Contraception Flashcards
Combined Oral Contraceptive Pill (COCP), Patch, Ring
MOA
Key Ci’s (6)
suppresses LH & FSH
thickens cervical mucus
Key Contraindications:
VTE risk
migraine with aura
smoking >35 years
BMI >35
uncontrolled hypertension.
Breast & cervical cancer risk (but lowers ovarian & endometrial cancer risk)
Progestogen-Only Pill (POP)
MOA:
Key point:
Thickens cervical mucus
Key Points: Ideal for those who cannot take estrogen
Most effective LARC?
MOA
Duration
Implant (Nexplanon)
MOA Inhibits ovulation + thickens cervical mucus.
Duration: 3 years.
Intrauterine System (IUS - Hormonal)
MOA
Duration:
Key Benefit:
Contraindications (2)
Intrauterine System (IUS - Hormonal)
MOA: Prevents endometrial proliferation + implantation
Duration: 5 years
Key Benefit: Lighter periods
Contraindications (2): Current PID, uterine abnormalities.
Intrauterine Device (IUD - Copper)
MOA:
Duration:
Key Point:
Downside:
Intrauterine Device (IUD - Copper)
MOA: Prevents fertilization (toxic to sperm & egg).
Duration: Up to 10 years.
Key Points: Best 1st Line EC
Downside: Can cause heavier, more painful periods.
Depo-Provera Injection (DMPA)
MOA:
Duration: .
SE(3) :
MOA: Inhibits ovulation + thickens cervical mucus
Duration: Given every 12 weeks.
SE(3) : Weight gain, delayed fertility return, osteoporosis risk.
What is most effective (99%) and first-line if feasible EC?
What is more effective oral EC?
EC for obese?
✅ Copper IUD
→ Most effective EC (over 99%)
→ First-line if insertion is possible and within 5 days of UPSI or expected ovulation
✅ Ulipristal acetate (ellaOne)
→ Most effective oral EC
→ Use within 5 days (120 hrs) of unprotected sex
✅ Obese patients (BMI ≥26 or weight ≥70 kg):
→ Copper IUD remains most effective
→ Ulipristal preferred over levonorgestrel (which is less effective at higher weights)
Stick with COCP for how long minimum?
What reduces effectiveness of COCP?
Stick with it for 3 months before switching due to initial side effects.
Liver enzyme inducers (e.g. rifampicin, phenytoin, carbamazepine) reduce effectiveness. → Use extra contraception.
What reduces effectiveness of COCP (3)?
Liver enzyme inducers eg
rifampicin
phenytoin
carbamazepine
COCP protective againts (7)
Ovarian cancer
endometrial cancer
PCOS (regulates periods)
Heavy periods
dysmenorrhoea
Acne
Endometriosis
COCP dosing regimen
Take for 21 days, stop for 7 days (withdrawal bleed).
💊 Starting the Pill, Patch, or Ring – when & what to Do ref your menstrual cycle
✅ If you start on Day 1 to Day 5 of your period
→ It works straight away – no condoms needed
🚨 If you start after Day 5
→ You need to use condoms (or other contraception) for 7 days until it kicks in
🟩
COCP – Missed Pills
guidance For:
Missing 1 pill
Missing 2+ pills
Does the week in the pack matter?
✅ Missed 1 pill (anywhere in pack):
Take it as soon as remembered
No extra contraception needed
Continue pack as normal
✅ Missed 2 or more pills:
Take most recent missed pill ASAP+Todays pill
Discard other missed pills
Continue rest of pack as normal
Use condoms for 7 days
🗓️ Check which week you’re in:
Week 1: If UPSI → consider EC
Week 2: No EC needed if previous 7 days of pills were taken
Week 3: Skip the 7-day break → start next pack immediately
Missed COCP Pills + Unprotected Sex (UPSI)
Days 1-7 →
Days 7-14 →
Days 14-28 →
Days 1-7 → EC + 7 days condoms
Days 8-14 → NO EC+ 7 days condoms if ≥2 pills missed
Days 15-28 → No EC needed, but omit the pill-free interval (i.e., skip the 7-day break).
POP (Progestogen-Only Pill) (3)
MOA
Strict timing:
Bleeding pattern
Thickens cervical mucus to prevent sperm entry
Desogestrel POPs can also suppress ovulation
Must be taken at the same time daily
if >3 hours late OR >12 hours for desogestrel POPs, use extra contraception for 2 days.
Mainly Irregular bleeding
Amenorrhea (desogestrel)
Best EC
Copper IUD
When/how long does Copper IUD work after UPSI
Works up to 120 hours (5 days) after UPSI
or up to day 19 of a regular cycle.
Copper IUD Ci’s (3)
Active pelvic infection
menorrhagia
uterine abnormalities.
Ulipristal (ellaOne) Vs Levonorgestrel (Levonelle)
Which is better?
Time windows?
MOA’s of both
Ci’s (2)
Ulipristal (ellaOne) > Levonorgestrel (Levonelle)
Ella= Up to 120 hours (5 days) vs LNG Up to 72 hours (3 days)
Ella= Selective progesterone receptor modulator (SPRM) → Delays ovulation
LNG= Progestogen → Inhibits/delays ovulation
Ella= Severe asthma on steroids, Liver disease
LNG= Liver disease
Vomit within 3 hours of taking an EC pill? Do what?
Always do a pregnancy test at x weeks if no period.
What is x
🔹 Vomit within 3 hours of taking an EC pill? REPEAT the dose!
🔹 Always do a pregnancy test at 3 weeks if no period.
Why avoid Depot (3)
delayed return to fertility
weight gain
Breast Cancer
When to use depot (4)
VTE risk
migraine with aura
smokers >35
Breast cancer history
i.e. women who can’t take estrogen
Big R.F for Depot?
osteoporosis→ Use for ≤2 years max unless no other options
Irregular bleeding with Depo? → Next steps?
Reassure (improves with time),
can offer COCP short-term to stabilize.
