Contraception Flashcards
State 7 key contraceptive methods available
- barrier methods (condoms)
- combined oral contraceptive pill
- progesterone only pill
- implantable contraceptives
- injectable contraceptives
- intrauterine system (IUS): progesterone releasing coil
- intrauterine device (IUD): copper coil
What is the mode of action of the COCP
Inhibits ovulation
What is the mode of action of progestogen-only pills (excluding desogestrel)
Thickens cervical mucus
What is the mode of action of desogestrel
Primary: Inhibits ovulation
Also: thickens cervical mucus
What is the mode of action of Injectable and implantable contraceptives
Primary: Inhibits ovulation
Also: thickens cervical mucus
What is the mode of action of a Intrauterine contraceptive device (IUD)
Decreases sperm motility and survival
What is the mode of action of Intrauterine system (IUS)
Primary: Prevents endometrial proliferation
Also: Thickens cervical mucus
What criteria guides the decision of starting different methods of contraception in different individuals
UK medical eligibility criteria (UKMEC)
What is the UKMEC
UKMEC categorises the potential cautions and contraindications of starting different methods of contraception in different individuals
Describe the 4 levels of the UKMEC
- UKMEC 1: a condition for which there is no restriction for the use of the contraceptive method
- UKMEC 2: advantages generally outweigh the disadvantages
- UKMEC 3: disadvantages generally outweigh the advantages
- UKMEC 4: represents an unacceptable health risk
Give 5 examples of UKMEC 3 conditions for the COCP
- BMI ≥ 35 kg/m^2
- Ex smoker stopped <1y ago and ≥35y
- immobility e.g. wheel chair use
- controlled hypertension (>140/90)
- carrier of BRCA1/BRCA2
- FHx of VTE in first degree relatives < 45y
Give examples of UKMEC 4 conditions for the COCP
- ≥35y and smoking more than 15 cigarettes/day
- migraine with aura
- breast feeding < 6 weeks post-partum
- SLE and antiphospholipid syndrome
- Uncontrolled hypertension (≥160 / ≥100)
- major surgery with prolonged immobilisation
What are some side effects/ risks of the COCP
- small risk of VTE
- Headaches
- small risk of heart attacks and strokes
- increased risk of breast cancer and cervical cancer
When is additional contraception needed when starting the Combined Oral Contraceptive pill
if COCP is started at any time other than the first 5 days of the cycle
How long should extra contraception be used after starting the COCP outside of the first 5 days?
extra contraception (e.g. condoms) should be used for the first 7 days of consistent pill use
What are the three regime options for taking the COCP
- 21 days on and 7 days off
- 63 days on (three packs) and 7 days off (“tricycling“)
- Continuous use without a pill-free period
What is the medical benefit of having a withdrawal bleed while taking the COCP?
There is no medical benefit/ indication for a withdrawal bleed while taking the COCP.
What advice should be given if one COCP is missed (>24hr late)
- take the last pill asap even if it means taking two pills in one day
- no additional contraceptive protection needed
What should a woman do if she misses 2 or more COCP and what precaution should they take ?
- take the last pill even if it means taking two pills in one day
- the women should use condoms or abstain from sex until she has taken pills for 7 days in a row
What should be considered if the COCP is missed in week 1 (Days 1-7)?
Emergency contraception should be considered if there was unprotected sex during the pill-free interval or in week 1.
What advice is given if the COCP is missed in week 2 (Days 8-14)?
After 7 consecutive days taking the COCP, there is no need for emergency contraception.
What should a woman do if the COCP is missed in week 3 (Days 15-21)?
Finish the pills in the current pack and start a new pack the next day, thus omitting the pill-free interval.
What factors can reduce the effectiveness of the pill?
Vomiting, diarrhoea, and certain medications (e.g., rifampicin) can reduce the effectiveness of the pill, and additional contraception may be required.
What are the three forms of emergency hormonal contraception
- levonorgestrel
- ulipristal acetate
- IUD
What is the standard dosage of levonorgestrel?
- A single dose of 1.5 mg
- 3mg in women with a BMI >26 or weight over 70 kg.
When should levonorgestrel be taken for maximum efficacy?
It should be taken as soon as possible and within 72 hours of unprotected sexual intercourse
What should be done if vomiting occurs within 3 hours of taking levonorgestrel/ ulipristal?
The dose should be repeated.
What is ulipristal and its primary mode of action?
Ulipristal is a selective progesterone receptor modulator that primarily inhibits ovulation
What should you know about starting hormonal contraception after using Levonorgestrel for emergency contraception?
Hormonal contraception can be started immediately after using Levonorgestrel for emergency contraception.
What is the dosage and ideal time frame for taking ulipristal as emergency contraception?
30 mg oral single dose should be taken ASAP, no later than 120 hours after intercourse.
How does ulipristal affect hormonal contraception?
Ulipristal may reduce the effectiveness of hormonal contraception, so contraception with the pill, patch, or ring should be started or restarted 5 days after taking ulipristal.
In which patients should ulipristal be used with caution?
Patients with severe asthma.
Can ulipristal and Levonorgestrel be used more than once in the same menstrual cycle?
Yes, both ulipristal and Levonorgestrel can be used more than once in the same menstrual cycle.
What is the most effective method of emergency contraception?
A copper IUD
Within how many days should a copper IUD be inserted after unprotected sexual intercourse ?
It must be inserted within 5 days of UPSI.
Under what circumstances can a copper IUD be inserted after 5 days of unprotected sexual intercourse?
within 5 days after the earliest estimated date of ovulation
Mode of action of copper coil
Inhibit fertilisation or implantation
What additional precaution may be given to patients at high risk for STIs when using a copper IUD?
Prophylactic antibiotics may be given.
What happens to the copper IUD after its emergency use?
It may be left in situ to provide long-term contraception
What should be considered when a client wishes to remove the copper IUD after emergency use?
The IUD should be kept in until at least the next period if the client wishes for it to be removed.
When should the Progestogen-Only Pill be started for immediate protection?
should be commenced up to and including day 5 of the cycle for immediate protection
What should be done if the progesterone only pill is started after day 5 of the cycle?
Additional contraceptive methods (e.g., condoms) should be used for the first 2 days.
POP takes 48 hours before it becomes effective
