Contraception Flashcards
Oestrogen containing contraceptives should be discontinued how long before elective surgery?
Oestrogen-containing contraceptives should preferably be discontinued (and adequate alternative contraceptive arrangements made) 4 weeks before major elective surgery and all surgery to the legs or surgery which involves prolonged immobilisation of a lower limb; they should normally be recommenced at the first menses occurring at least 2 weeks after full mobilisation
What alternative contraceptive could you offer someone stopping their oestrogen containing pill before surgery?
A progestogen-only contraceptive may be offered as an alternative and the oestrogen-containing contraceptive restarted after mobilisation
What is medroxyprogesterone acetate?
A long acting progestogen given byy injection
The IUD device is a suitable contraceptive for women of all ages, however, it is less appropriate for those with an increased risk of pelvic inflammatory disease, e.g. ….
women under 25 years
How should you manage a long-term course of an enzyme inducing drug in a patient taking a combined oral hormone contraceptive?
Use a monophasic COC at a dose of ethinylestradiol 50mcg or more daily and use either an extended or a ‘tricycling’ regimen i.e. taking three packets of monophasic tablets without a break followed by a shortened tablet free interval. Continue for the duration of treatment with interacting drug and for four weeks after stopping.
Does ampicillin reduce the effectiveness of the COC?
There had been concerns that some antibacterials that do not induce liver enzymes (e.g. ampicillin, doxycycline) reduce the efficacy of combined oral contraceptives by impairing the bacterial flora responsible for recycling ethinylestradiol from the large bowel. However, there is a lack of evidence to support this interaction.
True or false? The risk of using CHC in women with a BMI >35 usually outweighs the benefits?
True- UKMEC 3
Interaction between lamotrigine and CHC
Women taking lamotrigine (except in combination with sodium valproate) should be advised
that due to the risk of reduced seizure control whilst on CHC, and the potential for toxicity in
the CHC-free week, the risks of using CHC may outweigh the benefits.
Migraine with aura is what UK MEC category?
UKMEC 4 - condition which presents an unacceptable health risk
CHC increases risk of …. cancer and decreases risk of ….. cancer
Increased risk of breast and cervical cancer
Decreased risk of ovarian and endometrial cancer
A women has forgotten to take her COC pill (>24 hours) and she asks for your advice on what to do? She is in the first week of the cycle.
The woman should take the last missed tablet as soon as she remembers this, even if this means that she has to take 2 tablets at the same time. Hereafter, she continues taking the tablets at the usual time point. She should use a barrier method concomitantly, e.g. a condom, for the next 7 days. If intercourse has taken place during the previous 7 days, the possibility of pregnancy must be considered.
A women has forgotten to take her COC pill (>24 hours) and she asks for your advice on what to do? She is in the second week of her cycle
The woman should take the last missed tablet as soon as she remembers this, even if this means that she has to take 2 tablets at the same time. Hereafter, she continues taking the tablets at the usual time point. Provided that the tablets have been taken correctly during the 7 days preceding the first missed tablet, it is not necessary to take further contraceptive precautions. However, if this is not the case, or if more than 1 tablet has been forgotten, the woman should be advised to additionally use a barrier method (such as a condom) for 7 days.
A women has forgotten to take her COC pill (>24 hours) and she asks for your advice on what to do? She is in the third week of her cycle.
The risk of contraceptive failure is imminent because of the ensuing tablet-free interval. The reduced contraceptive protection may, however, be prevented by adjusting the tablet intake. Therefore, by following one of the following two alternatives, it is not necessary to take further contraceptive precautions, provided that all tablets have been taken correctly during the 7 days preceding the first missed tablet. If this is not the case, the woman should be advised to follow the first of the two alternatives. Additionally a barrier method (such as a condom) should be used concomitantly for the next 7 days.
- The woman should take the last missed tablet as soon as she remembers this, even if this means that she has to take 2 tablets at the same time. Thereafter, she should continue to take the tablets at the usual time point. She should start on the next blister pack immediately after taking the last tablet in the current blister pack, i.e. there will be no tablet-free interval between the blister packs. A withdrawal bleeding is unlikely until the end of the second blister pack, but she may experience spotting or break through bleeding on the days she is taking tablets.
- The woman may also be advised to stop taking tablets from the current blister pack. In this case, she should keep a tablet-free interval of up to 7 days, including the days she forgot to take her tablets, and thereafter continue with the next blister pack.
What age is considered a risk factor for VTE
> 35 years
