contraception Flashcards
what type of lubricants should be avoided with latex condom use
oil based
COCP MoA
stops ovulation
also thickens cervical mucus (reducing chance of semen entering uterus) and thins endometrial lining (reducing chance of implantation)
risks of taking COCP
- blood clots
- heart attacks/stroke
- breast and cervical cancer
(>99% effectice if taken correctly)
true or false - there is a medical benefit from having a withdrawal bleed when on the COCP
FALSE !!!!!
no med benefit
- COCP is conventionally taken for 21 days then stopped for 7 days
- Options include never having a pill-free interval or ‘tricycling’ - taking three 21 day packs back-to-back before having a 4 or 7 day break
** intercourse during the pill-free period is only safe if the next pack is started on time
are barrier methods required when initially starting COCP?
if started within the first 5 days of the cycle then there is no need for additional contraception
-> any other point, alternative contraception should be used for the first 7 days
when might efficacy of COCP be reduced
- vomiting with 2hrs of taking
- drugs that induce D or V e.g. orlistat
- liver enzyme inducing drugs
—> rifampicin, Carbamazepine, Phenytoin, Primidone, Topiramate
UKMEC scale
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
UKMEC3 for COCP
- more than 35 years old and smoking less than 15 cigarettes/day
- BMI > 35 kg/m^2*
- family history of 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
Diabetes mellitus diagnosed > 20 years ago is classified as UKMEC 3 or 4 depending on severity
UKMEC4 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)
smokers and the COCP
UKMEC 2: age < 35 years
UKMEC 3: age > 35 years and smoking < 15 cigarettes/day
UKMEC 4: age > 35 years and smoking > 15 cigarettes/day
(no increased risk of cardiovascular disease with progestogen-only contraceptives so they are classed as UKMEC 1, regardless of the patient’s age/cigarette intake.)
obesity + COCP
UKMEC 2: BMI 30-34 kg/m²
UKMEC 3: BMI >= 35 kg/m²
patients who have had gastric sleeve/bypass can never have oral contraception due to lack of efficacy
recommended contraception for those taking antiepileptics
UKMEC1 - depo-provera, IUD, IUS
which cancers can COCP reduce risk of
ovarian + endometrial
-> this effect may last for decades after cessation
also reduced colorectal cancer
if one COCP pill is missed at any time in cycle, what should they do
take the last pill even if it means taking two pills in one day and then continue taking pills daily, one each day
no additional contraceptive protection needed
if 2 COCP pills are missed, what should they do
take the last pill even if it means taking two pills in one day, leave any earlier missed pills and then continue taking pills daily, one each day
–> use condoms until taken pills for 7 days in a row
missed in week 1 - emergency contraception should be considered if she had unprotected sex in the pill-free interval or in wk 1
week 2 - after 7 consecutive days of taking the COC there is no need for emergency contraception
week 3 - finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval
COCP in women >40
- use in the perimenopausal period may help to maintain bone mineral density
- may help reduce menopausal symptoms
- a pill containing < 30 µg ethinylestradiol may be more suitable for women > 40 years
UKMEC for women >=40
POP MoA
thicken cervical mucus
- irregular bleeding common side effect
injectable contraception MoA
primary - inhibits ovulation
also - thickens cervical mucus
lasts 12 weeks
implant MoA
primary - inhibits ovulation
also - thickens cervical mucus
lasts 3 years
- irregular bleeding common SE
copper coil MoA
decreases sperm motility + survival
IUS MoA
primary - prevents endometrial proliferation
also - thickens cervical mucus
SE - irregular bleeding
MoA of emergency contraception
ulipristal + levonorgesteral - inhibits ovulation
IUD - toxic to sperm + ovum, also inhibits implantation
days of additional contraception required when starting different methods after day 6 of cycle
COCP - 7
POP - 2 **quickest
inject - 7
IUS - 7
IUD - 0
(IUS is safe day 1-7 so would be day 8 onwards)
testosterone therapy and contraception
Testosterone therapy does not provide protection against pregnancy and if the patient becomes pregnant, testosterone therapy is contraindicated as can have teratogenic effects.
Regimes containing oestrogen are not recommended in patients undergoing testosterone therapy as can antagonize the effect of testosterone therapy.
recommend - POP, IUS, inject
Legal/ethical issues with contraception in young people
conset age 16, practioners can provide advice + contraception if young person deemed “competent” by Fraser guidelines
- kids <13 - automatic trigger of child protection
when should you take an STI test after unprotected sex
2 and 12 weeks after unprotected sexual intercourse (UPSI)
LARC of choice in young people
PO implant
(long acting reversible contraception)
IUS + IUD = UKMEC2 for <20s
forms of emergency contraception
levonorgestrel
ulipristal - ellaOne
IUD
levonorgestrel
stops ovulation + inhibits implantation
- must be taken within 72hrs of UPSI (efficacy decreases with time)
double dose if BMI>26 or weight >70kg
- vom within 3hrs - repeat dose
- can be used more than once in cycle
- hormonal contraception can be started immediately after
ulipristal (EllaOne)
inhibits ovulation
- take within 120hrs post UPSI (5days)
contraception with pill patch or ring should be started/restarted 5 days after (barrier inbetween)
can be used more than once in cycle
contraindications/caution for ulipristal
patients with severe ASTHMA
breastfeeding should be delayed for one week after taking ulipristal. There are no such restrictions on the use of levonorgestrel
most effective method of emergency contraception
copper IUD
- must be fitted within 5days or up to 5 days after likely ovulation date
99% effective refardless of where used in cycle
implant key points
most effect form of contraception (+IUD)
lasts 3 years
no oestrogen, can use if VTE or migraine
can be inserted immediately followng TOP
adverse affects of implant
irregular/heavy bleeding
- sometimes managed with coprescription of COCP
progestogen effects - headache, nausea, breast pain
enzyme inducing drugs (epileptics/rifampicin) can reduce efficacy
contraindications of implant
ukmec4 = current breast cancer
3 = ischaemic heart disease, stroke, unexplained vaginal bleeding, past breast cancer, liver cancer, liver cirrhosis
adverse effects of injection
irregular bleeding
weight gain
may increase risk of osteoporosis
not quickly reversible, may take a while for fertility to return
contraindication = current/previous breast cancer
infection + expulsion of intrauterine devices (IUS/IUD)
increased risk of PID in 1st 20days after inserion, after reduces to that of standard population
expulsion - 1 in 20, most likely to occur in 1st 3 months
intrauterine devices (IUS/IUD) contraindications
UKMEC 3 = between 48hrs + 4 wks postpartum (increased perforation risk), initiation with ovarian cancer
UKMEC4 = pregnancy, pelvic infection, recent abortion, unexplained vag bleeding, fibroids
screen for STIs if at risk
