Contraception Flashcards
What is the mechanism of action of the COCP, and what is its efficacy?
Negative feedback on gonadotropin release, stopping ovulation (oestrogen)
Thins the endometrium (progesterone)
Thickens cervical mucus (progesterone)
99% effective if used correctly
What are the benefits of the COCP?
Benefits: Good contraception if used correctly Cycle control Improves pre-menstrual symptoms Can be used to treat endometriosis May make periods lighter Reduces risks of ovarian tumours and colorectal Ca.
What are the side effects and disadvantages of the COCP?
Not a LARC and therefore more room for human error
Increases risk of:
-VTE
-Stroke and CVD
-Breast Ca (minimal)
-Associated with an increased risk of cervical ca this is due to more unprotected sex = more HPV
Side effects:
- Breakthrough bleeding in the first 3 months
- Headache
- Nausea
- Breast tenderness
What are the contraindications for the COCP?
Lifestyle:
- Pregnancy
- Breast feeding
- Older than 35yo and smokes more than 15 a day
- BMI over 35
Illness:
- Migraine with aura
- Current breast ca (within last 5 years)
- CVD or high risk
- VTE or thrombophilia
- Hepatic disease
- SLE
How can the COC pill be taken?
Monophasic: same amount of hormone in each pill.
It is usually taken for 21 days followed by a 7 day break where the women bleeds.
Phasic pill: hormone levels vary to mimic normal fluctuations. It is again taken for 21 days followed by a 7 day break for a bleed.
Everyday pill: Last 7 days are placebo pills.
Pills are taken everyday.
Monophasic can be taken on repeat to stop periods.
What different methods do the combined contraception come in and how are they taken?
Patches: Put on any part of the skin except for the breast. Put patch on weekly for 3 weeks followed by 1 week off.
Vaginal ring: Put in the vagina for 3 weeks and removed for 1 week. Can be removed from the vagina for upto 3 hours.
What is the mechanism of action of the different POP’s?
Most pills work by:
- Thickening cervical mucus
- Thinning endometrium
Desogestrel works by:
-Anovulation
99% effective if used correctly
What are the classic progesterone side effects?
- Mood disturbances
- Headaches
- Acne
- Breast tenderness
- Increased appetite
- Bloating
How does POP affect a women’s bleeding pattern?
Unpredictable periods may be:
- absent 5/10
- regular 4/10
- irregular 1/10
What are the advantages and disadvantages of POP?
Advantages:
- Few contraindications (only absolute is current breast ca)
- Safe medication few risks associated
- Good efficacy if used correctly
- Works within 48hrs
Disadvantages:
- S/e’s
- Depending on the pill needs to be taken within 3 hours of the same time everyday.
How should POP be taken?
It is taken as an everyday pill.
Desogestrel can be up to 12hrs late before emergency contraception is needed.
Other pills must be taken within a 3hr window everyday
How does the nexaplon implant work and how long does it last for?
Releases progesterone can last upto 3 years.
It causes:
- Anovulation
- Thickened cervical mucus
- Endometrial thinning
What are the side effects of the implant and risks of the procedure?
Progesterone effects:
- Mood
- Headache
- Acne
- Breast tenderness
- Increased appetite
- Bloating
Also affects bleeding:
1/5 have frequent bleeding
1/5 have amenorrhoea
3/5 have regular bleeds
Risks:
- Bleeding
- Bruising
- Infection
Are there any contraindications to having the implant?
- Pregnancy
- Current breast Ca (within last 5 years)
- Severe liver disease as affects metabolism
How does deep provera injection work?
It gives a very large dose of progesterone in one go. This occurs every 12 weeks (licensed unto 14 weeks).
Progesterone causes:
- Anovulation
- Cervical mucus thickening
- Endometrial thinning
