CTP)
How do combined hormonal contraceptions work?
inhibit ovulation, by thickening cervical mucus and impacting endometrial lining
How do progestogen-only pills work?
thicken cervical mucus and inhibit sperm penetration
What are the 3 permanent contraceptive methods?
Vasectomy
Tubal occlusion with clips/rings (usually via laparoscopy)
Tubal occlusion via hysteroscope
What are the methods of emergency contraception?
Copper bearing intrauterine device (Cu-IUD)
Ulipristal acetate (UPA)
Levonorgestrel (LNG)
What are the conditions for use of copper IUD as emergency contraception?
fit within 120hrs of UPSI or within 5 days of earliest predicted ovulation
What are the conditions for use of UPA as emergency contraception?
effective up to 120hrs of UPSI
What are the conditions for use of LNG as emergency contraception?
effective up to 72hrs after UPSI
What is UKMEC for contraception?
recommendations which identify health conditions (e.g. hypertension) or characteristics (e.g. smoking) which may affect the safety of the method
What is category 1 UKMEC?
A condition for which there is no restriction for the use of the method
What is category 2 UKMEC?
A condition where the advantages of using the method generally outweigh the theoretical or proven risks
What is category 3 UKMEC?
A condition where the theoretical or proven risks usually outweigh the advantages of using the method
What is category 4 UKMEC?
A condition which represents an unacceptable health risk if the method is used
When are the combined hormonal and progestogen-only contraceptive pills licensed to be initiated?
1-5 days of the natural menstrual cycle
When can the IUS be fitted without requiring extra precautions?
days 1-7 of a menstrual cycle
Which method is preferred for efficacy?
LARC
Which method is preferred for making periods lighter?
combined hormonal pill or progesterone-only contraception
Which examination is needed for those wanting to initiate a CHC?
BP measurement
BMI
What is monophasic CHC?
21 identical tablets followed by 7-pill free days (some may contain 7 placebo pills) e.g. Microgyon
What is phasic CHC?
different hormone strengths in each pill - mimic fluctuating cycle e.g. Qlaira
What are non-contraceptive benefits of CHC?
Reduce heavy periods
Acne
PMS
Reduce risk of endometrial, ovarian and colorectal cancer
Endometriosis
PCOS
What are risks of CHC use?
VTE
Ischaemic stroke
Migraine with aura
Cervical cancer
Breast cancer
If COC is chosen, what is the typical first line formulation?
<30ug EE with levonorgestrel or norethisterone
On which days of the cycle can CHC be started without additional need for contraception?
Day 1 to 5 of the cycle
When is the combined transdermal patch applied?
New CTP applied weekly on same day for 3 consecutive weeks
4th week is patch-free (withdrawal bleed)
Where is the combined transdermal patch applied?
buttock, abdomen, torso or upper-arm
How is the combined vaginal ring inserted? How long for?
inserted in the vagina and retained for 3 weeks, then 7-day free interval
does not need to be positioned precisely
What are the two vaginal rings?
Nuvaring® and Syreniring®
Which are the current progestogen-only pills?
levonorgestrel (LNG) and norethisterone (NET)
desogestrel (DSG)–containing pills
How can the progestogen only injectables be injected?
IM or SC
What are contraindications to progestogen only contraception?
Breast cancer
Severe cirrhosis
What is the timing of NET/LNG POP for it to be effective?
within 3 hours of the same time each day
What is the timing of DSG POP for it to be effective?
within 12 hours of the same time each day
What are side effects of POP’s?
Reduced libido
Mood changes
Altered bleeding patterns
Acne
Breast tenderness
Weight changes
Headaches
When may POPs be started without need for additional contraception?
Up to day 5 of a natural cycle
Up to 5 days after first or second trimester termination of pregnancy or miscarriage
Up to 21 days postpartum
What are side effects of DMPA injection?
Weight gain
Reduction in bone density
What are the types of subdermal implants?
Nexplanon and Implanon
How does nexplanon SDI differ from implanon SDI?
Nexplanon contains barium sulphate to enable X-ray detection
Applicator for nexplanon has been modified to reduce risk of deep insertion
How long is an SDI licensed for?
3 years
How does the SDI work?
Inhibition of ovulation by preventing LH surge
Increased viscosity of cervical mucus inhibits sperm penetration
Thinning endometrium to prevent implantation
What are disadvantages of an SDI?
Change in bleeding pattern
Change in weight, mood, libido
Acne (improves/worsens)
Headache
Breast cancer risk
When can the SDI be inserted without additional contraception?
Day 1-5 of cycle
What are the licensed IUDs?
Mirena
Lecosert
Kyleena
Jaydess
Complications of IUD
Perforation
Infection
Ectopic pregnancy
Expulsion
