Contraception Flashcards
COCP ukmec3 conditions? (Disadvantages outweigh advantages)
35 years old+ and smoking less than 15 cigarettes/day
BMI > 35 kg/m^2*
fh thromboembolic disease in first degree relatives < 45 years
controlled hypertension
immobility e.g. wheel chair use
carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
current gallbladder disease
Ukmec4 conditions for cocp?
more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)
Post partum contraception?
Need after 21 days.
Fully breast fed ok for 6 months
Cocp CI less than 6 weeks and not recced for less than 21 days.
Pop first line after 21 days (2 day cover)
Cocp needs 7 day cover
Breast feeding 6weeks to 6 months, wants cocp?
This is ukmec2, cocp if benefits outweigh the risks
Emergency contraception for women who have missed COCPP? According to pill pack
if pills are missed in week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1
if pills are missed in week 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception*
if pills are missed in week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval
Oral emergency contraception?
Ulipristal - ci asthma with steroids. Take within 120 hrs. Restart pill/ patch/ ring afted 5 days. Restart breast feeding after 1 week. 30mg.
Levonorgestrel - take within 72 hrs. 1.5 mg or double if 70kg+/ bmi 26+
Oral emergency contraception?
Ulipristal - ci asthma with steroids. Take within 120 hrs. Restart pill/ patch/ ring afted 5 days. Restart breast feeding after 1 week. 30mg.
Levonorgestrel - take within 72 hrs. 1.5 mg or double if 70kg+/ bmi 26+
Nexaplannon
Se dysfunctional bleeding. 1 in 5 have amenn after 1 year. Alters cervical mucus, prevents ovulation, only progesterone.
Insert after termination/ day 1 to 5 of cycle. If inserted after day 1 to 5, use 7 days protection. Ci breast cancer, ukmec3 any stroke/ vte/ pv bleed/liver disease/ previous breast cancer.
Reduced efficacy by enzyme inducers ( rifampicin/ antiepileptics)
Depot injection pros/ cons?
Thickens cervical and endometrial lining. 150mg medroxyprpgesterone in IM. 12 weekly. Up to 14 week without extra protection. Se: OP, irregular bleeding, not easily reversible. Weight gain
Depot injection pros/ cons?
Thickens cervical and endometrial lining. 150mg medroxyprpgesterone in IM. 12 weekly. Up to 14 week without extra protection. Se: OP, irregular bleeding, not easily reversible. Weight gain
50+ YO contraception?
Any non hormonal stop after amen for 2 yrs <50 or 1 yr 50+
Any cocp - stop at 50 and switch
Any depot, stop after 50.
Any pop/ius/nexaplannon - continue until amen. Then stop if fsh 30+.
Missed POP pill? Window?
If more than 3 hrs late, take extra precautioms for 48 hrs after taking again.
If desogestrel/ cerazette has window of 12 hrs
Time until effective for injection/ implant/ ius?
7 days
Anti-epileptics and contraceptives
For women taking phenytoin,carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine:
UKMEC 3: the COCP and POP
UKMEC 2: implant
UKMEC 1: Depo-Provera, IUD, IUS
For lamotrigine:
UKMEC 3: the COCP
UKMEC 1: POP, implant, Depo-Provera, IUD, IUS
If a COCP is chosen then it should contain a minimum of 30 µg of ethinylestradiol.
