Contraception Flashcards
SOME factors to consider with COCP
Smoking - MEC 3 >35 years and <15, MEC 4 if >35 and >15
Obesity - MEC 3 >35kg/m2
Migraine - MEC4
Epilepsy - Most AEDs with COCP MEC 3
Outline UKMEC system (2-4)
UKMEC 2: advantages generally outweigh the disadvantages
UKMEC 3: disadvantages generally outweigh the advantages
UKMEC 4: represents an unacceptable health risk
Preferred contraception in epilepsy
Depo-Provera, IUD, IUS
Advantages of COCP in women >40
COCP use in the perimenopausal period may help to maintain bone mineral density
COCP use may help reduce menopausal symptoms
Women of 46 with IUCD has amenorrhoea, when can she stop?
after 2 years of amenorrhoea
Woman of 50 on COCP, what should be done?
Switch to non-hormonal or progestogen-only method
Types of emergency contraceptives
Levonogestrel
EllaOne
IUCD
Levonogestrel time window
<72 hours
EllaOne time window
<120 hours
IUCD time window
5 days or 5 days from ovulation date
CI to IUCD
Pelvic inflammatory disease history pregnancy puerperal sepsis immediate post-septic abortion distorted uterine cavity (any congenital or acquired abnormality distorting the uterine cavity in a manner that is incompatible with IUD insertion) including uterine fibroids
When to women require contraception post-partum?
Day 21
When can the POP be started postpartum?
Any day
When can the COCP be used postpartum?
Absolutely CI until 6 weeks
how long is lactational amenorrhoea effective?
6 months post-partum
Advantages COCP
highly effective (failure rate < 1 per 100 woman years)
doesn’t interfere with sex
contraceptive effects reversible upon stopping
usually makes periods regular, lighter and less painful
reduced risk of ovarian, endometrial and colorectal cancer
may protect against pelvic inflammatory disease
may reduce ovarian cysts, benign breast disease, acne vulgaris
Disadvantages of COCP
people may forget to take it
offers no protection against sexually transmitted infections
increased risk of venous thromboembolic disease
increased risk of breast and cervical cancer
increased risk of stroke and ischaemic heart disease (especially in smokers)
temporary side-effects such as headache, nausea, breast tenderness may be seen
4 points of advice on taking the COCP
if the COC is started within the first 5 days of the cycle then there is no need for additional contraception. If it is started at any other point in the cycle then alternative contraception should be used (e.g. condoms) for the first 7 days
should be taken at the same time everyday
taken for 21 days then stopped for 7 days - similar uterine bleeding to menstruation
advice that intercourse during the pill-free period is only safe if the next pack is started on time
What happens if woman missed 2 pills in a row?
If 2 or more pills missed
take the last pill even if it means taking two pills in one day, leave any earlier missed pills and then continue taking pills daily, one each day
the women should use condoms or abstain from sex until she has taken pills for 7 days in a row. FSRH: ‘This advice may be overcautious in the second and third weeks, but the advice is a backup in the event that further pills are missed’
Give 5 absolute contraindications to COCP
more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
Give five relative contraindications to COCP
more than 35 years old and smoking less than 15 cigarettes/day
BMI > 35 kg/m^2*
family history of thromboembolic disease in first degree relatives < 45 years
controlled hypertension
immobility e.g. wheel chair use
carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
When is early menopause
<45
When is premature menopause
<40
When is average menopause
51
What is range for usual menopause
45-55
When should HRT not be given??
Age over 60
What are four key risks of HRT?
Stroke
VTE
Breast cancer
Endometrial cancer (Oestrogen only)
Give four types of patient in which you should be cautious prescribing HRT
1) There is sudden change in menstrual pattern, intermenstrual bleeding, postcoital bleeding, or postmenopausal bleeding - refer for endometrial assessment.
2) There is a personal or family history of VTE - a thrombophilia screen may be helpful.
3) There is a high risk of breast cancer - consider mammography or MRI scan; refer to NICE guidance on familial breast cancer.[34]
4) The woman has arterial disease or risk factors for arterial disease - consider checking lipid profile.
