Contraception Flashcards
What are the contra-indications to the COCP?
Smoker >35 years Breast cancer Liver cirrhosis Breast feeding Hypertensive VTE/CVD Migraine with aura
What is the method of action and side effects of the COCP?
Stops ovulation, thickens cervical mucus, thins endothelium
SE: increased risk of breast/cervical cancer
Give an example of the POP, what are the CI of the POP and what is the method of action?
Cerazette
CI: breast cancer, PV bleeding, liver disease
method of action: thickens cervical mucus, thins endothelium
What is the guidance on how to take the POP?
No need for extra precautions when taking ABx
Must remember to take the pill at the exact same time
If you miss a pill, take ASAP but if >12h = condom + EC
What are the CI of the IUD, it’s method of action, and guidance?
CI: PID <3m, gynae cancer, small cavity, undiagnosed PV bleeds, allergic
MoA: spermicide, causes inflammation
Guidance: check for string monthly. STI check before insertion. if fitted >40y = can stay until menopause
What is the MoA of the IUS?
levonorgestrel
stops ovulation
increases cervical mucus
thins endothelium
what are the CI of the progesterone implant? how long does it last for?
etonogestrel
CI: liver/genital/breast cancer
liver disease
PV bleeding
on enzyme inducers
lasts for 3 years
what are the CI of the progesterone injection? what are the side effects? how long does it last for?
liver/genital/breast cancer
liver disease
PV bleeding
on enzyme inducers
lasts for 3m
SE: unpredictable periods, weight gain, osteoporosis, takes time for fertility to return
What are the different methods of emergency contraception?
How long does EllaOne and Levonelle work?
IUS/IUD/EllaOne/Levonelle
IUS: inhibits ovulation
EllaOne (ulipristal): inhibits ovulation, take no later than 120 hours (5 days)
IUD: toxic to sperm, inhibits implantation. can be inserted 5 days after unprotected sex.
Levonelle (levonorgestrel pill): use within 3 days (72 hours)
what are the CI for ulipristal acetate (EllaOne)?
severe asthma on steroids
do not use within 7 days of hormonal contraception
avoid if taking enzyme inducers
ranitidine and PPIs make it less effective
discard breast milk for a week
what contraception can be used for women >40?
COCP = reduces menopausal symptoms, can be continued up to 50 years max. Depo-Provera = small loss in mineral density, continue to 50 years. after 50, switch to non hormonal method. Implant/POP/IUS = can be continued beyond 50
what are the rules for missing COCP pills?
One missed pill = take next one as planned and no need for EC
2+ missed pills = use condoms for 7 days plus need for EC depends on where you are in the pack
Week 1: EC may be needed
Week 2: EC not needed
Week 3: EC not needed but miss HFI and carry straight to next pack
What is the guidance on contraception in the first 21 days of a woman post partum?
Contraception is not needed for the first 21 days
Earliest ovulation in a non breast-feeding woman is 28 days
Avoid IUD in this period = higher risk of perforation
Avoid COCP in first 21 days
What is the lactational amenorrhoea method?
over >98% effective if
<6m postpartum
amenorrhoeic
fully breast feeding day and night
In non breast feeding women <21 days, what contraception options are available?
POP
Progestogen only injectables/implants
Barrier methods
