Contraception Flashcards
what hormone are in combined hormonal contraception
oestrogen and progesterone
what are the combined hormonal contraceptive methods
pill, patch, vaginal ring
what is the failure rate of CHC
perfect use 0.3%
typical use 9%
how do you take the COC
start in first 5 days of period or at any time if reasonably sure you arent pregnant
take for 21 days and have 7 day break
OR
tricycle (run three packets together and have 7 days withdrawal bleed at end of three months)
if you bleed for more than 4 days or more stop for another 4 and then restart (some people cannot take pills continuously will still bleed)
what can affect the effectiveness of CHC
impaired absorption (GI condition and COC) increased metabolism (liver enzyme induction, drug interaction) compliance
what are the risks of CHC
venous thrombosis (especially with other RF- BMI, smoking)
arterial thrombosis
adverse effects on some cancers
which type of pill have bigger risk for VTE
oestrogen dominant ones- gestodene, desogestrel, etonogestrel
what are oestrogen dominant pills better for
skin
when are you most at risk of VTE
postnatally
also high risk in pregnancy
what are the unwanted circulatory effect of COC
systemic hypertension (need to check before starting prescription)
arterial disease - increased risk of MI (esp in smokers), and ischaemic stroke (both higher in HPTx)
what does migraine with aura mean for contraception
increases risk of ischaemic stroke
CHC use is contraindicated in patients with migraine with aura
what age is a relative CI to COC
> 35
what cancers can be affected by CHC
breast cervical (long term use >5 years, returns to baseline after 10 years not taking, condom use + cervical screening important)
what is the UKMEC
quantifies risk of contraception
what cancers can CHC protect against
ovarian and endometrial
which CHC have a beneficial act on acne
all
why is dianette good and bad
EE/Cyproterone acetate (Dianette)
very good for acne= antiandrogen/ progestagen/ antiglucocorticoid
higher risk of blood clots
what are the non contraceptive benefits of CHC
less bleeding fewer functional decreased ovarian cysts premenstrual syndrome (cycling stops so no ups and downs) polycystic ovarian syndrome- helps regulate cycle endometriosis
what are the common side effects of CHC
nausea spots breast tenderness bleeding headaches
should you avoid CHC in people with thrombophilia/ FHx of clots
yes
how do you take the progesterone only pill
every day, dont have a break, even if getting period
day 1-5 of period/ any time if sure not pregnant
use condoms when starting pill for 7 days/ 2 days if POP
what are the forms of progesterone only contraception
progesterone only pill
subdermal implant
DMPA
what is the lower risks of in progesterone only methods rather than CHC
cardio events, clots, cancer
is a common SE of progesterone only treatments
irregular bleeding
what is depo provera / sayana press
large injection of progesterone
lasts 3 months
syanan press is self administered, depo is done by health care professional
what are the pros of progesterone injection
very effective
high chance of amenorrhoea
lasts 3 months
doesnt interact with enzyme inducing drugs (antiepileptics)
how does depo injection work
lowers estradiol
suppresses FSH
what is a risk of depo injection
oestopenia due to lack of oestrogen
what advice should you give on condoms
wear them with other contraceptive methods, good for STIs
not good on own
who are diaphragms good for
women in 40s with CI to hormonal contraceptives
how do diaphragms work
put spermacide along rim
squeeze into right shape then insert
leave in for 6 hours after sex, gives spermicide and vaginal acid time to kill sperm
if have sex 3 hours after insertion need to reapply spermicide
what is more invasive, male or female sterilisation
male - no scalpel technique
can be done under local or general anaesthetic
what are the possible complications of a vasectomy
anaesthetic
pain
infection
bleeding/ haematoma
can a vasectomy fail
yes
what method of female sterilisation is done in UK
clips
is female sterilisation good
no
high failure rate
invasive
permanent if successful
how effective is natural family planning
76% with typical use
what are the possible SEs of estrogenic contraceptives
bloating breast swelling and tenderness decreased sex drive growth of uterine fibroids headaches irregular bleeding mood swings nausea and vomiting raised BP weight gain (water retention, cyclical gain)
what are the possible SEs of progestogenic contraceptives
acne anxiety bloating breast tenderness associated with depression depression headaches hirsutism irregular bleeding mood swings weight gain (increased appetite, sustained gain, mostly DMPA)
what are the possible side effects of combined
acne/ hirsutism bloating breast tenderness headache heavy withdrawal bleeding loss of sex drive mood changes (depression, anxiety, irritability) nausea unscheduled bleeding water retention weight gain
how many pregnancies a year are unplanned
40%
what are the mechanisms of action of contraception
preventing ovulation- hormonal methods, suppresses FSH and LH
preventing fertilisation- condoms, diaphragms + spermicide, female and male sterilisation, IUD, hormonal methods (cervical mucous effect)
prevention of implantation- IUD (esp copper coil) hormonal method, create a hostile endometrium/ direct toxicity
what contraceptives thicken the cervical mucous
IUS (hormonal coil, IU system), DMPA, POP, SDI (subdermal implant)
what contraceptives have a direct toxic effect
IUD (Copper), spermicides
what contraceptives act as a mechanical barrier
F+M condoms, diaphragms, cervical caps
what contraceptives cause endometrial changes/ thinning
IUS, IUD, SDI, DMPA, POP, CHC
what contraceptives suppress ovulation
CHC, DMPA, SDI, LAM (lactational amenorrhoea method), desogestrel-containing POP, IUS
what are the emergency methods of contraception
copper IUD
pills- ulipristal acetate, levonorgestrel
what is the most important thing when choosing a contraceptive method
her personal preference
what are the 3 most effective contraceptive methods
SDI vasectomy IUS female sterilisation IUD
what type of lube shouldnt you use with condoms
oil based
what is the average pain for IUD insertion
parous women 3/10
nulliparous 5/10
what makes a women unsuitable for and IUD
submucosal fibroids
how long does a copper IUD last
up to 10 years
what are the common SEs of the copper IUD
often makes periods heavier, longer and more painful (especially in first 3 months)
what can help with pain and bleeding caused by the copper IUD
NSAIDs
is a copper IUD or IUS more effective
IUS
how long can IUS’s last
3-5 years
what is common in the weeks/ months following IUS insertion
spotting, unpredictable periods/ bleeding, acne or headaches for first few months usually settles to no/ light periods
what can a mirena treat
heavy periods, HRT, endometriosis, hyperplasia
how many women with IUS have amenorrhoea
50% at 6 months
why are hormonal side effects low with an IUS
as systemic hormones low
what is nexplanon
subdermal contraceptive device
how long does an SDI last
3 years
what hormone in SDI
progesterone only
what is the main side effect of SDIs
prolinged PV (vaginal) bleeding
what can help prolonged bleeding in a SDI
CHC
how long after sex can a copper coil be used an emergency contraception
5 days
how does the CHC help to regulate cycle and reduce acne
decreases testosterone in blood by increasing sex hormone binding globulin
what do you have to do in patients under 13 having sex
involve social work
when should patients check threads of an IUD after fitting
4-6 weeks after fitting
when should you use condoms when getting IUD fitted/ rmoved
7 days before/ after insertion/ removal
what are the big risks in contraception
VTE, cardiovascular, liver problems, breast cancer, IUDs- perforation, ectopic pregnancy
how do you use the patch
how to use a patch
apply 1 on 8th day
apply another after 7 days (take old one off)
apply another for last 7 days
if falls off for less than 48 hours reapply, if more than than use condoms and start a whole new patch cycle
what is the main side effect of the implant
bleeding problems
what are the differentials for irregular bleeding
STI, cancer, miscarriage, pregnancy
what are the negatives of the depot injection
Risk of weight gain
Can not be stopped once injected
Delayed return of fertility (up to a year)
(CVD risk, VVA, osteopenia/osteoporosis, mood/depression)
what has higher risk of VTE the ring or the COC
ring
how do you use the ring
keep ring in the fridge, lasts 3 week when inserted, ring free week, insert again on same day as taken out. if falls out in weeks 1-2 then rinse and reinsert if out for less than 3 hours, more than 3hrs use condoms. if more than 3 hours in 3rd week then insert new ring immediately (may have withdrawal bleed) or stay ring free week
what are the pros and cons of 2nd gen and 3rd gen CHC
2nd gen CHC have lower risk of DVT than 3rd gen but 3rd may have better non contraceptiv effects
what is the mini pill
progesterone only pill
what are the option of emergency contraception
IUD (copper coil) up to 5 days after, most effective
pills that stop ovulation:- ulipristal acetate (progesterone receptor, non hormonal, makes uterine contract) (aka ellaone) and levonorgestrel (progesterone pill)
pills need to be taken before ovulation so only work at specific time in cycle
what are the pros and cons of levonorgestrel
least effective EC method
only works up to 72hrs after UPSI
not effected after start of LH surge (48 hours before ovulation)
affectiveness best at BMI<30
can quick start it
Double dose can be given when on liver enzyme inducers.
No reduced effectiveness with lower gastric pH.
No problems with breastfeeding.
what are the pros and cons of ulipristal acetate
most effective pill
effective after LH surge
not affected by BMI
effective up to 120 hours after UPSI (5 days)
less effective if already on pill
delay in quick starting necessary
Not effective just before LH peak (24 hours before ovulation).
Can’t be given with liver enzyme inducers.
Can’t be given with drugs reducing gastric pH.
Breast-feeding is contraindicated (or discard milk for a week).
wait 5 days before starting normal pill again if forgot (ella one stops ovulation for 5 days)
when can you start contraception after mini pill
48 hours
what are the non contraception benefits of progesterone
thins endometrium- light periods and prevents endometrium cancers, ovarian cysts.
Thickens cervical mucous so protective against PID
