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Women's health > Contraception > Flashcards

Contraception Flashcards

1
Q

Combined contraceptive patch : Regime

A
  • 1-3 week : Change patch weekly
  • 4th week : No patch - withdrawal bleed
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2
Q

Combined contraceptive patch : Patch change delayed end of week 1/2

A
  1. < 48 hours : No further precautions
  2. > 48 hours : Condoms for 7 days
    * Emergency contraception if
    i) If Sexual intercourse during patch free interval or last 5 days
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3
Q

Combined contraceptive patch : Patch change delayed week 3

A
  1. No additional contraception needed
  2. Reapply at usual day for next cycle
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4
Q

Combined contraceptive patch : Patch change delayed after patch free interval

A

Additional barrier contraception for 7 days

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5
Q

COCP :Advantages

A

Gynaecological adv
1. Reduce ovarian cysts
2. Period lighter and less painful
3. Reduces risk of Ovarian and Endometrial cancer

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6
Q

COCP : Disadvantages

A
  1. Increases risk of VTE
  2. Increases risk of CVS disease
  3. Increases risk of Breast and Cervical cancer
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7
Q

COCP : Contradindications

A
  1. > 35 year old smoking > 14 cigarettes
  2. 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

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8
Q

Combined oral contraceptive pill: Absolute CI

A
    • 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)
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9
Q

Combined oral contraceptive pill: counselling

A
  1. <5 days of start of cycle : no condoms needed
  2. > 5 days after start cycle : Condoms for 7 days
  3. Take at the same time every day
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10
Q

Combined oral contraceptive pill: 1 missed pill

A
  1. Take current + missed pill
  2. No additional contraception needed
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11
Q

Combined oral contraceptive pill: 2 missed pill

A
  1. Take current + missed pill + 7 days of condoms
  2. Week 1 : Emergency contraception if sex in week 1/pill free interval
  3. Week 2 : No emergency contraception ( cover from week 1)
  4. Week 3 : Omit pill free interval
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12
Q

Contraception for young people : Fraser guidelines

A

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

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13
Q

Contraception for young people : Preferred method

A

Progesterone only implant - Nexplanon

Coil not offered to nulliparous women < 18

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14
Q

Which is the most effective form of contraception?

A

Progesterone only implant

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15
Q

Contraception : Progesterone only implant - Key features

A
  1. Length : 3 years
  2. MOA : Does not contain oestrogen so can be used if CI to COCP
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16
Q

Contraception : Progesterone only implant - Adverse effects

A

Adverse effects :
* Irregular/Heavy menstrual bleeding
* Interact with enzyme inducing drugs

17
Q

Contraceptive : Depo Provera - MOA

A

Contains : Medroxyprogesterone acetate
MOA : Primarily inhibits ovulation but can also increase cervical mucus

18
Q

Contraceptive : Depo Provera - Adverse effects

A
  1. Irregular bleeding
  2. Weight gain
  3. Osteoporosis
  4. Delayed return of fertility } unto 12 months
19
Q

Contraceptive : Depo Provera - Regime

A

IM injection every 12 weeks - can be extended to 14 weeks

20
Q

Contraceptive : Depo Provera - Contraindication

A

Breast cancer - current or previous

21
Q

Contraceptive : IUD - MOA

A
  • Prevention of fertilisation by causing decreased sperm motility and survival
  • Begins to work straight after insertion
22
Q

Contraceptive : IUD - MOA

A
  • Levonestragel (progesterone) releasing IUS
  • Length of time : 5 years
  • Begins to work after 7 days } barrier contraception
23
Q

Contraceptive : Intrauterine devices - adverse effects

A
  1. Copper coil : Menorrhagia and dysmenorrhea
  2. Uterine perforation
  3. Ectopic pregnancy
  4. Increases risk of PID
  5. Expulsion: occurs in 1/20 women
24
Q

Contraceptive : Post-partum

A
  1. POP : anytime postpartum
  2. COCP : not within <3 weeks of delivery due to risk of VTE
    * > 6 weeks is safe if breast feeding
  3. IUD/IUS : < 48 hours or after 4 weeks following delivery
25
Q

POP : Advantages

A
  • Can be used whilst breastfeeding
  • Used in smokers and women with hx of VTE
26
Q

POP : Main CI

pop

;

A
  1. Current breast cancer
  2. Acute porphyries
27
Q

POP : Disadvantages

A
  1. Irregular vaginal bleeding } most common issue
  2. Increased risk of functional ovarian cysts
28
Q

POP : Regime

A
  1. Starting POP;
    * < 5 days of start of menstrual cycle } Immediate protection
    * Otherwise : Condoms for first 2 days
  2. Every 24 hours : take at the same time every day
29
Q

POP : Regime - Missed pill

A
  • < 3 hours late } continue
  • > 3 hours late } Condoms for 48 hours
30
Q

Emergency contraception : Levonestrogel -MOA

A

Stops ovulation and inhibits implantation

31
Q

Emergency contraception : Levonestrogel - regime

A
  1. < 72 hours after UPSI
    * x2 dose if BMI>26 or weight > 70kg
  2. Long term contraception : Hormonal contraception can be started ASAP.
32
Q

Emergency contraception : Ulipristal - regime

A
  • <120 hours (5 days) after UPSI
  • Long term contraception : Reduces effect of COCP - use condoms for 5 days
33
Q

Emergency contraception : Most effective?

A

Copper IUD

34
Q

Emergency contraception : Copper IUD - Regime

A

< 5 days after UPSI or Up to 5 days after ovulation date

35
Q

HIV patient - contraception

A

Condoms - risk of transmission of different virus variants between two HIV+ patients

Women's health (12 decks)

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