Contraception Flashcards
List 4 types of long-acting reversible contraception
Copper intrauterine device (IUD)
Progesterone-only intrauterine devive (IUS)
Progesterone-only Depo injection
Progesterone-only implant
Which type of contraception increases the patient’s risk of ectopic pregnancy?
The intrauterine devices i.e. IUD and IUS
How long is the copper coil used for?
5-10 years
In women > 40 years old it will be effective until contraception no longer needed
How long is the progesterone-only coil used for?
5 years
In women > 45 years old with no regular periods it will be effective until contraception no longer needed
What is the main side effects of the copper coil?
Heavier, painful periods
What are the main complications of the copper coil?
PID, uterine perforation, iron deficiency anaemia, increased risk of ectopic pregnancy if pregnancy occurs whilst in situ
What are the main complications of the progesterone-only intrauterine device?
PID, uterine perforation, increased risk of ectopic pregnancy if pregnancy occurs whilst in situ
What are the main side effects of the progesterone-only intrauterine device?
Irregular bleeding / spotting up to 6 months after insertion, acne, mood change
True / False: The progesterone-only intrauterine device causes oligo/amenorrhoea 6 months after insertion in the majority of women?
True
What is the method of action of the deep injection contraception?
Prevents ovulation
How long does the depo-provera injection last for?
12 weeks
List 6 types of short-acting reversible contraception
Male condoms Female barrier methods Combined oral contraceptive pill Progesterone-only pill Transdermal contraceptive patch Combined contraceptive vaginal ring
Which hormones does the combined oral contraceptive pill contain?
Oestradiol and progesterones (levonorgestrel or norethisterone)
List some side effects of the combined oral contraceptive pill
Headache Acne Weight gain Breast symptoms Increased risk of VTE Depression Breakthrough bleeding
How is the combined oral contraceptive pill taken?
Oral pill taken for 21 days with a 7 day break
List 3 methods of emergency contraception
Levonelle
EllaOne
Copper IUD
How long can sperm survive in the uterus / fallopian tubes?
Up to 7 days
When does ovulation occur?
14 days before the first day of a woman’s period
In a 35 day cycle, what day will ovulation happen?
21
Ovulation occurs 14 days before the first day of a woman’s period
What is the earliest date of ovulation post partum?
28 days
How long can an egg survive for if unfertilised?
24 hours
What is the mechanism of action of the IUD (copper coil)?
Inhibits implantation
How effective are the IUS, IUD and implant?
Over 99% effective i.e. if 100 women using these methods had sex, less than 1 will become pregnant each year
Which hormones are in the IUS (intrauterine system) i.e. Mirena coil?
Progesterone only
What is the mechanism of action of the Depo provera injection?
Prevents ovulation
After removal of an implant, when is the earliest date of ovulation?
7 days after removal of implant
When is the earliest date of ovulation after Depo injection?
15 weeks
Give 3 types of female barrier methods of contraception?
Cervical cap
Diaphragm
Female condom
What is the risk of pregnancy with perfect and typical use of the male condom?
Perfect use = 2%
Typical use = 15%
How is the contraceptive patch used?
The same patch is worn for 3 weeks and then 1 week break taken (exactly like the COCP)
How is the contraceptive ring used?
The same ring is worn for 3 weeks and then 1 week break taken (exactly like the COCP)
List some absolute contraindications for the COCP
Age over 35 and smoking more than 15 cigarettes daily
Current or previous VTE
Major surgery with prolonged immobilisation
Migraine with aura
Breast or liver cancer
6/52 post fatally
How would you counsel a woman about the risk of VTE with the COCP?
Advise patient that the risk is slightly increased with COCP use (from about 5 in 10,000 without COCP to about 10 in 10,000 with the COCP), but the risk is still very small. It is also much lower than if they were pregnant (about 30 in 10,000). Advise patient to seek medical advice if any chest / calf pain.
How is the progesterone only pill taken?
Continuously - no breaks
Taken at the same time every day (a ‘late’ pill is anything over 3 hours late)
List some contraindications of the POP
New IHD or stroke
Current / past breast cancer
Liver cancer / cirrhosis
What effect does the progesterone only pill have on endometrial cancer risk?
Reduces risk of endometrial cancer
How effective is the copper IUD as emergency contraception?
More than 99%…..If 1000 women had UPSI, only 1 woman would become pregnant if they used the copper IUD
How long after an episode of UPSI can Levonelle be used?
Up to 72 hours after episode of UPSI
How long after an episode of UPSI can EllaOne be used?
Up to 120 hours (5 days) after episode of UPSI
How long after an episode of UPSI can the copper IUD be used?
Up to 5 days after UPSI…or…up to 5 days after the earliest calculated date of ovulation
When can hormonal contraception be started after EllaOne is taken for emergency contraception?
Wait 5/7 before starting hormonal contraception otherwise effect of EllaOne might be reduced
When can hormonal contraception be started after Levonelle is taken for emergency contraception?
Immediately
Give some contraindications to using EllaOne as emergency contraception
Severe asthma on steroids
Severe hepatitis
Use of enzyme inducers (anti-epileptics, anti-TB drugs, St. John’s wort, anti-retrovirals)
Use of meds to neutralise stomach acid (PPIs, H2 antagonists)
Can Levonelle be used if taking an enzyme inducer medication?
Yes, but double the dose
How long after starting the POP is it effective?
2 days
How long after starting the COCP is it effective?
7 days
How long after having the Mirena coil fitted is it effective?
7 days
How long after having the copper coil fitted is it effective?
Immediately
On stopping or missing a COCP, when is the earliest date of ovulation?
- Day 10 of an extended hormone free interval
- The day after the 2nd missed pill if in the 1st week of the packet (the missed pills don’t have to be on consecutive days)
What are the missed pill rules for COCP?
- *Take the last missed pill and continue taking the rest of the pack
- If one missed pill, she does not require additional protection OR emergency contraception
- If 2 or more missed pills, advise to use condoms for 7 days, and find out where in the packet she was as emergency contraception may be required
What advice should be given to a woman who has missed 2 or more pills in a packet?
- Take the last missed pill and continue taking the rest of the pack
- Use condoms for 7 days
- If missed pills in 1st week of the pack, she may require emergency contraception due to extension of pill-free week
- If missed pills in 2nd week of pack, she does not require emergency contraception and should continue taking the rest of the pack as normal
- If missed pills in 3rd week of pack, she does not require emergency contraception but she should continue straight onto the next pill pack after finishing this current pack, do not take a week’s break
What are the missed pill rules for POP?
- *Take missed POP as soon as you remember
- Use extra protection for 2/7 after missing POP
- Emergency contraception is required if UPSI within 2/7 of a missed pill
What are the limitations on fitting an IUD as emergency contraception in women who are on the POP?
Cannot use the earliest predicted date of ovulation because they are unlikely to have regular bleeding pattern. Can only fit within 5/7 of USPI
