Contraception Flashcards
1
Q
Name some Combined hormonal contraceptive brands:
A
- Microgynon (21 day and 7 day HFI)
- Microgynon ED/Zoely - 28 days
- Logynon
- Logynon ED/Qlaria
2
Q
Name some Progesterone only contraceptive brands:
A
- Noriday
- Desogestrel (Cerazette)
3
Q
What is a CHC?
A
COC: EE + progestogen
4
Q
What is a POP?
A
Progesterone only pill
5
Q
CHC mechanism of action?
A
- Primary action - inhibit ovulation
- Thickened cervical mucus and altered endometrium
- Oestrogen – endometrial proliferation, progestogen opposes proliferation
6
Q
POC mechanism of action?
A
- Suppression of ovulation
- Thickens cervical mucus, delays ovum transport, renders endometrium hostile to implantation, reduced cilia activity in FT
- Various mechanisms to various degrees
7
Q
Efficacy of hormonal contraception?
A
CHC and POC –similar effectiveness
- 0.3% with perfect use in 12 months
- 8% with typical use
8
Q
Non-hormonal methods with ‘user’ failure?
A
- Male condom up to 98% effective
- Female condom up to 95% effective
- Diaphragm or cap + spermicide up to 96% effective
- Natural Family Planning:combining two or more fertility indicators new technologies (Persona) up to 98% effective
9
Q
What is LAM?
A
LAM – lactational amenorrhoea
Breastfeeding (lactation) can be used as a contraceptive method (LAM).
10
Q
Efficacy of LAM up to 98% only if ALL the following condition apply:
A
- You are fully breastfeeding – (no other liquids or solid food)
- You are nearly fully breastfeeding – (mainly breastfeeding & other liquids infrequently ) and
- Baby under six months and
Amenorrhoeic
11
Q
The risk of pregnancy increases in LAM if:
A
- breastfeeding reduces
- long intervals between feeds – both day and night, or
- night feeds cease and use supplement feeding occurs.
Risk of pregnancy increases once baby reaches 6 months, regardless of menstrual patterns, level of breastfeeding
12
Q
What determines contraceptive choice ?
A
- Patient choice
- Medical conditions ?
- Medication ? DDI?
- UKMEC* categories for contraindications
- Advise on other suitable methods and offer if appropriate
- Discuss advantages, disadvantages, risks, efficacy, adverse effects and when to seek advice
- Advise on how to start HC
- CHC regimens – standard and tailored
- Advise on missed/late pill/use of vaginal ring
- Need for ‘Quick-starting’ contraception
13
Q
Advantages of COC?
A
- Menstrual period regular, lighter, less painful
- Reduced acne, functional ovarian cysts, benign ovarian tumours
- Reduced risk of ovarian, uterine, and colon cancer
14
Q
Disadvantages of COC?
A
- Minor ADRs – nausea, breast tenderness, cyclical weight gain?, loss of libido?, vaginal discharge, breakthrough bleeding
- Increased risk blood pressure (angiotensin), MI, stroke, Venous thromboembolism, breast cancer, cervical cancer
15
Q
Advantages of POC?
A
- High efficacy
- Suitable when COC isn’t
- Reduced risk of endometrial cancer, benign breast disease, uterine fibroids, anaemia
16
Q
Disadvantages of POC?
A
- ADRs – acne, headaches, depression?, loss of libido?, sustained weight gain?, vaginal dryness?
- Menstrual irregularities (oligomenorrhoea and menorrhagia)
- Efficacy – obesity
- Increased risk of functional ovarian cyst, ectopic pregnancy, breast cancer
17
Q
Definition of a missed pill (COC)?
A
- > 24* hrs LATE
- If starting on day 6 or later, add precautions for 7 days
- Critical at end or start of cycles as PF period elongated
- If 2 or more missed (>24 hrs) and UPSI occurs EHC indicated
18
Q
Definition of a missed pill (POP)?
A
- > 3/12hrs LATE
- Continue pills with 2 days extra precautions
- If 1 or more ACTIVE pills missed (>3/12hrs) [and UPSI before 2 more tablets taken correctly] then EHC indicated
19
Q
Missed pill protocol for EHC when on COC:
A
- Is it a missed pill (more than 24 hours late) - if yes move on to next point
- 1 pill missed = EHC not required
- 2 or more missed pills = EHC required if UPSI occurs before 7 tablets taken correctly
- If Ellaone (ulipristal acetate) given, omit daily dose of COC for 5 days and extra precautions until next monthly period. If within last 7 days of ACTIVE pills, omit 7 day break/placebo pills
- If levongestrel (Levonelle) given, miss daily dose of COC and use extra precautions for the next SEVEN days. If within last 7 days of ACTIVE pills, omit 7 day break/placebo pill
20
Q
Missed pill protocol for EHC when on POP:
A
- Is it a missed pill (more than 24 hours late) - if yes move on to next point
- 1 or more missed pills?
- EHC required if UPSI occur before two tablets taken correctly
- If supplying levongestrel, miss daily dose of POP and use extra precautions for the next two days
- If UPA (Ellaone), omit daily dose of POP for 5 days and extra precautions until Nmp
21
Q
UK MEC health risks and the COC. Category 4 conditions:
A
- Breast feeding women < 6 weeks post partum
- Women>35 + 15 cigarettes a day
- Multiple CVS risks
- Consistently elevated BP
- Vascular disease & history of VTE (inc thrombogenic mutations), IHD and stroke
- Migraine WITH aura
- Current breast cancer
- DM with nephropathy, retinopathy or neuropathy
- Benign hepatocellular adenoma and malignant hepatoma
- SLE
22
Q
CVS risks with COC:
A
- Increased risk of myocardial infarction; only current COC users who smoke
- Normotensive, non-smoking COC users have no increased risk of haemorrhagic stroke, whilst the risk of ischaemic stroke, in this group, is 1.5 times higher than it is for non-users
23
Q
Starting COC protocol:
A
- Day 1 of natural cycle
- Day 1-5, no additional precautions
Quick-starting (day 6 or later) = additional precautions for 7 days
24
Q
Starting POP protocol:
A
Norethisterone (Noriday)
Desogestrel(Cerazette)
- Day 1-5, no additional precautions
Quick-starting (day 6 or later) - additional precautions for 2 days
25
Changing oral hormonal contraception:
| COC to POP
- Ensure previous contraception taken effectively or exclude pregnancy; use additional precautions for 2/7, if pill-free period
- COC(ED) to POP – use addition precaution for 2/7, if ED/placebo pills taken
- COC(non-ED) to POP – for immediate cover, omit pill-free period, start POP immediately
- COC to Cerazette (POP) – for immediate cover, omit pill-free period.
26
Changing oral hormonal contraception:
| POP to COC:
- POP – Qlaira (COC) (additional precautions for 9 days)
- POP – Zoely (additional precautions for 7 days)
- POP-COC (add precautions for 7/7)
27
Missed pill advice for COC:
Missed pill = > 24 hours late
If starting on day 6 or later, add precautions for 7 days
Critical at end or start of cycles as PF period elongated
EHC indicated if 2 or more missed (>24 hrs)*
Vomiting within 2 hours or persistent diarrhoea over 24 hours, use additional precautions for 7 or 2 days
28
Missed pill advice for POP:
>3 hrs late [Micronor/Noriday]
>12hrs late [*Cerazette Cerrelle]
Continue pills with 2 days extra precautions
EHC indicated if 1 or more pills missed (>3/12hrs) [and UPSI before 2 more tablets taken correctly]
29
Example of non hormone contraception:
CU-IUD
30
What dose is given for Levongestrel EHC?
1.5mg
31
What dose is given for UPA Ellaone?
30mg
32
Examples of hormonal contraception and DDI's
Enzyme inducing drugs + griseofulvin e.g.
Antiepileptics:
- Carbamazepine, oxcarbazepine, phenytoin, phenobarbital, primidone, topiramate
Antiretrovirals: Nevirapine, ritonavir
Antibiotics: Rifabutin, rifampicin
Other: St John’s Wort and griseofulvin
INCLUDING 28 DAYS AFTER CESSATION
NOT AFFECTED by enzyme inducing drugs
Parenteral POC, IUS*
33
Sodium valproate - PPP:
- Valproate: epilepsy or bipolar disorder
- Serious risk from taking valproate in pregnancy (Congenital malformation and neurodevelopmental disorders)
- Specialist initiation
Requires HIGHLY effective contraceptive option (LARC or any with failure rate of <1%), and if not, implement regular pregnancy testing
- ALL female patients of child-bearing age, regardless of sexual activity
- Give patient card, patient guide, and complete Annual risk Acknowledgement form
34
Effectiveness of non hormonal contraception:
- Cu-IUD: 99% effective
- Male condom: 98% effective, typical use 82%
- Female condom: 95% effective, typical use 79%
- Diaphragm/cap with spermicide: 92-96% effective, typical use 71-88%
