Contraception Flashcards
List the three types of contraception
Hormonal
IUD
Barrier method
Which method of contraception is contraindicated in women with Pelvic inflammatory disease?
INTRAUTERINE DEVICE
What are Combined Hormonal Contraception
Oral contraception containing Estrogen and progestogen
State the estrogen content in CHC
Ethinylestradiol( main One)
Other Estradiol and mestranol
State the progestogen content in CHC
Desogestrel, Gestodene, Drospirenone, Levonogestrel , Northisterone , normegestrol and dienogest
What are the factors that may cause contraception failure?
Weight, malabsorption and drug interaction
It’s highly recommended that CHC are not used beyond what age?
50 as safer alternative exists due to risk of cancer due to estrogen content
Content of CHC
Take one tablet daily for 21days , 7days pill free interval for withdrawal bleeding
Advantages of CHC
Reduces periods pain and heavy bleeds
Reliable and reversible
Reduced menopausal symptoms
Predictable bleeding pattern
Improvement of acne
Reduced risk of ovarian, endometrial and colorectal cancer
Maintain bone density in peri- menopausal women under 50
Examples of pills that are monophasic
Fixed amount of estrogen and progestogen in each active tablet
Yasmin
Microgynon
Rigevidon
Cilest
State when to give low strength Ethinylestradiol to women
20mcg
For women with risk factors for circulatory disease eg obesity, smoking, HTN, MI
What’s the standard strength of ethinylestradiol
30-35mcg
What’s drospirenone
A derivative of Spironolactone
Can cause Hyperkalaemia
Examples of multiphasic COC
Qlaira , symphase,
Use for women who have breakthrough bleeding with monophasic or who do not have withdrawal bleeding
Surgery and contraception
Discontinue CHC 4weeks before major elective surgery and all surgery to legs or pelvis which involve prolonged immobilisation to lower limbs
What to offer women on CHC during surgery if estrogen cannot be stopped
Thromboprophylaxis ( unfractionated or LMWH) and graduated stockings to prevent risk of dvt cause by estrogen
Symptoms to stop CHC
See photo fav.
Signs of DVT
Migraines
HTN
Signs of liver disease
Caution with CHC
Increased risk of VTE, increases with age and other risk factors
Increased risk of breast and cervical cancer ( risk disappear after stopping)
State when to use CHC with caution or avoid
Avoid if BMI is greater than 30kgm
Long term immobilisation
If smokes greater than 40 cigarettes daily
Avoid if greater than 50yrs
Avoid in diabetes complications
Migraine with aura
Pt and carer advice for those on CHC travelling
If greater than 3hrs on flight reduce risk of dvt by wearing graduated compression hoselery or exercising during the journey
Pt and carer advice for vomiting and diarrhoea on CHC
Take another pill ASAP if vomiting occurs 3hrs with taking the combined pill or if severe diarrhoea occurs for more than 24hrs
Use non oral contraception if diarrhoea and vomiting persist
What is missed pill for desogestrel, Zoely and Qlaira
Greater than or equal to 12hrs
What’s missed pill time for Levonorgestrel and Northisterone?
Greater than or equal to 3hrs
What’s missed pill time for othe r contraception?
Greater than or equal to 24hrs
See table for CHC missed pill
State when to take EHC when pill is missed for CHC
If you miss 2 or more pills on day 1-7
Advise pt to abstain from sex or use additional protection for 7days or 9days for zoely and Qlaira
State what to do if 2 or more CHC pills missed from day 14-21days
No EHC needed
Omit the pill free and start a new pack
State three forms of Progestogen Only Contraception
Oral
Parenteral
IUD
State when to use POC
Suitable alternative to CHC when estrogen is C.I
POC affects the menstrual cycle in what way?
Menstrual irregularities such as heavy or light periods more common
What’s the MOA for Oral POC
Eg desogestrel only preps consistently inhibit ovulation
What are the examples of Oral Progestogen Only Contraception?
Levonorgestrel 30mcg, desogestrel 75mcg. , noresthisterone 350mcg
Take everyday
No pill free period