Contraception Flashcards
The efficacy of the contraception is measured by
the pearl index
Whats the problem with giving contraception to women with IBD and what should be given?
Wont be absorbed, wont be effective.
Combined patches, prog only injectibles and implants, IU and vaginal methods.
Why should you avoid depo provera in <18 years?
Risk of osteoporosis
COCP is contraindicated in how much time postpartum
Defs not in the first 6 weeks- affects breast milk, relatively in 6 months
What recommended contraception for pregnant women?
Progesteron only after 6 weeks
IUS after 4 weeks
Advice on contraception for women over 40 under 50?
Continue contraception 2 years post last period
Advice on contraception for women over 50?
Continue contraception 1 year post last period
Which contraceptives are ideal for over 40?
IUDs- may not need to be replaced
IUS- greatly reduces menstrural loss
Others are all viable
Sterilization is preferred.
What are the forms of hormone contraception?
Progesterone - POP -Progesterone as depot- Nexplanon/Depo-provera/IUS (levonogestrel) Combined: -COCP-mono/bi/triphasic -Transdermal patch -Vaginal ring
How is COCP taken?
3 weeks and 1 week withdrawal bleed
Can be back to back to avoid bleeds but irregular spotting increases
What are the 2 types of COCP
-With Ethinyloestradiol- low dose/high dose, based on progesterone type.
Oestradiol valerate- Qlaira. 26 days with 2 days withdrawal
What do you do about missed pills?
2 days can be missed on high dose but low dose only 1. If more missed use condoms for 7 days.
What to do about the pill when ill or going for surgery?
Reduced absorption with D&V so should follow the missed pill regime for days of illness but use condoms.
Antibiotic use-use condoms and 7 days after.
Stop taking 4 weeks before surgery due to thrombotic effects
What are the major complications of COCP (2+8)
VTE and myocardial infarction
CVA, hypertension, headaches, focal migraine, jaundice, liver, cervical and breast cancer
What COCP would you prescribe some at high risk of thromboembolic disease?
2nd gen! 3rd gen progesterones are worse than 2nd gen
gestodene/desogestrel vs norethisterone and levonogestrel
Absolute contraindications for COCP
History of CVA/Heart disease/VTE History of migraines with aura Active breast/endometrial cancers Pregnancy Inherited thrombophilia BMI>40 Smoking Age>35 years or >15 cigarettes Diabetes with vascular complications Active/ chronic liver disease
What are the minor side effects for COCP
Nausea, headaches, breast tenderness, breakthrough bleeds settles in 3 months
Useful effects of COCP
Lighter periods, hirsutism and acne improve, prevents ovarian cysts, fibroids, endometriosis, bowel breast and endometrial cancer
Relative contraindications for COCP
Smoker, Chronic inflam disease, renal disease, diabetes, >40, BMI 35-40, Breastfeeding up to 6 months post partum.
Whats Evra
Combined transdermal patch changed every 3 weeks with patch free week
Whats Nuvaring
Combined vaginal ring
How is POP taken?
Everyday, no breaks Same time +/- 3 hours
How does POP work?
Makes cervical mucus hostile to sperm and inhibits ovulation in 50% women
Side effects of POP?
Breakthrough bleeds, Weight gain, mastalgia, PMS,functional ovarian cysts
indications of use of POP
Older women or postpartum, everyone who COCP is contraindicated in, no thrombotic effects or with antibiotics.
What if a POP is missed?
By more than 3 hours then take ASAP and use condoms for 2 days.
Whats cerazette?
POP preparation, 12h window, stops ovulation in 95%
What are LARCs
Long acting reversible contraceptives- pretty perfect progesteron release bypassing portal circulation.
Depo provera
IM 3 monthly injection progesterone
Explaining depo provera
Prog side effects, prolonged amenorrhoea post cessation warn if want to conceive, osteoporosis risk- not to children/older women
Noristerat
8 week depot as an interim for say vasectomy
Nexplanon
Subdermal progesterone rod in upper arm for 3 years
Good things about nexplanon vs depo provera
No osteoporosis and resumes fertility quickly
What are the 3 morning after options?
Levonelle-progesterone- within 24h <72h- vomiting/disrupted menstural cycle
Ulpristal (ellaOne)- selective progesterone receptor modulator. Prevents delays ovulation and implantation. Upto 120h. Reduces the effectiveness of contraceptives so intercourse should be avoided until next period.
IUD-prevents implantation, most efficacious can be used upto 5 days, antibiotic prophylaxis.
What are the methods of barrier contraception?
Male condom, female condom, diaphragms and caps, spermicides
Types of IUDs
Copper containing devices - copper ions toxic prevent fertilization and block implantation
Mirena coil- progestogen containing released over 5 years
Absolute contraindications for IUD
Endometrial/cervical cancer Undiagnosed vaginal bleeding Active/recent pelvic infecton Current Breast cancer Pregnancy
Relative contraindications for IUD
Previous ectopic pregnancy Excessive menstrural loss Multiple sexual partners Young/nulliparous Immunocompromised/HIV
Two methods of female sterilization
Filshie clip and Essure
Whats a filshie clip?
Occlusion of fallopian tube lap under GA
Whats Essure?
microinserts placed hysteroscopically into fallopian tubes- cause fibrosis and occlusion - confirm 3 months later with HSG
Complications of IUD
Pain/cervical shock Perforation/migration through the wall Heavier or more painful menses Infection-already have STI/young/multiple partners Ectopic pregnancy
Complications of female sterilization
Primary visceral damage/inadequate aceess to tubes, ectopic pregnancy if it happens
Vasectomy
Ligation and removal of small segment of vas deferens under LA.
How long do vasectomies take to lead to azoospermia
6 months, confirmed with 2 semen analyses
Complications of vasectomy
Failure, post op, haematoma, infection and chronic pain
Sterilization reversal is often prevented by
antisperm antibody formation which restricts motility
