Contraception Flashcards
Failure rate of diaphragm
Typical 12%
Perfect 6%
Failure rate condom
18% typical
2% perfect
Ukmec and diaphragms/ caps
High risk hiv (due to N9 not ok with condoms)
HIV positive
Hx of TSS
Sensitive to latex
Parous mec2
Uti Mec 2
Congenital or valvular heart disease mec 3
Progestogens first and second line and third
First northisterone
Second levonorgestrel
Third desogestrel gestodene, norgestimate
Newer other: drospirenone
Which cocp is used for mx of acne and hirsuitism
Co-cyprindiol
35ee with cyproterone acetate which is antiandrogen
How to use patch and CHC ring
Patch- new patch every week
Ring - new ring every 3 weeks (store an room temp)
CHC failure rates
Perfect 0.3%
Typical 9%
Enzyme inducers and CHC
Effectiveness reduced and for 28days post
If declines alternative then minimum of 50ug ee or increase to 70ee if breakthrough bleeding
(Not for rifampicin and rifabutin)
Lamotrigine and CHC
Serum lanotrigine reduced
Can reduced seizure control when on CHC
Can cause toxicity in HFI
D and v and CHC rules
Diarrhoea severe for over 24hours
If vomits within 3 hours - missed pill
Which pill 1st line for PMS
Yasmin
Drospirenone and ee
CHC which cancers does it reduce risk of?
Endometrial
Ovarian
Colorectal
How long can cap and diaphragm stay in for?
Diaphragm 48hours
Cap 30 hours
Vte and CHC discuss risk
X3-5 risk
Absolute risk v small - 10/10,000 compared to 2/10,000
Of small rate only 1% fatal
Highest risk in months after initiating or when restarting after 1/12 break
Progestogen lower risk with lng or net compared with dsg or drospirenone
Inherited thrombophilias and CHC
Mec 4
When to give EC for ring and patch
If patch or ring off for >48hours or extension of HFI of >48 hours
If I’m 1st week and UPSI in HFI or week 1
CHC increases risk of which cancers
Breast
Cervical
CHC and arterial thrombosis risk
Increased risk of MI stroke Increased with higher ee RR MI 1.6 RR stroke 1.7 consider with additional RFs
Migraine with aura and CHC what to quote
Double the risk of ichaemic stroke with CHC and migraine with aura
New migraine when starting CHC - Mec 3
Breast ca and CHC
X 1.2
Brca Mec 3
Prev breast ca Mec 3
Fhx nil restriction
Cervical ca risk with CHC
X2 risk over 5 years
Progestogen ses
Mood
Acne
Hirsuitism
Libido
Oestrogen ses
Bloating
Breast tenderness
Nausea
Headaches
Pill choice talk through pathway
1st line ee less than 30 and net or lng but more androgenic
If oestrogen ses - loestrin 20
If progestogen ses - marvelon (dsg/ ee30
Or less androgenic are :
Cilest - 35ee and norgestimate or
Yasmin 30ee and drospirenone
Major surgery and CHC
Stop 4 weeks before
Start 2 weeks after full mobilisation
Enzyme inducers
Reduced contraceptive efficacy
Carbamazepine, phenytoin, topiramate
Rifampicin rifabutin
St. John’s wort
Zoely regime and when missed pill
Estradiol containing
24 active 4 placebo
12 hour missed pill rule
7/7 to be effective
Qlaira regime
Quadriphasic
Estradiol
26active
2 placebo
9 days to work
Missed pill over 12 hours
If > day 24 take missed pill and nil additional
Post vasectomy advice
Rest No sex for 1/52 post Tight underwear for first 48hours NSAIDs Watch for bleeding and pain Leaflet PVSA
When to counsel pre sterilisation at time of section.
At least 2 weeks before hand
Failure rate of vasectomy post PVSA
0.05%
When to do PVSA
12 weeks post procedure
If azoospermia ok to use
If non motile sperm less than 100,000/ ml then can use
If at 7/12 still motile sperm - failed
When to stop contraception post lap steri
CHC/ pop / IUC 7/7
How long to wait to check essure occlusion and how to confirm occlusion
3/12
X-ray
Hsg better but only use when unable to confirm with X-ray or if difficult procedure
Pregnant with coil in situ
If less than 12 weeks remove - counsel woman that adverse or outcome greater risk than without
M/c risk
Left in risk of 2nd trimester m/c , preterm del and infection
Key changes in
Temp
Cervical secretions
Use of Callander method
Temp once raised on 3 days of at least over 0.2 degrees can have sex until next period
Cervical secretions - 3 dry days and can then have sex. When fertile near ovulation secretions become wetter, slippery, clear and stretchy and alkaline and v fertile
Calendar - record over. 1 year and work our shortest and longest cycle shortest cycle length minus 20 first fertile day
Longest cycle length minus 10 is last fertile day
2 day method describe
Simplified cervical secretions
Nil UPSI if secretions in prev 2 days
Standard days method
Simplified calendar
No sex D8 to D19
Only for cycles between 26-32
Symptothermal method
Combine cervical secretions with BBT and calendar
Failure rate 0.6 perfect and 7% typical
LAM feedign criteria
Fully day and night
No other liquids or water in addition to feed
Not longer than 4 hours during day or 6hiurs over night
No use of dummies
How long after baby can you use FAM and how long post stopping contraception can you use FAM
Wait until at least 3 cycles
Contraceptive methods and cardiac Hx consideration
CHC- increases MI risk, stroke, thrombosis and increased fluid retention and raised BP
DMPA - higher dose of progestogen an effect on lipid profiles
IUC - vasovagal and Brady
POP safe bridging method whilst seeking advice of cardio
Cardiac conditions with increased risk of VTE
Patent FO ASD Right to left shunts Closure of cardiac defect in prev 6/12 Arrhythmia, impaired cardiac function or mechanical value
POP failure rate
Perfect 0.3%
Typical 9%
POP and
VTE
Breast ca
Ovarian cysts
VTE- no evidence
Breast ca - no clear evidence of link but small data did show increase but likely to be very small
Ovarian cysts - caused by POP
POP and bleeding side effect
Common
Half no bleeding after taking for a year
4 in 10 reg bleeding
1in 10 frequent bleeding
Which contraceptive methods can’t measure FSH with?
CHC and HRT
Implant and VTE risk?
None
When to diagnose menopause
Over 50 with one year of amenorrhoea
Under 50 with 2 years of amenorrhoea
If recurrent miscarriage which methods to avoid for contraception and why?
Avoid CHC until ix for antiphospholipid syndrome
Fertility post molar pregnancy and when can conceive
If complete mole then 6/12 from first normal hcg or from evac if hcg normal within 8 weeks of op
If partial mole aboid PT until 2 consecutive months of normal hcg
Contraceptive methods with GTD which contraindicated
IUC until hcg normal
CHC ok
Doses of lng in different coils and size of fit
Mirena 52mg 5 years 4.4 insertion tube
Jaydess 13.5 mg 3 years 3.8 tube
Kyleena 19.5mg 5 years 3.8 tube
IuD coils duration and size
T380A 10 years 4.75
Nova T 380 5 years 3.6mm
Risks with IUC
1 in 1000 for ectopic
Expulsion 1 in 20
Infection
Perforation 2 per 1000
Risk of peer with IUC if breastfeeding
6 fold higher
Brady with IUC fit
Atropine 500mg Iv or IM
Max 3g so 6 doses
ALOs and pelvic pain and IUC in situ
Remove coil
Abx 8 weeks
Dmpa failure rate
Perfect 0.2%
Typical 6%
Measurement of coil from fundus and when not ok?
2cm
Osteoporosis risk factors
Female Over 50 Menopausal Fhx Low bmi Low ca vit D Malnutrition Inactivity Smoking Alcohol over 3 units per day Steroids for over 3/12 Medical conditions- ckd, Crohns RA Cushing t1dm, copd, chronic liver disease
Dmpa and cv risk
Not significant evidence for VTE
Small data which can’t exclude link with MI or strokif SLE with positive antiphospholidpid antibodies- Mec 3
Risks of cancer and dmpa
Slight increase with breast ca possible
Cervical ca - weak link over 5 years
Dmpa and weight gain, what is predictive
If higher initial BMI and < 18 years with BMI over 30
Or
If gain more than 5% of body weight in first 6/12
Obesity risk factors
VTE HTN Dm Raised cholesterol Cv disease Stroke EndometriL and breast ca
VTE risk and obesity
Rises over 30 and again over BMI 35
2 fold higher risk
Raised BMI with other CV risk factors ukmec
IUD Mec 1
Ius, pop, implant Mec 2
Dmpa and CHC Mec 3
Obesity and CHC Mec
BMI > 35 Mec 3
Implant and obesity
Nil evidence of increased CV risk
Nil evidence to change early
Nil evidence of procedural difficulty
Dmpa and obesity Mec
Obesity alone Mec 1
With cv rfs mec 3
Which contraceptive methods ok with obesity
POP Implant ius IUD Dmpa aslonf as no additional CV risk factors
EC and BMI
Levonelle less effective over 70kg or BMI > 26
Upa over 85kg or BMI over 30
Considerations for LARC fit and anorexia
Deep implant
Small strophic uterus with short cavity
Bradycardia and vasocagal as not eaten
Long qt syndrome Mec 3
How to manage unscheduled bleeding with contraception
First 3/12 no need to examine
If over 3/12 then examine and trial 3/12 coc or pop
Unless risk factors for endometrial ca - obese, smoker, pcos, diabetes
Consider txa mefanamic
Pipellle if > 45 or < 45 with rfs or perisitent Sx
Ukmec and postnatal
Breastfeeding and less than 6 weeks - CHC Mec 4 dmpa Mec 2 rest Mec 1
Non breastfeeding 0-3 nil VTE rfs CHC 3 dmpa 2 rest 1 0-3 weeks with VTE rfs CHC 4 dmpa 2 rest 1 Same as above for 3-6 weeks with rfs 3-6 weeks nil other rfs CHC 2 rest 1
VTE risk factors postnatal
Immobility Transfusion BMI > 30 Pph Post c/section Pet Smoking
IBD and contraception
VTE- increases risk Osteoporosis more common Heaptobilarh disease can cause cirrhosis Can impact on sperm quality Check if on methotrexate Mycophenolate 6/52 Infliximab 6/12 All methods suitable CHC and pop Mec for oral absorption
FAM failure rate
0.5
24
IUD failure rate
- 6
0. 8
Ius failure rate
- 2
0. 2
Female sterilisation failure rate
0.5
Vasectomy 0.1
