Contraception Flashcards
Options for nulliparous, not desiring pregnancy in next few years, estrogen not contraindicated
Any hormonal method
NOT IUCD
In women wanting to delay for 1 year what is better, and what should not be used and why
OCP or barrier
Depot has variable return to fertility, better to avoid
Method most effective in controlling bleeding due to fibroids, adenomyosis, dysfunctional uterine bleeding
OCP Mirena
Which cancers do COCP offer protection
Ovarian
Endometrial
Contraception in women who have completed their families
Mirena
Depot
Subdermal implants
Overview of contraceptive methods (6)
Physiological
Barrier
Hormone
Copper IUD
Surgical
Emergency
Physiological contraceptives (5)
Withdrawal
Rhythm
Lactational amenorrhea
Chance Abstinence
Barrier methods (6)
Condom
Spermicide
Female condom/diaphragm
Sponge
Cervical cap
Hormonal options (6)
OCP
Minipill
Mirena
Nuva ring
Transdermal
Depot-provera
Emergency contraception methods (3)
Yupze
Plan B levonorgestrel
IUD
Oestrogen in COCP
Ethinyl estradiol
Progesterones in COCP (remember 2)
Norethisterone
Levonorgestrel
Monophasic
Estrogen and progesterone dose remains the same over 21 days, then 7 day free
Biphasic
Same oestrogen ProG + during last 11 days of active cycle
Triphasic
Oestrogen + in middle, and progesterone + as cycle progresses
Progestogen only
Same dose of progesterone is taken without a break
Number of +breast cancer cases in 40-44 and 45-54
11-17/100 000
When does breast cancer risk return to normal
10 years after stopping
Mechanisms of action of OCP
Inhibit HPA->-ve ovulation
+viscosity of cervical mucus (proG),
less sperm penetration
-ve receptiveness of endometrium->growth is suppressed, unsuitable for implantations
Change in tubal function
In typical OCP use, what is the failure rate
as high as 8%
Contraindications to OCP use
Smoker (>15/day) and >35
Migraine with aura
History of VTE/PE
CardioV or cerebroV disease
Diabetes w/ circulator problems
Complicated valvular heart disease
Severe liver disease
BreastCa
Uncontrolled HTN
Prolonged immobilisation
Malabsorption syndrome
Unexplained vaginal bleeding->must investigate BMI >30 Postpartum
If COCP to be used postpartum, how long to delay
21 days
Benefits of COCP (11)
Reduction in bleeding
Reduced anemia
+ for dysmenorrhea
Less symptomatic fibroids
Ability to manipulate menses
Reduction in endometrial, ovarian Ca
Reduction in benign breast disease/lumps
Reduced functional ovarian cysts
Some protection against PID
Safe in long term if no risk factors
+ in management of endometriosis
-ve PMS
When does the COCP need to be stopped before major elective surgery and restarted
4 weeks prior
Start 2 weeks after full mobilisation
Can use progesterone only
VTE prophylaxis
Is there a risk to pregnancy if concommitant use
No
Are COCP good for breast feeding, why
Not as good, estrogen can reduce milk supply
Major adverse effects
VTE->+risk of DVT
Non- 5-6/100 000, 2nd gen 15/100 000, 3rd gen 30/100 000
Pregnancy 60/100 000
Hemorrhagic, thrombotic stroke
Breast cancer
Common side effects
Breakthrough bleeding
Amenorrhea
Nausea Vomiting
Breast enlargement Tenderness
HA
Mood changes, changes in libido
+BP
Fluid retention
Chloasma
Acne
Thrush
Approach to breakthrough bleeding >3 months and another cause not identified
- Change to monoP, if multiP
- Change the progesterone or +dose, (especially if bleeding late in cycle)
- Change to standard dose 30-35, if using low dose 20
- Change the progestogen again
- Change to high volume COCP (50mcg ethinylestradiol)
Nausea management
Reduce estrogen dose
Change to progestogen only