Contraception Flashcards
Types of progestogen only contraceptive pill
Levonorgestrel 30mcg/day
Norethisterone 350mcg/day
Effectiveness of progestogen only pill
3per 100 failure
Side affects of progestogen only pill
Lack of compliance Irregular cycle Irregular bleeds Breast tenderness Increase appeptite Breast tenderness Depression Acne N and V Headache Dizziness Lethargy Cholestatic Jaundice Reduced libido Androgenic - Hirsutism, greasy hair Hypersensitivity
Indications for progestogen only pill
> 45 yr
smokers aged >45
Pt who are contraindicated to or intolerance of oestrogen’s e.g. DM, migraine, chasm, lactation and well controlled HTN
Contraindication for progesterone only pill
Pregnancy Undiagnosed genital tract bleeding Absolute if PmHx or increase risk of ectopic pregnancy and concomitant use of enzyme-inducing drugs. Liver failure SLE Anticonvulsant
What is Depo Provera
Medroxyprogestreone acetate IM injection
Dose of Depo Provera
150mg deep IM in 1st 5 days of cycle and repeat every 12 week.
Failure rate Depo Provera
1 per 1000
Adverse effects of Depo Provera
Disrupted menstrual cycle e.g. irregular or prolonged, 70% amenorrhoea
Wt gain
Breast tenderness
Depression
Delay in return to fertility about 6 months
Long term use = decrease in bone
Contraindication of Depo Provera
No absolute
Not for >2yr or as 1st line in
Types of emergency contraception
Within 72hrs
- Postinor 1 (one dose of 1500mg)- 2 - ( 2 doses of 750mcg levonorgestrel 12hr apart . 80-85%
- Ulipristal acetate 30mg as a single dose.
Copper - IUCD within 5 days - 99%
Implanon MOA
Etonogestrel implant 68mg (25-30micg/day)
Inhibits ovulation and antimucus effect
Implanon AE
Irregular bleeding most common. Requires minor surgery to insert and remove.
Implanon failure rate
IUCD efficacy
96-99%
IUCD contraindication
Absolute - pregnancy, active PID, undiagnosed abnormal genital bleeding tract. Previous ectopic pregnancy, severe uterine cavity distortion
Relative - Menorrhagia, dysmenorrhoea, lesser uterine cavity distortion, very large or very small uterus, anaemia, defective immune system, impaired clotting mechanism, valvular heart disease, acutely anteverted or retroverted uterus, increase risk of PID e.g. multiple sex partners
IUCD AE
If pregnant 40-50% risk of abortion/sepsis, 10 times higher risk of pregnancy vs COCP. Increase risk of PID in first 30 day. extrusion, perforation, translocation, bleeding for 2-3m and pain.
increase risk of ectopic
Side effects of COCP
Advice to patient - Peroids become shorter, regular and lighter - No break from the pill is necessary - Drugs that effect the pill are - antacids, purgatives, vitamin C, antibiotics(griseofulvin and rifampicin) and anticonvulsants except sodium valproate. - Warfarin and oral hypoglycaemic may need adjustment - Acne - Amenorrhoea - brake through bleeding - Breast fullness/tenderness, mastalgia - Chloasma (tan skin) - Depression - Dysmenorrhea/menorrhagia -Libido loss - Headache - focal migraine - N and V - Wt gain Bloating Clot: DVT, PE, Stroke, MI, HTN Increase choleesterol and stasis = Gallbladder Breast and Cervical cancer
Types of contraception and their effectiveness
Physical - Withdrawal 77% - Rhythm method/calender/mucus/temp 98-76% - Lactational amenorrhea 98% 1st 6 m - Chance - no method 10% - Abstinence 100% Barrier method - Condom 98-85% - Spermicide 82-71% - Sponge parous 80-65%, nulliparous 91-84% - Diaphragm with spermicide 94-79% - female condon 95-79% - cervical cap 68-91% Hormonal - OCP 99.7-92% - Nuva Ring 99.7-92% - Transdermal 99.7-92% - Depo provera 99.7-97% - progestin only pill 90-99% - Mirena IUD 99.9% - Subnormal implant 99.9% Others - Copper IUD 99.5% - Surgical tubal ligation 99.65%, vasectomy 99.9% - emergency postcoital contraception- Yuzpe method 98%
Contraindications for COCP
Absolute - pregnancy - 1st 6 wk postpartum - Hx thromboembolic or thrombophilia - CVD - Focal migraine - CAD - Oestrogen dependent tumor - active liver disease - Polycythaemia Relative - Heavy smoker - >35yr and smoking or other risk of CAD - Undiagnosed abnormal vaginal bleeding - Breast feeding - 4 wks after surgery - HTN - Gall bladder or liver disease - DM - Long term immobilisation - complicated valvular heart disease - hyperlipidaemia - Chloasma - severe depression
Serious AE of COCP
CVS
- venous - DVT, PE, rarely mesenteric, hepatic and kidney thrombosis
- Arteries - MI, stroke, retinal and mesenteric thrombosis
Cancer - ↑ risk cervix, breast
Protective against endometrial and epithelial
Liver cancer
Counsel a patient only COCP
Contains Ethinyl estradiol 20-35mg and progestin
Failure rate is 0.03%
MOA - inhibits hypothalamic and pituitary function leading to anovulation
Component
- Estrogens - mestranol and ethingloestradiol
- Progesterone - Nor testosterone derivative, levonorgestrel, 3rd gen gestogens
Starting- lowest effective dose, 1st line is monophasic pill(levonorgestrel or norethisterone, 30mcg ethinyloestradiol)
Contraindications
AE
Counseling for emergency contraception
take ASAP within 72 hrs of sex
If vomiting less then 2 hours take again
It shouldn’t change your period but you may get intermensual spotting.
Come back if your period is light or late be a week
You may experience N/V, breast tenderness, spotting and headache.
Precautions with COCP
Unexplained bleeding Breast Cancer Migraine - stroke Diabetes - clot Smoking - clot BMI over 30 - clots Antiphospholipid syndrome Postpartum until day 42 Hx of CVS Age greater then 40 Liver disease Surgery
Indications for COCP use
Contraception Acne Menstral Disorder Endometrosis Prementrual syndrome
