Contraception Flashcards
How effective is the COCP?
> 99%
What is the mechanism of action of the COCP?
Inhibits ovulation
Increases cervical mucous
Thins endometrial lining
COCP increases the risk of which types of cancer?
Breast
Cervical
COCP decreases the risk of which types of cancer?
Endometrial
Ovarian
The COCP is effective immediately if started when?
Within 5 days of the start of the menstrual cycle
A girl comes in wanting to start the COCP. She is on day 13 of her cycle, what advice would you give her?
Start the COCP, however additional contraception (condoms or abstinence) is required for the first 7 days
What are some absolute contraindications of the COCP?
BMI ≥ 40 Migraine with aura Breastfeeding < 6 week postpartum 35 years old + smoking ≥ 15 a day Hx of CVA/IHD/ uncontrolled hypertension Current breast ca Prolonged immobilisation/ recent surgery
What advice would you give someone who has missed a COCP pill at any point in the pack?
Take the missed pill as soon as you remember, even if it means taking 2 in 1 day. Take next one as normal - no need for emergency contraception
If 2 missed - take 1 pill immediately and and use condoms for 7 days - further management depends on week of pack
What advice would you give someone who has missed 2 COCP pills in week 1?
Will need emergency contraception if she had sex in pill free week or 1st week
What advice would you give someone who has missed 2 COCP pills in week 2?
No emergency contraception required, use additional contraception for 7 days
What advice would you give someone who has missed 2 COCP pills in week 3?
Omit the pill free week (i.e. back to back next packet)
No contraception required
What drugs can reduce the efficacy of the COCP?
CYP450 inducers - Carbamazepine Rifampicin Barbiturates Phenytoin St John's Wart
What is the mechanism of action of the POP?
Thickens cervical mucous
Inhibits ovulation in 50%
What advice about additional protection would you give someone commencing on the POP?
If starting within 5 days of starting period, POP effective immediately
If starting at any other point in the cycle, use condoms for 2 days
What are common side effects of the POP?
Spotting, particularly in first few months
Weight gain
What are some absolute contraindications to the POP?
Pregnant
Breast cancer in last 5 years
Undiagnosed PV bleeding is a relative contraindication
What are the windows for taking the POP?
Normal - 3 hours, if ≥ 3 hours take missed pill and use condoms for 2 days
Cerazzete - 12 hour window
What are the advantages of the POP compared to the COCP?
Lighter or absent periods
Not contraindicated in htn, CVD, migraine
What are the E & 6Ps of IUD & IUS?
Expulsion - usually within first 3 months
Pregnancy
Perforation
PID
Periods - heavier on IUD, spotting on IUS
Procedure (pain)
Progestognenic side effects (IUS) - acne, weight gain, loss of libido etc
What is the mechanism of action of Depo-provera and how often is it taken?
Inhibits ovulation –> causes amenorrhea (after initial spotting)
12 weeks
The Nexplanon emits how much progesterone daily?
How often must it be changed?
~25-70mg
3 years
What is the mechanism of action of the IUD?
Spermotoxic
Prevents implantation
What is the mechanism of action of the IUS?
Inhibits ovulation
What are the non-contraceptive uses of the IUS?
First line treatment of menorrhagia
How long is the IUS effective for?
5 years
IUS & IUD increase the risk of what?
PID if inserted whilst woman has an asymptomatic STI
Ectopic pregnancy if the woman becomes pregnant
What effect does the IUD have on periods?
Heaver & prolonged
How often must a women check for the strings of an IUS/IUD?
Monthly
What contraception is available to all women immediately postpartum?
POP
When do women require contraception after giving birth?
After 21 days (longer if breastfeeding)
When can an IUD be inserted postpartum?
4 weeks
How often is the patch changed?
weekly for 3 weeks then patch free week
What is the generic name of Levonelle?
Levonorgestrel
What is the generic name of EllaOne?
Ullipristal
EllaOne can be taken how long after unprotected intercourse?
5 days
Levonelle can be taken up to how long after unprotected intercourse?
3 days
What is the most effective emergency contraceptive?
Copper coil
When is the copper coil effective as emergency contraception?
5 days after intercourse
5 days after expected date of ovulation (if sex occurs 4 days before ovulation IUD can be fitted up to 9 days after intercourse)
What should additionally be prescribed for the patient if the copper IUD is used as emergency contraception?
Antibiotic prophylaxis
Which emergency contraceptive can only be used once per cycle?
Ullipristal/ EllaOne
How long after being used as emergency contraception can the copper IUD be removed?
4 weeks
Which emergency contraceptive inhibits the action of some contraceptives?
EllaOne/Ullipristal
Inhibits action of progestogens –> barrier contraception required until next period
