Contraception Flashcards
what does Fraser guidelines when prescribing contraception?
-she understands the doctors advice
- she cant be persuaded to inform her parents
-she is very likely to continue having sex
-unless she receives contraception her mental and physical health will suffer
-in her best interests to provide treatment
what are the different types of contraceptions?
-combined oral oestrogen content
-combined oral progestogen content
-progestogen only oral
-progestogen parenteral
-progestogen IUD
-transdermal patch
-vaginal ring
what is an example of a combined oral oestrogen content pill?
estradiol
what is an example of a combined oral progestogen content pill?
-norgestimate
-desogestrel
-drosperinone
these can be used for women with acne, headaches, depression and other symptoms
how do the oral contraception’s work and example of what they are?
-oral contraception is the combined oral contraceptive and progestogen only pill
-inhibits ovulation. Contains oestrogen and progestogen
how do you take the combined oral contraception?
-take one tablet daily for 3 weeks + 1 weeks pill free interval for withdrawal bleeding
-start any time in menstrual cycle; if started on day 6 or later use protection for 7 days
-not for women above 50 years
when to avoid CHC?
patients who are:
-hypotensive
-age 35 years who smoke
women with multiple risk factors of:
smoking
hypertension
high BMI
dylipidemida
Diabetes
-migraine with aura
-new onset migraine with aura during use of chi
what is monophasic and multiphase preparations?
mono= fixed dose of oestrogen and progestogen in each tablet
multi= different does of each in each tablet
what can increase the risk of VTE using oestrogens?
-type of progestrogen
-obesity BMI >30
-smoking
-primary relative under 45 with VTE
-superficial thrombophlebitis
-long term immobilisation
-age .35 years
what are the risk factors for increased risk of arterial thromboembolism using oestrogens?
-DM
-hypertension
-migraine without aura
when should you avoid using oestrogens?
when you have 2 risk factors or more
if your having surgery when should you stop taking the oestrogen pill?
4 weeks before surgery
-for major surgery and all surgery to the legs or that result in prolonged immobilisation of the lower limb
what are the options for people having surgery on the oestrogen pill?
-progestogen-only pill contraceptive is an alternative
-restart usal contraception on the first menses at least 2 weeks after full mobilisation
-thromboprophylaxis in emergency surgery or if combined contraceptive was not stopped
what should you do if you are travelling taking the oestrogen pill?
-for journeys over 3 hours. reduce the risk by wearing compression stocking and leg exercises
when should you stop the combined or oestrogen containing HRT?
-Venous thromboembolism: severe chest pain, sudden breathlessness or cough with blood-stained sputum (pulmonary embolism), unexplained swelling or severe pain in calf of one leg (DVT)
-Stroke: serious neurological effects: prolonged severe headaches, sudden partial or complete loss of vision, disturbance in hearing, dysphasia- slurred speech, bad fainting attacks, collapse, sudden numbness of one side or part of the body
-liver dysfunction: jaundice, hepatitis, liver enlargement, severe stomach pain
-blood pressure: above systolic 160mmHg or diastolic 95mmHg
-prolonged immobility after surgery or leg surgery
-detection of a risk factor which contraindicates treatment
how does the progestogen only pill work?
prevents pregnancy by thickening the mucus of the cervix to stop sperm reaching an egg
how is the progestogen only pill taken?
take one daily on a continuous basis starting day one of cycle and taken same time each day.
If started after 5 days of menstrual cycle, additional precautions is required for 2 days
what are some side effects of hormonal contraceptives?
-increased risk of cervical cancer (combined) and breast cancer (progestogen only and combined)
what is the benefits of combined oral contraceptives?
-reduces the risk of ovarian and endometrial cancer
-reduces dysmenorrhea and menorrhagia, premenstrual tension, reduced risk of PID, less benign breast cancer, less symptomatic fibroids or functional ovarian cysts.
what should be done if you miss a pill >24 hours of the combined oral contraception? 1 missed or 2 or more missed pills?
-1 missed= take one pill ASAP + condom for 7 days (9 days if zoely /qlaira)
-no extra precautions
-2 or more missed pill= take one pill ASAP + condom for 7 days (9 days if zoely /qlaira)
-omit pill free interval, if missed in last 7 days
-EHC, if missed in first 7 days and unprotected sex occurs. Use condoms till 7 consecutive doses take. Week 2-3 no EHC needed tKE asap 7 DAYS CONDOM. If missed 7 days before HFI carry on taking pill throughout HFI.
what to do if you miss the progestogen only pill >3 hours (DESTOGESTREL >12HOURS)?
-take it asap + use a condom
-EHC= unprotected sex occurs before 2 pills AFTER RESTARTING or between missed pills are taken correctly
what to do if you are vomiting/have diarrhoea when taking the COC?
-vomiting <2 of taking= take another ASAP
- >24hours (severe)= protection until 7 days after recovery and pill is resumed (9 days if qlaira)
-if it occurs in last 7 days= omit pill free interval
what to do if vomiting /diarrhoea what should you do if taking POP?
-vomiting <2hrs of taking it=take another one asap
-severe of if pill not taken within 3hrs of normal time (12hrs if desogestrel) = protection until 2 days after recovery and pill is resumed
how do you used the transdermal patches?
1 cycle: weekly patch for 3 weeks then one patch free week
what to do if detached for >24hr or detached application at the beginning of cycle when using the transdermal patches?
-apply new patch ASAP
-start a ‘new day 1 cycle” _ condom for 7 days
what should you do if you delay application in the middle of the cycle or beginning of week 2 (day 8) or week 3 (day 15)?
<48hrs =apply new patch and continue as normal
>48 hrs= start a ‘new day 1 cycle’ + condom for 7 days
what are some main interactions with drugs that are enzyme inducers and hormonal contraceptive drugs cause reduced contraceptive effectiveness?
-caramazepine
-phenytoin
-phenobarbitol
-st johns wort
-rifampicin
-rifabutin
what regular contraception should be used until after 4 weeks after stopping the interacting drug?
copper IUD
progestogen- only injection
what are the different types of emergency contraception?
-copper IUD
-3mg dose of levonorgestrel (unlicensed)
-ulipristal efficacy is also reduced by drugs that increase gastric pH (antacids, H2 receptor antagonists, PPIs)
what is the first line emergency hormonal contraception? and why?
Copper IUD
-most effective form of EHC
-inserted up to 120hrs (5 days) after unprotected sex or unto 5 days after earliest calculated ovulation
what is the second line EHC?
hormonal methods
-if a copper is not appropriate to the patient
-oral EHC: levonorgestrel or Ulipristal (more effective)
-offer asap after unprotected intercourse to increase efficacy
-if BMI >26kg/m2 or over 70kg: ulipristal or a double dose of levonorgestrel ( high body weightier BMI may reduce the effectiveness of oral EHC, partially levonorgestrel)
what is the dose of levonorgestrel? and their cautions?
dose: 1500mg <72hrs of unprotected sex
-if vomiting <3hrs of taking dose give replacement
cautions:
-crohns disease (severe malabsorption syndromes)
past ectopic pregnancy
-ciclosporin (toxicity)
how does levonorgestrel work?
prevents ovulation and fertilisation
how does ulipristal work?
progestogen receptor modulator inhibits or delays ovulation. more effective than levonorgestrel
how is ulipristal used and the dose?
> 96-120 hours unprotected sex
-within the last 5 days of unprotected sex was likely during 5 days before the estimated day of ovulation
-dose: 30mg<120rs of unprotected sex
if vomiting <3hrs of taking dose give replacement
what is the cautions and contra-indicators of ulipristal?
-cautions: severe asthma treated by oral steroids (not recommend)
-avoid on severe liver impairment
-contraindications: repeated use within the same menstrual cycle. (repeated use with levonorgestrel is not contra-indicated but manufactorers advice to avoid, due to increased menstrual irregularities
what is some counselling for ulipristal?
-redcued the effectiveness of regular contraceptives
-use additional barrier protection
~combined= 14 days (16 days if qlaira)
~progestogen-only= 9 days for pill (14 days if parenteral)
-also wait 5 days before starting regular normal contraception or using levonergesteral as EHC. Use condoms reliably or abstain from intercourse during this period as contraceptive effect of ulipristal will be reduced
what are some normal contraception side effects?
-menstrual irregularities
what is the counselling points for normal contraception?
-next period may be early or late
-use barrier protection until next period
-if lower abdominal pain; see GP to rule out ectopic pregnancy
-if periods are abnormal; light heavy brief or absent; take a pregnancy test (must be at least 3 weeks after unprotected sex)
why is IUD less suitable
for prescribing in under 25 years?
can increase risk of pelvic inflammatory disease
what are the different types of IUD?
-copper and levonorgestrel
what are the notes to be taken from levonorgestrel?
-reduced bleeding and period pain and has a lower risk of pelvic inflammatory disease
-prescribed by brand as caring indicators, duration of use and introducers
what are the 3 types of IUD levonorgestrel releasing?
-mirena
-levosert
-jaydess
how long should each IUD releasing levonorgestrel ?
-mirena = 5 years
-levosert = 3 years
-jaydess = 3 years
what are some side effects of IUDs?
-pain on insertion and bleeding
-uterine perforation
-risk of infection, excess risk in first 20 days= pre-insertion chlamydia screening for high risk groups, antibiotics prophylaxis
what are the notes for removal of IUDs?
-dont remove IUD mid cycle unless additional contraception is used for 7 days
-if removal is essential and unprotected sex occurs give EHC
-if pregnant remove in 1st trimester
what are the parenteral contraceptions
-medroxyprogestrone injection
-noresthieterone injection
-etonogestrel implant
how long do they different type of parenteral contraceptions last? + side effects
-medroxyprogestrone injection = depot injection every 13 weeks. Can cause loss of bone density. delayed return to fertility of up to 1 year after treatment stopped
-noresthieterone injection= 8 weeks
-etonogestrel implant= 3 years, implant can reachh the lungs via pulmonary artery, must be palpable- otherwise locate and remove asap, if unable to locate implant in arm use chest imaging
what is a spermicdal contraceptive?
-barrier preparations along (condoms, caps, diaphragms) are less effective but can be reliable in well-motivated couples who use a spermicide
-not suitable for those at high risk of STI, high use associated with genital lesions and increased risk of acquiring infections
