Contraception Flashcards
Combined contraceptive patch : Regime
- 1-3 week : Change patch weekly
- 4th week : No patch - withdrawal bleed
Combined contraceptive patch : Patch change delayed end of week 1/2
- < 48 hours : No further precautions
- > 48 hours : Condoms for 7 days
* Emergency contraception if
i) If Sexual intercourse during patch free interval or last 5 days
Combined contraceptive patch : Patch change delayed week 3
- No additional contraception needed
- Reapply at usual day for next cycle
Combined contraceptive patch : Patch change delayed after patch free interval
Additional barrier contraception for 7 days
COCP :Advantages
Gynaecological adv
1. Reduce ovarian cysts
2. Period lighter and less painful
3. Reduces risk of Ovarian and Endometrial cancer
COCP : Disadvantages
- Increases risk of VTE
- Increases risk of CVS disease
- Increases risk of Breast and Cervical cancer
COCP : Contradindications
- > 35 year old smoking > 14 cigarettes
- Large BMI > 35
Factors which raise VTE risk
3. Personal or 1st degree FH of VTE
4. Major surgery/Immobility
Factors which increase CVS risk
5. Uncontrolled hypertension
6. Hx of Stroke/TIA } Migraine with Aura
Factors which increase cancer risk
7. BRACA gene / Current breast Ca
Combined oral contraceptive pill: Absolute CI
- more than 35 years old and smoking more than 15 cigarettes/day
- migraine with aura
- history of thromboembolic disease or thrombogenic mutation
- history of stroke or ischaemic heart disease
- breast feeding < 6 weeks post-partum
- uncontrolled hypertension
- current breast cancer
- major surgery with prolonged immobilisation
- positive antiphospholipid antibodies (e.g. in SLE)
Combined oral contraceptive pill: counselling
- <5 days of start of cycle : no condoms needed
- > 5 days after start cycle : Condoms for 7 days
- Take at the same time every day
Combined oral contraceptive pill: 1 missed pill
- Take current + missed pill
- No additional contraception needed
Combined oral contraceptive pill: 2 missed pill
- Take current + missed pill + 7 days of condoms
- Week 1 : Emergency contraception if sex in week 1/pill free interval
- Week 2 : No emergency contraception ( cover from week 1)
- Week 3 : Omit pill free interval
Contraception for young people : Fraser guidelines
Age of consent : 16 years if 13-16 years then refer to Fraser guidelines
1. Understands advice
2. Cannot be persuaded to inform parents
3. Likely to have sex without contraception anyway
4. Mental and physical health will suffer without it and it is in their best interests
Contraception for young people : Preferred method
Progesterone only implant - Nexplanon
Coil not offered to nulliparous women < 18
Which is the most effective form of contraception?
Progesterone only implant
Contraception : Progesterone only implant - Key features
- Length : 3 years
- MOA : Does not contain oestrogen so can be used if CI to COCP
Contraception : Progesterone only implant - Adverse effects
Adverse effects :
* Irregular/Heavy menstrual bleeding
* Interact with enzyme inducing drugs
Contraceptive : Depo Provera - MOA
Contains : Medroxyprogesterone acetate
MOA : Primarily inhibits ovulation but can also increase cervical mucus
Contraceptive : Depo Provera - Adverse effects
- Irregular bleeding
- Weight gain
- Osteoporosis
- Delayed return of fertility } unto 12 months
Contraceptive : Depo Provera - Regime
IM injection every 12 weeks - can be extended to 14 weeks
Contraceptive : Depo Provera - Contraindication
Breast cancer - current or previous
Contraceptive : IUD - MOA
- Prevention of fertilisation by causing decreased sperm motility and survival
- Begins to work straight after insertion
Contraceptive : IUD - MOA
- Levonestragel (progesterone) releasing IUS
- Length of time : 5 years
- Begins to work after 7 days } barrier contraception
Contraceptive : Intrauterine devices - adverse effects
- Copper coil : Menorrhagia and dysmenorrhea
- Uterine perforation
- Ectopic pregnancy
- Increases risk of PID
- Expulsion: occurs in 1/20 women
Contraceptive : Post-partum
- POP : anytime postpartum
- COCP : not within <3 weeks of delivery due to risk of VTE
* > 6 weeks is safe if breast feeding - IUD/IUS : < 48 hours or after 4 weeks following delivery
POP : Advantages
- Can be used whilst breastfeeding
- Used in smokers and women with hx of VTE
POP : Main CI
pop
;
- Current breast cancer
- Acute porphyries
POP : Disadvantages
- Irregular vaginal bleeding } most common issue
- Increased risk of functional ovarian cysts
POP : Regime
- Starting POP;
* < 5 days of start of menstrual cycle } Immediate protection
* Otherwise : Condoms for first 2 days - Every 24 hours : take at the same time every day
POP : Regime - Missed pill
- < 3 hours late } continue
- > 3 hours late } Condoms for 48 hours
Emergency contraception : Levonestrogel -MOA
Stops ovulation and inhibits implantation
Emergency contraception : Levonestrogel - regime
- < 72 hours after UPSI
* x2 dose if BMI>26 or weight > 70kg - Long term contraception : Hormonal contraception can be started ASAP.
Emergency contraception : Ulipristal - regime
- <120 hours (5 days) after UPSI
- Long term contraception : Reduces effect of COCP - use condoms for 5 days
Emergency contraception : Most effective?
Copper IUD
Emergency contraception : Copper IUD - Regime
< 5 days after UPSI or Up to 5 days after ovulation date
HIV patient - contraception
Condoms - risk of transmission of different virus variants between two HIV+ patients
