contraception Flashcards
general side effects of hormonal contraception
headache weight gain bloating breast tenderness loss of libido
side effects of progesterone contraception
acne mood changes hirsutism vaginal dryness like a moody teenager
side effects of oestrogen contraception
fibroids
nausea/vomiting
hypertension
vaginal discharge
what are the 2 broad categories of contraception
LARC
non-LARC
hormones in combines oral contraceptive pill
oestrogen and progesterone = ethinylestradiol
mode of action of COCP
inhibits ovulation
decreased endometrial thickening
when should COCP be started? what should you do if this is not possible?
days 1-5 of cycle
use condoms for 7 days if unable to do so
benefits of COCP
protective against ovarian and endometrial cancers
good for acne
risks with COCP
thromboembolic disease
breast and cervical cancer
when is COCP contra-indicated
current breast cancer post-partum <6 weeks and breast feeding migraine with aura cardiac history immobile >50 years
when should break through bleeding stop on COCP and what should you investigate if persists
should stop >3months check compliance rule out chronic vomiting/diarrhoea STI screen smear pregnancy?
mode of action of progesterone only pill
inhibits ovulation
slows fallopian tube transport (decreases action of cilia)
decreases endometrial thickening
thickens cervical mucous
most common POPs
levongestrel, norethisterone, desogestrel
when should POPs be started and what should you recommend if unable to do so
days 1-5 of cycle
use condoms for 2 days after starting
when is POP contraindicated
breast cancer trophoblastic disease (molar pregnancy) SLE liver disease (interacts with liver enzyme drugs) malabsorption
patient is on POP and has new onset migraine with aura/MI/stroke/TIA
stop medication
POP can/cannot be continued after 50 years
can be continued
missed pill rules for COCP
1 missed - take as soon as realise. take next pill as normal
2 missed - take next one as normal. condoms until 7 days consecutive pill
missed pill rules for POP
1 missed - if > 3 hours, use condoms for 48 hours (unless devogesterel - if more than 12 hours)
what should patients be warned about timings of POPs
very narrow window - should be taken at same time every day
what is depoprovera and what hormone does it use
injection
progesterone
how often should depo be given vs how long does it last
given every 12-13 weeks
lasts 14 weeks
when should depo be given and what should you do if unable to do so
days 1-5 of cycle
7 days condoms if cant
advantages of depo
helps PMS and menorrhagia
what effect does depo have on fertility
delay in return of fertility after stop depo
when is depo contraindicated
> 50 years
risk of osteoporosis
same risk factors for POP
what hormone does implant use
progesterone
how long does implant last
3 years
implant can/cannot be continued after 50 years
can be continued
why might effectiveness of implant decrease in third year
if obese (>35 years) - should change implant early
when should implant be inserted and what to do if unable to do so
days 1-5 of cycle
7 days condoms if cannot
benefits of implant vs depo
no osteoporosis risk
immediate return of fertility
side effect of implant
amenorrhoea with infrequent bleeding
what hormone does IUS have
progesterone
what are the 2 types of IUS and how long do they last
mirena - 5 years
jaydess - 3 years
mode of action of IUS
prevents implantation
prevents endometrial thickening
thickens cervical mucous
when should IUS be inserted and what to do if cant
days 1-5 of cycle
7 days condoms if not
benefits of IUS compared to IUD
less risk of PID and ectopic pregnancy
lighter, less painful periods
special circumstances IUS is good for
breastfeeding obesity CVD liver enzyme drugs endometriosis
SE of IUS
spotting for first few weeks
intermestrual bleeding
mode of action of copper coil
copper is a spermicide
inflammatory response in endometrium - no implantation
how soon are you protected after insertion of copper coil
immediately
SE of IUD
expelled
heavier, more painful periods
cervical shock
what should be checked before insertion of IUD
STI check
what should be checked after each period
threads
what is used for emergency contraception
copper coil
ella-one (ullipristal acetate)
levonorgestrel
what is the most effective emergency contraception
copper coil
if unable to screen for chlamydia before emergency insertion of copper coil - what should be given
azithromycin
what emergency pill can be given if <120hours since sex
ullipristal acetate
how long after sex can you give levonorgestrel
up to 72 hours
contraindications of ullipristal acetate
breast feeding
liver enzyme enducing drugs
gastric pH lowering drugs
severe asthma
