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IP > Contraception > Flashcards

Contraception Flashcards

1
Q

How long a supply can oral contraceptives be prescribed for and why?

A

Up to 12 months in order to avoid unwanted discontinuation and increased risk of pregnancy.

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2
Q
A
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3
Q

What must be done before supplying another 12 months of oral contraception?

A

Review of medical eligibility, satisfaction, adherence, drug interactions, and consideration of alternative contraception.
BP and BMI must also be recorded annually.

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4
Q

Who is the combined oral contraceptive not suitable for?

A

> 50
Diabetes with comorbidity
Migraine with aura
CVD or multiple risk factors
Obese (BMI>35kg/m^2)
Hypertension
VTE - curent or history, not recommend if family history or immobile.
Smoking - not recommended
Menopause - not recommended
Lamotrigine - reduces lamotrigine

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5
Q

Who is the IUD not recommended for?

A

Abnormal vaginal bleeding
Pelvic inflammatory disease
STI

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6
Q

When should someone with vomiting/diarrhoea follow the missed pill rule?

A

If vomiting occurs within 3 hours of taking or severe diarrhoea occurs within 24 hours.

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7
Q

How does COC work?

A

Oestrogen and progesterone inhibit ovulatoin by acting on the hypothalamo-pituitary axis to reduce leutinising hormone (LH) and follicile-stimulating hormone (FSH) production.

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8
Q

What are the types of COC pill?

A

Monophasic - fixed amount of oestrogen and progesterone in each pill. 21-day dosing schedule.
Multiphasic - varying amounts of the 2 hormones in each table. 28-day dosing schedule. Can be biphasic, triphasic, or quadraphasic.

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9
Q

What are the active ingredients in COC?

A

Oestrogen in the form of ethinylestradiol
Progesterone in the form of levonorgestrel or norethisterone.

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10
Q

What are the different possible regimens for the monphasic COC?

A

Traditional - 21 days continuous use, 7-day hormone-free interval (HFI).

Shortened HFI - 21 days continuous use, 4-day HFI.

Tricycyling - 9 weeks continuous use followed by 4 or 7 day HFI.

Flexible extended use - continuous use followed by 4-day HFI when breakthrough bleeding occurs.

Continuous - continuous use with no HFI.

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11
Q

Is it better to use the traditional regimen over tailored regimens of COC?

A

There is no difference in efficacy or safety of using the traditional regimen which mimics the natural menstrual cycle over a tailored regimen.
In fact, traditional regimen may be associated with disadvantages such as heavy/painful withdrawal bleeds, headaches. mood changes, and increased risk of incorrect use with sibsequent unplanned pregnancy.

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12
Q

What are some adverse effects associated with COC?

A

Nausea
Bloating
Irritability
Increased risk of breast cancer

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13
Q

What are some benefits of COC?

A

Reduced risk of ovarian, endometrial, and colorectal cancer.
Reduced dysmenorrhoea and menorrhagia.
Management of PCOS, endometriosis, and PMS.
Improvement of acne
Reduced menopausal symptoms.
Maintaining bone density in peri-menopausal female under 50 years.

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14
Q

When should women start using the COC?

A

At any time, unless:
Postpartum breastfeeding - 6 weeks, 7 day barrier method.
Postpartum not breastfeeding - day 21, 7 day barrier method.
Miscarriage/abortion - gestation <24 weeks, within 5 days, no barrier. Gestation >24 weeks, 6 weeks, 7 day barrier method.

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15
Q

When do women require barrier method when starting COC?

A

Depends on the stage of their cycle:
Day 1 (day 1 of period) - no barrier.
Day 2-5 - no barrier unless taking Qlaira (9 days barrier) or Zoely (7 days barrier).
Any other time - 7 days barrier, 9 for Qlaira.

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16
Q

What is the active ingredient in POPs?

A

Progesterone in the form of either:
Levonorgestrel
Norethisterone
Desogestrel
Drospierenone.

17
Q

Which forms of progesterone tend to be better?

A

Desogestrel and drospirenone suppress ovulation more consistently and may improve symptoms of dysmenorrhoea.

18
Q

How should the POP be taken?

A

At the same time every day.
If vomit within 2 hours, take another ASAP. If vomiting and diarrhoea lasts for a while, follow missed pill rules and use contraception for 48 hours.

19
Q

What are some adverse effects of POP?

A

Headaches and migraines
Breast tenderness and breast cancer
CVD
Menstrual irregularities - 50% prolonged bleeding, 70% spotting
Ectopic pregnancy (except desogestrel)
Ovarian cysts
Libido changes

20
Q

When do women require barrier method when starting POP?

A

Drospirenone:
Day 1 - no barrier
Any other day - 7 days barrier

Other POPs:
Day 1-5 - no barrier
Any other day- 2 days barrier

21
Q

When should women start using the POP?

A

At any time unless:
Postpartum - start immediately with no barrier within 21 days. If after 21 days, use barrier for 2 days or 7 if on drosperinone.

22
Q

When is a combined pill classed as a missed pill?

A

After 12 hours

23
Q

In the case of a missed combined pill, what should someone do?

A

1 pill - take missed pill ASAP and continue remaining pills at usual time. No EHC or barrier.

2 pills - take missed pill ASAP and continue remaining pills at usual time. If UPSI occurred in:
HFI - no EHC or barrier.
Day 1-7 - consider EHC. Use barrier for 7 days.
Day 8-14 - no EHC needed. Continue taking as normal. Use barrier for 7 days.
Day 15-21 - no EHC needed. Continue taking but omit HFI and start new pack straight after current one. Use barrier for 7 days.

24
Q

When is a progesterone only pill classed as a missed pill?

A

Levonorgestrel or Norethisterone - >3 hours late
Desogestrel - >12 hours late
Drospirenone - >24 hours late

25
Q

How should a missed POP be managed?

A

Take one ASAP, then continue at normal time. Avoid sexual intercourse of use barrier method for 2 days, or 7 if taking drospirenone.

26
Q

What are the options for emergency contraception?

A

Cooper coil - 120 hours after UPSI or after ovulatoin (14 days before next period), whichever is later
Ellaone (ulipristal acetate) - 120 hours.
Levonelle (Levonorgestrel) - 72 hours.

27
Q

How does an IUD work as emergency contraception?

A

Inhibits fertilisation by its toxic effects which cause reduced motility and viability of sperm and reduced viability and transport of ova. If fertilisation does occur, the local endometrial reaction resulting from the presence of Cu-IUD prevents implantation.

28
Q

How does Ellaone work as EHC?

A

Ulipristal acetate acts by inhibiting or delaying ovulation by bind to the human progesterone receptor and suppressing the luteinizing hormone surge.

29
Q

What are some counselling points for Ellaone?

A

If you vomit within 3 hours, take another.

Can cause nausea, headaches, and painful periods.

Take a pregnancy test after 7 days to check.

30
Q

When can ellaOne not be given?

A

Under 13.
EHC already been given this cycle.
120 hours after UPSI or ovulation.

31
Q

How does Levonelle work as EHC?

A

Levonorgestrel acts by inhibiting ovulation, theyrby delaying or preventing follicular rupture and causing luteal dysfunction.

32
Q

Why is Levonelles efficacy variable?

A

If taken prior to the start of LH surge, it inhibits ovulation for the next 5 days, until sperm from USPI is no longer viable, however, in the late follicular phase, levonorgestrel becomes ineffective.
Does work up to 96 houes after UPSI but efficacy decreases with time.
Only licensed for use within 72 hours.

33
Q

When can Levonelle not be given?

A

Under 16.
After 72 hours.

34
Q

What must a child be able to do if deemed Gillick competent?

A
  • Understand the issue, and what it involves, including advantages, disadvantages, and potential long-term impact.
  • Understand the risks, implications, and consequences that may arise from their decision.
  • Understand any advice or information they have been given.
  • Understand any alternative options.
  • Explain a rationale around their reasoning and decision making.
35
Q

In order to give contraception to a minor, what must you be satisfied of under the Fraser guidelines?

A
  • They cannot be persuaded to inform their parents or carers that they are seeking this advice or treatment.
  • They understand the advice given.
  • Their physical or mental health or both are likely to suffer unless they receive the advice or treatment.
  • It’s in their best interests to receive the advice, treatment, or both without their parents’ or carers’ consent.
  • They are likely to continue having sex with or without contraceptive treatment.
36
Q

What warrants child protection referral when a child asks for EHC?

A

Indication of sexual exploitation, grooming, or abuse.
Sexual activity under 13.

37
Q

Normal ovulation process.

A

Follicular phase:
1. Pituitary gland in brain releases FSH.
2. Follicles in ovaries develop.
3. On day 7, follicles day except one which matures.
Luteal phase:
4. Day 12, mature follicle releases burst of oestrogen which stimulates pituitary to release LH.
5. LH supports oocyte development.
6. Follicle bursts open and ejecte egg which enters fallopian tube and is wafted down towards the uterus by fimbraie.

IP (18 decks)

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