Contraception Flashcards
Fraser guidelines
under 16s
May provide contraception without parental consent if:
- Understand doctor’s advice
- Cannot be persuaded to inform parents
- Very likely to continue having sex
- Mental + physical health will suffer other wise
- In best interests to provide treatment
COC: MOA
- Inhibits ovulation, contains oestrogen + progestogen
- 99% effective but user dependent
COC: first line
Monophasic: <30mg ethinylestradiol + levonorgestrel/norhisterone
COC: patient factor
- Weight >90kg: NOT topical
- Malabsorption: NOT oral
COC: how to take
One pill, same time each day
- Day 5+: condom for 7 days
- 21 day: 7 days pill free
- 28 day: 7 days inactive pill
COC: missed pill
- missed pill >24H
- zoely/qlaira >12H
- 1 missed pill: take ASAP and next pill at normal time
-2+ missed pill
- Take ASAP + condom for 7 days
- 9 days if zoely/qlaira
- Missed in last 7 days: omit pill free interval
- Missed in first 7 days + sex: ECH
COC: vomiting and diarrhoea
- Vomiting <3H of dose: follow missed pill
- Severe diarrhoea >24H: follow missed pill
- Persistent diarrhoea/vomiting: consider non-oral
COC: CI
- Hx of VTE
- Smokers 35+
- Major surgery + immobilized
- CVD (stroke/TIA, angina + MI)
- AF
- Migraine w aura
- Severe hypertension: >160/>100
COC: side effect
- Abnormal bleeding, weight gain, acne, headache (common)
- Cervical + breast cancer
COC: surgery
Stop 4 weeks before
- For: Major surgery, legs or pelvis surgery that results in prolonged immobility of lower limbs
- Progestogen only contraceptive = alt
- Restart usual contraceptive on first menses at least 2 weeks after full mobilisation
- Thromboprophylaxis in emergency surgery or if COC was not stopped
COC: travel
3H
- Counsel: risk of DVT, leg exercises + compression stockings
POP: MOA
- Alters cervical mucus to prevent sperm penetration + may inhibit ovulation
- 99% effective, highly user dependent (oral)
POP: drugs
POP:
- Desogestrel (cerelle, cerazette)
- Norethisterone (noriday)
- Levonorgestrel (emergency contraception)
Parenteral:
- Medroxyprogesterone (injection)
- Norethisterone (injection)
Intra-uterine device:
- Levonorgestrel
POP: how to take
- One pill, same time each day
- Start day 1 of cycle
- Day 5+ (condom for 2 days)
POP: side effect
- Menstrual irregularities (common)
- Breast cancer
POP: missed pill
- Missed pill >3H
- Desogestrel >12H
- Take ASAP + condom for 2 days
- ECH: unprotected sex before 2 pills taken
POP: Vomiting + diarrhoea
- Vomiting <2H: Take ASAP
- No replacement pill, persistent vomiting or severe diarrhoea: condom during + 2 days after illness
POP: parenteral
Medroxyprogesterone injection - 12 weeks
- Delay in return to full fertility
- Osteoporosis
Norethisterone injection - 8 weeks
- Delay in return to full fertility
Etonogestrel implant - 3 years
Contraceptive device: indication
Long term contraception (copper or levonorgestrel brand)
Contraceptive device: side effect
Bleeding, menstrual irregularities, ectopic pregnancy
Uterine perforation
- MHRA: uterine perforation
- Counsel: report severe pelvic pain after insertion, sudden change in periods, pain during sex, pain or inc bleeding for more than few weeks or unable to feel threads
Infection + pelvic inflammatory disease
- Chlamydia screening if high risk (under 25 OR 25+ w multiple partners
- Abx prophylaxis w emergency contraception
EC: first line
Copper IUD
- <120H (or <5 days after ovulation)
EC: second line (levonorgestrel)
Levonorgestrel 1.5mg
- <72H
- Caution: malabsorption (crohn’s disease)
- Contraception: start asap + use condom until effective
EC: second line (ulipristal)
Ulipristal 30mg (more effective )
- <120H
- Overweight: BMI >26/70kg
- CI: severe asthma on oral steroids
- Contraception: wait 5 days + use condom until effective
EC: counselling
- Vomiting within 2 hrs - need replacement dose
- Next period may be early/late
- Use barrier methods
- If delayed periods >7 days, lighter + atypical abdominal pain → take pregnancy test
Spermicides
- Does not provide enough protection alone
- Unsuitable if high risk of STIs
Barrier methods
- Less effective than other contraceptive methods
- Protect against STIs
Drug interactions
Enzyme inducers (carbamazepine, pheyntoin, phenobarbital, rifampicin) + COC/POP/CH → red effectiveness
- IUD (copper or levonorgestrel)
- Progestogen only injections
- EC: copper IUD OR 3mg levonorgestrel
MHRA: teratogenic drugs
- Use: IUD or Progestogen only implant
