Contraception 2: Non-oral contraceptives Flashcards
What are the contents in transdermal patch (evra)
Administration?
Location?
Estradiol 35mcg + 200mcg norelgestromin/day
Admin:
- Once weekly for 3/4 weeks
- Not for patients over 90kg
Location:
- abdomen, arm, or buttocks
NOT breast/pelvic area
What are advantages of transdermal patches?
- increased estrogen exposure
- Lower rates of BTB/spotting
- Patch can maintain ovulation inhibitory levels for 9 days (in case you forget to take it off after day 7)
What are disadvantages of transdermal patches?
- More breast discomfort/pain
- NV
- dysmenorrhea
When should a new patch be applied?
- If a patch becomes loose
- lifts off or falls off 24hr+
If a patch is detached 24hr+ during week 1 or unsure how long, what do you do?
- Apply a NEW patch
- back-up contraception for 7 days
- Consider EC
If a patch is detached less than 3 days during week 2/3, what do you do?
- Apply a NEW patch
- Start a NEW cycle of 3 patches with no HFI
If a patch is detached 3+ days during week 2/3, what do you do?
- Apply a NEW patch
- Start a NEW cycle of 3 patches with no HFI
- Backup contraception for 7 days
- consider EC
What are the contents of the NuvaRing?
Administration?
Etonogestrel 0.120mg/ ethinyl estradiol 15ug per day
Administation
- remain in vagina for 3 weeks (can be used with/without ring-free period
- reinsert within 3 hours
- Can work up to 4 weeks
If the ring is delayed insertion 24hr+ or removed more than 3 hours during week 1 or unsure how long, what do you do?
- Insert ring asap
- back-up contraception for 7 days
- Consider EC
If the ring is removed less than 3 days in week 2/3, what do you do?
- Insert ring asap
- Start a NEW CYCLE with a NEW RING with no HFI
If the ring is removed more than 3 days in week 2/3, what do you do?
- Insert ring asap
- Start a new cycle with a new ring with no HFI
- Backup contraception for 7 days
- Consider EC
Explain the administration of medroxyprogesterone acetate (depo-provera)
Dose?
Start therapy?
Backup how long?
- IM every 3 months at doses of 150mg
- Start therapy within 5 days of menstrual bleeding
- Use backup contraception for the first 2 weeks after injection
What are some adverse effects of Depo-provera?
Most common reason for stopping?
Infertility?
Risk factors?
ADRs
- headaches, dizziness
- weight gain
- depression, decreased libido
Most common (after 9-12 months)
- excessive bleeding and amenorrhea
Infertility lasts 6-12 months after stopping
Risk factor
- increases risk of osteoporosis (avoid use in patients at risk of this)
What happens if your last injection was between 13-14 weeks ago?
Give next injection asap
What happens if you your last injection was 14+ weeks and you had sex within 5 days ago and preg test is negative
- Give EC
- Take injection asap
- Back-up contraception for 7 days
- Take preg test 3 weeks later
What happens if you your last injection was 14+ weeks and you had sex more than 5 days ago and preg test is negative
- Take injection asap
- Back-up contraception for 7 days
- Take preg test 3 weeks later
What happens if you your last injection was 14+ weeks and you did not have sex and preg test is negative
- Give next injection ASAP
- Back-up contraception for 7 days
What are the primary and secondary MOA of IUD/IUS?
How long are they effective for?
Primary: prevention of fertilization
- impaired sperm transport
- Morphological changes in endometrium
- Thicken cervical mucous
Secondary mechanism
- inhibit implantation
- inhibit of ovulation
Effective for 5 years
What can copper IUD be used for?
Emergency contraception up to 7 DAYS AFTER unprotected sex
What is the first line option for canadian youth
IUDs/IUS
What are the adverse effects of IUD vs IUS
Bleeding?
Pain/dysmenorrhea?
Hormonal?
Functional ovarian cysts?
Bleeding
- Copper IUD inc bleeding
- IUS decreases bleeding
Pain
- Copper IUD: occurs in 6% of women
- IUS: reduced pain
Hormonal
- Only IUS: low incidence of depression, acne, headache, breast tenderness
Functional ovarian cysts occur in up to 30% of IUS users
What are risks associated with IUD/IUS
Uterus perforation (hole in uterus), risk of:
- inexperienced operator
- Immobile uterus
- Postpartum insertion
What is the contraceptive implant?
How long does it last?
Content?
Etonogestrol (nexplanon)
Lasts for 3 years (effective up to 4-5 years)
Contains:
- Extended release 68mg etonogestrel –> delivers 70mcg/day
- 15mg of barium sulfate
** must be able to feel it all times
- remove it if you don’t feel it
What are benefits of associated with COC use?
Endometrial cancer
Ovarian cancer
Colorectal cancer
Menstrual symptoms
Pelvic inflammatory disease
Benign breast disease
Acne
Osteoporosis
