Contraception Flashcards
What counts as a missed combined pill
More than 24 hours since you should have taken it
Advice if missed 1 combined pill
Take the missed pill now
It’s fine to take 2 in one day
Take the rest of the pack as normal
Don’t need to use extra contraception
Advice if missed 2+ combined pills
Take the last pill you missed now
It’s fine to take 2 in one day
Leave any earlier missed pills
Use extra contraception for the next 7 days
Use emergency contraception if missed 2+ pills in 1st week of a pack and had unprotected sex in the previous 7 days
What to do at the end of the combined pill pack after missing 2+ pills
If 7+ pills left after missed pills:
Finish the pack, take the pill free break/placebo pills as normal before starting a new pack
If <7 pills left after missed pills:
Finish pack and start a new pack the next day I.e don’t take the pill free break/placebo pills
What counts as a missed POP
More than 3 hours since you should have taken it
OR
More than 12 hours since you should have taken it for desogestrel pills
Advice for missed POP
Take last pill you missed now
Take the next pill at the usual time (it’s fine to have 2 in one day)
Take the rest of the pack as normal
Use extra contraception for next 48 hours after taking the last missed pill
Use emergency contraception if you have unprotected sex during the 48 hours after your missed pill
Effectiveness of implant
> 99% effective
Up to 3 years
Advantages of implant
Useful if can’t use oestrogen contraceptives
Fertility returns very quickly once removed
Safe while breastfeeding
Can help heavy or painful periods
Considerations for implant
Can make periods irregular or stop them completely
Can make acne worse
Doesn’t protect against STIs
Small procedure to have fitted and removed with local anaesthetic
Side effects for first few months common e.g nausea, headaches, breast tenderness
When are you protected against becoming pregnant after implant is fitted (include after giving birth)
If fitted in first 5 days of menstrual cycle you are immediately protected
If fitted after day 5 of menstrual cycle you need extra contraception for 7 days
If fitted within 21 days after giving birth you are immediately protected
If fitted after 21 days from giving birth you need extra contraception for 7 days
What medications interact with the implant and COCP
Treatment for HIV, epilepsy and TB
St Johns Wort
Rifampicin (an antibiotic)
Aftercare for implant fitting
Contact GP if: Can't feel implant Implant has changed shape Pain or skin changes at site of implant You become pregnant
Advice about extra contraception
Aftercare for IUD
May get period type cramps or bleeding for few days after fitting
Need check up appointment in 3-6 weeks
Contact GP if: Lower abdo pain High temperature Odorous vaginal discharge Can't feel the threads
How long do the IUD and IUS last for
Paragard - 10 years
Mirena - 5 years
Kyleena - 5 years
Jaydess - 3 years
Advantages of IUD
Works straight away No hormonal side effects Safe to use in breastfeeding Fertility returns as soon as IUD removed Not affected by other medications
Considerations for IUD
Doesn’t protect against STIs
Periods may become heavier, longer and more painful
Risk of pelvic infection, displacement, expulsion and womb perforation
Fitting uncomfortable
Rules for protection against becoming pregnant if having IUD or IUS fitted after giving birth
IUD and IUS can be fitted 4 weeks after giving birth
Need to use alternative contraception from 21 days after giving birth. Use until IUD/IUS is fitted
When are you protected against becoming pregnant after IUS is fitted
If fitted in first 7 days of menstrual cycle you are protected straight away
If fitted after first 7 days of menstrual cycle you need extra contraception for 7 days afterwards
Advantages of IUS
Can help painful or heavy periods Safe to use when breastfeeding Not affected by other medications Option if can't have oestrogen contraception Fertility returns as soon as IUS removed
Considerations for IUS
Periods may become irregular or stop altogether
Side effects include nausea, headaches and breast tenderness
Can make acne worse
Doesn’t protect against STIs
Risk of pelvic infection, displacement, expulsion and womb perforation
Aftercare for IUS fitting
May have period type cramps for few days afterwards
Need check up appointment 3-6 weeks later
Contact GP if: Lower abdo pain High temperature Odorous discharge Can't feel threads
Instructions for taking first combined pill
Monophasic- marked with correct day of week
Phasic - first pill of the first colour
Everyday - marked with start
Instructions for using COCP packs
Phasic - take pill same time everyday until pack finished. Have 7 days pill free break where you will have a bleed. Start new pack on 8th day, starting on same pill as previous pack
Everyday - take pill same time everyday until pack finished. Start new pack straight away on pill marked start whether you are still bleeding or not.
Additional contraception for when starting the COCP
Starting within first 5 days:
No additional contraception (get advice if menstrual cycle every 23 days or less)
Starting after day 5:
Additional contraception for 7 days
