Contraception 2 Flashcards
3 methods of combined hormonal contraception?
combined pill
vaginal ring
patch
failure rate of CHC?
if perfect = 0.3%
typical use = 9%
how is the combined pill taken?
start in 5 days of period
or
at any time in cycle when reasonably sure not pregnant plus condoms 7 days
take daily for 21 days followed by a 7 day break
tailored regimes in combined pill?
can tricycle pill for 3 months then take a week off
or just keep taking until you have a breakthrough bleed
- stop while bleeding then start again
what may impair effectiveness of CHC?
impaired absorption (GI conditions etc) increased metabolism (liver enzyme induction, drug interaction etc) forgetting
risks in CHC?
venous thrombosis
arterial thrombosis
adverse effects on some cancers
what is the VTE risk in pregnancy?
21-30 per 10,000
i.e bigger risk than the pill
VTE risk in post-natal women?
130-140 per 10,000
even bigger than in pregnancy
unwanted effects of CHC?
systemic hypertension
- should check at 3 months initially then annually
aterial disease (small increase in MI risk, small increase in ischaemic stroke risk)
increases risk of ischaemic stroke in people who have migraine with aura (contraindication)
how can CHC affect cancer risk?
small increase in breast cancer risk
small increase in cervical cancer risk with long term use (>5 years)
- reduces to baseline 10 years after stopping
examinations in CHC?
record BP and BMI before prescribing
check smear status if relevant
check if there are multiple risk factors
protective factors of CHC?
20% reduction in ovarian cancer risk for every 5 years of use to a max 50% reduction after 15 years 20-50% reduction in endometrial cancer potential use in BRACA gene patients beneficial acne in acne - dianette
non-contraceptive benefits of CHC?
less bleeding
fewer functional ovarian cysts
premenstrual syndrome
PCOS
side effects of CHC?
nausea
bleeding
spots
breast tenderness
when should CHC be avoided?
inherited thrombophilia
migraine with aura
