Contraception Flashcards
Contraceptives: time till effective (if not the first day of period).
- IUD (1)
- POP (1)
- others (1)
instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS
Emergency contraceptives:
When to avoid EllaOne (uliprisatal) (1)
asthma
Nexplanon (estronogestrel):
where inserted?
subdermal
COCP and surgery:
when to stop (1)
4 weeks before
Mitch to progesterone only
COCP:
UKMEC 4 criteria
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)
Contraceptive side effects:
osteoporosis (1)
weight gain (1)
DEPO for both (and delayed return to fertility)
Anti-epileptics and contraception:
- phenytoin,carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine (3)
- lamotrigine (1)
The pills are the problem
Coil/ Depo good for all
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
POP late:
what to do? (1)
which is the exception to this rule (1)
Traditional’ POPs (Micronor, Noriday, Nogeston, Femulen)
-If less than 3 hours late > no action required, continue as normal.
Cerazette (desogestrel)
-If less than 12 hours late > no action required, continue as normal
Which contraception contraindicated >50?
DEPO (osteoporosis)
Mechanism of action:
- POP (other than desogestrol)
- desogestrel-only
- injectable
- IUS
- levonorgestrel
- IUD
- implant
- COCP
POP (EXCEPT desogestrel): thickens cervical mucus
IUS: prevents endometrial proliferation
IUD: toxic to ovum and sperm
THE REST STOP OVULATION.
COCP and postpartum - when to avoid
breast feeding < 6 weeks post-partum= UKMEC 4
stroke / IHD + COCP
UKMEC 4
current breast cancer contraceptive
only IUD
Cerazette (desogestrel) - why special
POP with 12hr window
Fraser gudeliens_ what ages
<13= ILLEGAL
13-15= Fraser
16+= allowed
when does Nexplanon work straight away
if inserted in first 5 days of period
how long does neplaxon last
3 years
what does neplaxon interact with
enzyme-inducing drugs such as certain antiepileptic and rifampicin may reduce the efficacy of Nexplanon
when should levonorgestrel 1.5mg dose be changed (2)
1) BMI >26 or weight over 70kg –> DOUBLE DOSE
2) enzyme inducing drugs
levonorgestrel - when to repeat dose
if vomit within 3hr
when can you start hormonal contraceptive after: levonogestrel (1)
EllaOne (ulipristal) (1)
- immediately
- Ulipristal may reduce the effectiveness of hormonal contraception. Contraception with the pill, patch or ring should be started, or restarted, 5 days after having ulipristal. Barrier methods should be used during this period
What is the most common adverse effect experienced by women taking the progestogen only pill?
irregular bleeding
postpartum contraceptive
progesterone after day 21
OR IUS/IUD within 48hr of childbirth OR after 4 weeks
NOTE:
COCP contraindicated <6 weeks postpartum if breastfeeding
UKMEC 2 6weeks-6 months
pregnancy interval optimal
An inter-pregnancy interval of less than 12 months between childbirth and conceiving again is associated with an increased risk of preterm birth, low birth weight and small for gestational age babies.
oestrogen contraceptive and surgery - when to stop
4weeks before (offer Progesterone instead)
These recommendations do not apply to minor surgery with short duration of anaesthesia, e.g. laparoscopic sterilisation or tooth extraction, or to women using oestrogen-free hormonal contraceptives.
when can copped IUD be inserted post UPSI
within 5 days OR Withn 5 days of earliest ovulation date, whichever is later
condom for latex allergy
polyurethane condom
contraceptive patch:
week 1 or 2 (1)
week 3 (1)
WEEK 1 or 2:
if <48hr okay
if >48hr = change, 7 days contraception additional
END OF WEEK 3: (i.e. delayed taking patch off at break)
if removal of patch delayed then just take it off and start new on on day you ere supposed to. If patch application is delayed at the end of a patch-free week, additional barrier contraception should be used for 7 days following any delay at the start of a new patch cycle.
investigation if concerned about ectopic
Pregnancy test! if -ve no concern
progesterone only pill - when is a late pill
3 hrs
post medical termination of pregnancy: when can neplanon be inserted
immediately
BUT ensure she is not pregnant on insertion
Examples of contraceptives that are unaffected by EIDs are:
Copper intrauterine device
Progesterone injection (Depo-provera)
Mirena intrauterine system
how long does POP take to be effective
2 days
Progestogen only pill + antibiotics
no need for extra precautions
