contraception Flashcards
IUD should be avoided in who?
pelvic inflammatory disease patients
what is COC
progesterone and oestrogen.
common ingredient oestrogen only
ethinylestradiol , mestranol
progesteron content?
desogesterel, gestodene, levongesterel, norethiserone,
advantages COC?
- reduces risk of endomentrial cancer
- reliable and reversible
- reduce dysmenorrhoea and menorrgoea
- reduce pre menstiural tension
less symptomatic fibroids and function ovarian cysts - reduce begnin breast disease and pelvic inflammatory disease
monophasic?
means fixed amount of oestrogen and progesterogen
phasic?
varying amounts of oestrogen and progestogen throughout the pack
low strength 20mcg ethinylestradiol used for?
used for women with risk factors for circulatory
ethinylestradiol and desogesterel/ dropirenone or gestodene used for who?
used for women with SE, such as acne, headache, depression, breast symptoms, breakthrough bleeding
drospirenone derrivative of what?
spironolactine - so risk of hyperkalemia
what are the egs of COC
microgynon
- yasmin
cilest
femodette
who are phasic COCs used for
women who hace breakthrough bleeding or do not have withdrwal bleeding
what happens if undergoing surgery?
stop oestrogen 4 weeks before major ellective surgery and all surgery to legs. offer progesterogen only contraceptive and once mobile then can restart
what is elective surgery?
planned surgery
if unplanned surgery and cant stop oestrogen 4 weeks before hand what do you do?
offer unfractioned LMWH and graduated stockings
- THROMBOPROPHYLAXIS
what conditions require oral contraceptives and HRT to be stopped immediately
- sudden sever chest pain radiating to left arm
- sudden breathlessness - cough with blood stained sputum
- pain in calf stomach
very strong long headaches - jaundice
liver enlargments - hypertension
prolonged immolity after surger - severe neurological effects
- unexplained swelling of leg
Cautions of COC
increase risk of VTE
increase risk of breast and cervical cancer
- the risks disappear after stopping
what advice to give with COC
travel, increased risk of DVT if more than 3 hours
- reduce risk by excersizing during journey and wearing graduated compression hosiery
- if and D and V take another pill ASAP if happens within 2 hours of taking pill
define missed pill?
24 hours or more
12 hours is for qlaira
critical time is at beginning or end of cycle
what to do if missed pill?
take as soon as remeber
take next one at normal time even if it means taking 2 pills
if one missed no precaution required if take next one as soon as remember
what to do if 2 or more pills missed?
espec if this happens in first 7 days, may no longer be protected
take an active pill as soon as remebered, abstain from sex or use protection for next 7 days
if these 7 days run beyond end of pack, start the next packet at once and OMIT the pill free interval or the 7 inactive tablets ED pills
when is EHC Used in missed pills?
if 2 or more COC tablets from the first 7 days and had sex since finishing last packet
when are progesterone only contraceptives used?
suitable when oetrogens are CI - VT , heavy smokers, hypertension above 160/95, vulvular disease, diabetes, migraines with aura
how do progesterone only work
they alter cervical mucus to prevent sperm penetration and ovulation in some women
what do desogestrel do?
inhibits ovulation
parenteral progesteron only contraceptive e.g.
medroxyprogesterone acetone. long acting , given by injection.
IUD EG?
mirena 0 effects local and hormonal
IUD CAN BE USED WHEN?
when women have heavy periods
advantages of mirena IUD over copper IUD
reduction in blood losss
improvement in any dysmenorrhea and reduction in pelvic disease
all progesterone only contraceptives are suitable to coc when?
before major elective surgery
spermicidal contraceptives?
used as additional, not effective alone
it has 2 componants spermide and vehicle
not reccomended for use with condoms or those at high risk of sti or hiv
when can IUD be insetered
5 days after sex or 5 after earliest calculated ovulation
iud not effected by?
other drugs and bmi
when do you have to give levonelle doubled unliscensed ?
when bmi greater that 26 or weight more than 70 or would just give ella one
what is the counselling advice for ehc
if vomitting occurs in 3 hours need another pill (ellaone)
- next period may be early or late
- barrier contraception needed till next period
- seek medical attention if any lower abdo pain - could be extopic pregnancy
- return in 3-4 weeks if period missed, is light, too heavy or brief. take the pregancy test
levongesterol when do you have to take another pill?
normal contraceptive take after 2 hours of vommiing
ehc - take after 3 hours of vommitting
when can take coc again after ehc?
5 days
what can effectiveness of all pocs and cocs and ehc be reduced by?
ENZYME INDUCERS : carbamepine, phenytoin, phenobarbital
st johns wart
rifampacin
rifabutin
which contraceptive methods are uneffected by enzyme inducers?
iud
medroxyprogesterone
norethisterone
non hormonal contraceptives
Are precautions required when cocs are used with antibacterials
no, unless the induce liver enzymes and unless d and v occur.
parental progestogen only contraceptives se?
troublesome bleeding
oesteoperosis can can reduce bone moneiral density
only use in adults when other measures are inappropriare
e.g of parental progestogen only contraceptives?
noristerat, nexplanon, implanon
any precautions with parental progestogen only contraceptives
delay first injection to 6 weeks after giving birth to reduce risk of bleeding
