Contraception Flashcards
Contraceptive used for acne
COCP:
Co-cyprindiol (contains cyproterone, which is anti androgenic)
Problem with co-cyprindiol
has a high clot risk
needs to be stopped after 2-3 mo post acne resolution
Mech of action of COCP
- inhibit ovulation via hypothalamo-pituitary-ovarian axis
- prevent fertilisation and implantation by altering mucus in cervix and endometrium
How does risk of clots on COCP compares to healthy controls/pregnant
20 in 100 000 on COCP
5-10 healthy
60 pregnant
SE of COCP
- increased BP
- Hormonal SEs: nausea, breast tenderness, mood changes, change in libido
- headaches
Monitoring whilst on COCP
BP annually
CI to COCP
- VTE or condition that increases its risk (SLE, phospholipid syndrome)
- arterial thrombosis or TIA
- Migraine with aura
- cholestatic jaundice or liver disease
- known pregnancy
- hormone dependent cancer, eg breast
- undiagnosed vaginal bleed
How to take COCP
- Take for 21 days, starting on day 1-5 of period
- 7 day break, expect bleed
Can COCP be taken back to back
yes, but need to have at least 4 periods per year
Which abx cant be taken with COCP
enzyme induced ones eg rifampicin
Drugs that may interact with COCP
Herbal prep eg St Johns wort
antiepileptics
SEs of POP
irregular or infrequent bleeding
amenorrhoea
2 different IM progesterone only contraceptives and how often given
Depot Provera 12wkly
Noristerat 8wkly
How often does progesterone only implant need to change
every 3 yrs
How often doe mirena coil IUS need to change
5 yrly
how often does copper coil IUD need to change
10 yrly
Effect of mirena coil on periods
reduces heavy painful periods
Effect of copper coil on period
makes them heavier and more painful
Risk with pregnancy in presence of coil
ectopic
Post coital contraception options
Levonorgestrel (Levonelle-1)
Ulipristal Acetate (ellaOne)
IUD copper coil
How long after intercourse is levonogestrel effective
72hrs
How long after intercourse is ulipristal acetate effective
120hrs (5dys)
How long after intercourse is IUD copper coil effective
120 hrs or up to 5 dys after estimated earliest date of ovulation
Mech of action of levonogestrel
unknown, maybe prevents ovulation/implantation
Mech of action of ulipristal acetate
SPRM (selective progesterone receptor modulator) ; inhibits/delays ovulation
What happens if vomiting after taking the emergency contraceptive pill
take a second dose with domperidone 10 mg (antiemtic)
When can someone have sex after levonelle
until contraceptive cover is resumed (7 days of COCP or 2 days of POP)
When can someone have sex after ellaOne
use barrier methods or completely avoid until next period (as reduces the efficacy of hormonal contraceptives)
How long does it take for cocp contraceptive cover to start
7 days post start (shouldnt have sex)
How long does it take for pop contraceptive cover to start
2 days post start
CIs to copper coil
suspected pregnancy PID Cervical abnormality Cervical or endometrial cancer Trophoblastic disease
Mech of action of copper coil
prevents fertilisation
Missed POP pill
<3 hrs, take it, no action (unless cerazette 12hrs)
>3hrs actions:
- take the pill
- condoms more 2days
