Contraception Flashcards
What are the two hormones in Contraception?
Oestrogen
Progesterone
Which hormone would be used as an emergency contraception?
Leveongesterol
Selective progesterone receptor modulator with a partial progesterone antagonist effect
What is mode of delivery for combined contraceptive?
Oral
subderma
Vaginal
What is the mode of delivery for Progesterone only contraceptive?
Oral
subdermal
intramuscular
intrauterine
subcutaneous
How does estrogen work?
Inhibits secretion of follicle-stimulating hormone (FSH) via negative feedback on the anterior pituitary,
ovarian follicle does not develop
How does progesterone work?
inhibits the secretion of the luteinising hormone preventing ovulation.
sperm also does not implant and endometrium not receptive to implantation.
What is entheropathic circulation?
Enterohepatic circulation is the process by which certain substances, such as bile acids, hormones (e.g., oestrogen), and some drugs, are cycled between the liver and intestines.
stages of metabolism and contraception?
e.g: intestine- liver- intestine- liver-intestine- urine
What drugs may inhibit absorption of Contraceptives?
Proton Pump Inhibitors (PPI) can affect the absorption due to increasing the PH level of the gastric which makes the Oestrogen less soluble.
What drugs can effect efficacy and metabolism of Contraceptive?
Enzyme inducing drugs such as anti-epileptic, antibacterials, antivirals speed up CYP3A4 via Cytochrome p450 so speedinging the metabolism and having lower contraceptive levels in the body. Enzyme inhibiting drugs like Vasodilaters and HIV medication can have the opposite effect and may lead to toxicity.
What are the health benefits of Combined Hormone contraceptive/
Reduced cancer risk
regular bleeding pattern
Reduced dysmenorrhoea and menorrhagia
manage symptoms of PCOS, ENDOMETRIOSIS
Improvement of acne
reduction in menopause symptoms
Maintaining bone mineral density in peri-menopausal females under the age of 50 years
What are the health benefits of Progesterone?
It may help with dysmenorrhoea.
What are the health benefits of Intra uterine system?
The Mirena 52 mg LNG-IUS can be used to provide endometrial protection in conjunction with estrogen therapy for up to 5 years (outside product licence)
The 52 mg LNG-IUS may reduce pain dysmenorrhoea, endometriosis or adenomyosis
The 52 mg LNG-IUS is effective in reducing menstrual blood loss and can be used in the management of HMB.
What are the health benefits of Injectable contraceptives?
Amenorrhea or reduced bleeding
Decrease pain associated with sickle cell crisis and endometriosis
What are the health benefits of Implants?
Improvement of Dysmenorrhea and endometriosis pain
Risks with Combined hormonal contraceptive?
Deep Vein Thrombosis
PE
MI
small increased risk breast and cervical cancer
Risks with Progesterone Contraceptive?
Cardiovascular health- no evidence
Breast cancer- no evidence- cannot be excluded.
Ectopic pregnancy- the overall risk of pregnancy is reduced with use of traditional POPs, around 1 in 10 pregnancies that do occur may be ectopic.
Risk of injectable contraceptives?
one mineral density
Progestogen-only injectable use is associated with a small loss of bone mineral density, which is usually recovered after discontinuation.
Breast cancer
There is possibly a weak association between current use of DMPA and breast cancer. Any increased risk is likely to be small and reduce with time after stopping.
Venous thromboembolism (VTE) (including deep vein thrombosis and pulmonary embolism)
A causal association between DMPA and venous thrombosis has not been demonstrated in the small number of studies that have investigated this relationship.
Arterial thromboembolic disease
From the limited evidence available it is not possible to confirm or exclude an association between progestogen-only injectable use and myocardial infarction or stroke.
There is a weak association between cervical cancer and use of DMPA for 5 years or longer. Any increased risk appears to reduce with time after stopping and could be due to confounding factors.
Use of DMPA is not associated with an increased risk of ovarian or endometrial cancer and may offer some protection.
Risk Intrauterine system contraceptives?
Venous thromboembolism (VTE) (including deep vein thrombosis and pulmonary embolism) and arterial thromboembolic disease
Evidence suggests there is little or no increased risk of VTE or MI associated with the use of a LNG-IUS.
Ovarian cysts
Although ovarian cysts may occur when using the LNG-IUS, most cysts are asymptomatic and resolve spontaneously.
Breast cancer
Evidence does not support a link between breast cancer and use of the LNG-IUS.
Ectopic pregnancy
The overall risk of ectopic pregnancy is reduced with use of IUC when compared to using no contraception.
If pregnancy does occur with an intrauterine method in situ, the risk of an ectopic pregnancy occurring is increased and in some studies half of the pregnancies that occurred were ectopic.
Data are insufficient to determine if the 13.5 mg LNG-IUS is associated with a greater risk of ectopic pregnancy than other IUC methods.
Which contraception should you avoid with a migraine and why?
Avoid contraceptives with Oestrogen:
Risk of Stroke: Oestrogen in the pill can increase the risk of blood clots and stroke, especially in women who already have vascular risk factors like migraine with aura. Oestrogen increases the production of clotting factors, makes platelets stickier, and inhibits clot breakdown,
Migraine Exacerbation: Oestrogen can also make migraines worse by affecting serotonin levels in the brain.
What followup is needed for Contraceptives?
Depends on method
CHC annual
POP annual
SDI 3 yearly
IUS 3 to 6 yearly depending on type
Injectables
Depo-Provera up to 14 weeks
Noristerat 10 weeks
Sayana Press annually
