Contraception Flashcards
Mechanism of action COCP
Inhibits ovulation
Mechanism of action progesterone only pill (excluding desogestrel)
Thickens cervical mucus
Mechanism of action desogestrel-only pill
Primary: inhibits ovulation
Also: thickens cervical mucus
Mechanism of action injectable contraceptive (medroxyprogesterone acetate)
Primary: inhibits ovulation
Also: thickens cervical mucus
Mechanism of action implantable contraceptive (etonogestrel)
Primary: inhibits ovulation
Also: thickens cervical mucus
Mechanism of action IUD
Decreases sperm motility and survivalMechanism of action
Mechanism of action IUS (levonorgestrel)
Primary: prevents endometrial proliferation
Also: thickens cervical mucus
Mechanism of action levonorgestrel as emergency contraception
Inhibits ovulation
Mechanism of action ulipristal as emergency contraception
Inhibits ovulation
Mechanism of action IUD as emergency contraception
Primary: toxic to sperm and ovum
Also: inhibits implantation
Alternative condoms in latex allergy
Polyurethane
When to wear/change combined contraceptive patch (Evra)
For first 3 weeks, patch worn every day and needs changing each week
During 4th week, patch not worn - withdrawal bleed
Action if Evra patch change delayed at end of week 1 or 2
If less than 48 hours, change immediately and no further action
If greater than 48 hours, change immediate and barrier contraception for 7 days. If UPSI in last 5 days, emergency contraception
Action if Evra patch change delayed at end of week 3
Patch removed, new patch applied on usual cycle start date of next cycle, even if withdrawal bleed is occurring. No additional contraception
Action in Evra patch change delayed at end of patch-free week
Additional barrier contraception for 7 days
Advantages COCP
Contraceptive effects reversible on stopping
Usually makes period light, regular, less painful
Conditions COCP reduces risk of
Ovarian cancer
Endometrial cancer
Colorectal cancer
PID
Ovarian cysts
Benign breast disease
Acne
Disadvantages COCP
May forget
No protection against STI
Temporary side effects - headache, nausea, breast tenderness
Conditions COCP increases risk of
Breast cancer
Cervical cancer
Stroke
Ischaemic heart disease
UKMEC categories
UKMEC 1 - no restriction
UKMEC 2 - advantages generally outweigh disadvantages
UKMEC 3 - disadvantages generally outweigh advantages
UKMEC 4 - unacceptable health risk
UKMEC 3 COCP
- More than 35 and smoking less than 15/day
- BMI >35
- FHx VTE in first degree relative <45
- Controlled HTN
- Immobility, e.g. wheel chair user
- BRCA1/2
- Current gallbladder disease
UKMEC 4 COCP
- More than 35 and smoking over 15 cigarettes per day
- Migraine with aura
- History of VTE or thrombogenic mutation
- History of stroke or IHD
- Breastfeeding <6 weeks postpartum
- Uncontrolled hypertension
- Current breast cancer
- Major surgery with prolonged immobilisation
- Positive antiphospholipid antibodies
Diabetes and COCP
Diabetes mellitus diagnosed >20 years ago UKMEC 3 or 4 depending on severity
Additional contraception when starting COCP
If started within first 5 days of cycle, no need for additional contraception
If started at any other point, alternative contraception for 7 days