Contraception Flashcards
Absolute contraindications for COCP
- > 35 years old and smoking more than 15 cigarettes/day
- migraine with aura
- history of thromboembolic disease or thrombogenic mutation
- history of stroke or ischaemic heart disease
- breast feeding < 6 weeks post-partum
- uncontrolled hypertension
- current breast cancer
- major surgery with prolonged immobilisation
Generally disadvantages outweight advantages of COCP
- more than 35 years old and < 15 cigarettes/day
- BMI > 35 kg/m^2*
- FH of VTE in first degree relatives < 45 yrs
- controlled HTN
- immobility e.g. wheel chair use
- carrier of mutations associated with breast cancer
- current gallbladder disease
When can the copper IUD been inserted after unprotected sexual intercourse
- Up to 5 days after unprotected sex
- Up to 5 days after the earliest ovulation date
When does ovulation occur
14 days before the next cycle
How long after UPSI can Levonorgestrel be taken
Up to 72 hours but ASAP as efficacy decreases over time
84% effective within 72 hours
If vomiting occurs within 2 hours of Levonorgestrel, what should you do
repeat dose
Can Levonorgestrel be used more than once in a menstrual cycle
yes
Ulipristal or ellaone can be taken how long after UPSI
120 hours
What further advise regarding protection should be given if ellaone/Ulipristal has been taken
- Ulipristal may reduce the effectiveness of hormonal contraception.
- Contraception with the pill, patch or ring should be started, or restarted, 5 days after having Ulipristal.
- Barrier methods should be used during this period
What breastfeeding advise should be given with ellaone/Ulipristal
Breastfeeding should be stopped for one week after taking
What condition should you be careful with when prescribing ellaone/ulipristal
severe asthma
If fitting an IUD for emergency contraception, what is the minimum amount of time it should be left in for
until the next period
What advise should be given to women who miss one pill (COCP) in any week
- take the last pill even if it means taking two pills in one day
- then continue taking pills daily
- no additional contraceptive protection needed
What advise do you give if you miss 2 or more pills in week one
- 2 pills in one day then cont as normal
- Condoms for 7 days
- emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1
What advise do you give if 2 pills are missed in week 2 (Days 8-14):
- Take 2 pills in one day then continue as normal
- after seven consecutive days of taking the COC there is no need for emergency contraception*
What advise do you give if 2 or more pills are missed in week 3 (Days 15-21):
- finish the pills in her current pack
- start a new pack the next day; thus omitting the pill free interval
On which day would you carry out mid-luteal progesterone level?
7 days before the end of a ladys cycle
On average, how long does conception take
Around 84% of couples who have regular sex will conceive within 1 year, and 92% within 2 years
What are some causes of infertility
male factor 30% unexplained 20% ovulation failure 20% tubal damage 15% other causes 15%
What basic investigations do you complete if assessing someones fertility
semen analysis
serum progesterone 7 days prior to expected next period.
At what concentration does serum progesterone indicate ovulation
> 30nmol
What key advise do you give to people who wish to concieve
folic acid
aim for BMI 20-25
advise regular sexual intercourse every 2 to 3 days
smoking/drinking advice
Which is the only form of contraception proven to associated with weight gain
depo provera
What is the main method of action for the depot
- inhibits ovulation
- cervical mucus thickening
- endometrial lining thinning
What is the main disadvantage of the depot injection
Once administered it can not be reversed
delay of returning fertility for up to a year
What are the main adverse effects of the depot injection
irregular bleeding
weight gain
may potentially increased risk of osteoporosis: should only be used in adolescents if no other method of contraception is suitable
not quickly reversible and fertility
What are the best contraception options for women on phenytoin,carbamazepine, barbiturates, primidone, topiramate,
Depot
IUS
IUD
(implant UMEC 2)
What are the best contraception options for women on lamotrigine
POP
implant
Depo-Provera
IUD IUS
MOA COCP
Inhibits ovulation
MOA POP (except desogesrel)
Thickens cervical mucus
MOA Desogestrel-only pill
Primary: Inhibits ovulation
Also: thickens cervical mucus
MOA Injectable contraceptive (medroxyprogesterone acetate)
Primary: Inhibits ovulation
Also: thickens cervical mucus
MOA Implantable contraceptive (etonogestrel)
Primary: Inhibits ovulation
Also: thickens cervical mucus
MOA Intrauterine contraceptive device (copper coil)
Decreases sperm motility and survival
MOA Intrauterine system (levonorgestrel)
Primary: Prevents endometrial proliferation
Also: Thickens cervical mucus
Which cancers do the COCP Increase
Breast and cervical
Which cancers do the COCP decrease
Ovarian and endometrial
Advantages COCP
highly effective (failure rate < 1 per 100 woman years)
doesn’t interfere with sex
contraceptive effects reversible upon stopping
usually makes periods regular, lighter and less painful
reduced risk of ovarian, endometrial - this effect may last for several decades after cessation
reduced risk of colorectal cancer
may protect against pelvic inflammatory disease
may reduce ovarian cysts, benign breast disease, acne vulgaris
Disadvantages COCP
people may forget to take it
offers no protection against sexually transmitted infections
increased risk of venous thromboembolic disease
increased risk of breast and cervical cancer
increased risk of stroke and ischaemic heart disease (especially in smokers)
temporary side-effects such as headache, nausea, breast tenderness may be seen
