Contraception Flashcards
When do you need to apply more spermicide to a
diaphragm/cap
If you have sex again
OR
If you’ve had it in for more than 3 hours
How long after sex do you need to leave the diaphragm/cap in for
At least 6 hours
What is the max length of time you can leave a diaphragm/cap in for
30 hours
How long after giving birth do you have to wait before using a diaphragm/cap
6 weeks
Things that may mean the diaphragm/cap isn’t suitable
Latex or spermicide allergy
Recurrent UTIs
Unusual position/shape of cervix
Vaginal infection
Possible side effects/risks of the combined oral contraceptive pill
Mood swings Nausea Breast tenderness Headache DVT Cervical cancer STIs not protected against
How does the COCP work
Inhibits ovulation
Thickens cervical mucus
Thins endometrium
What counts as a missed pill for the COCP
More than 24 hours since you should have taken it
Rules if you miss 1 COCP
Take it as soon as you remember, continue as normal
Rules if you miss 2 COCP
Take the last one you missed as soon as you remember
Use condoms for 7 days
If there was less than 7 left in your pack skip your pill free break
If you missed it in the first 7 days of the packed and had unprotected sex in the pill free break or since you may need emergency contraception
Advice regarding the COCP if you get vomiting or diarrhea
If you vomit within 2 hours of taking the pill then take another one
If you’re been sick lots then use condoms until you’ve managed to keep your pill down for 7 days
If you’re having 6-7 watery stools a day then use condoms while you have diarrhea and for 2 days after its stopped
Contraindications to the COCP (or patch)
Age >35 and smoker (or stopped less than 1 year ago) BMI 35+ Hx of DVT/PE Hx of stroke/MI FH of VTE age < 45 HTN Migraines with aura Hx of breast cancer DM with complications
Advice about COCP after having a baby
Start taking it 3 weeks after (start it ON day 21)
If its been more than 3 weeks since giving birth you’ll need to use condoms for 7 days as well
If breastfeeding need to wait 6 weeks after birth
Pros of the COCP
Can make periods more regular, lighter and less painful
Can reduce PMS
Can reduce acne
Reduces risk of ovarian, uterine and colon cancer
Cons of the COCP
Side effects - headaches, nausea, breast tenderness, mood swings (but all usually go away after a few months)
Can increase BP
Doesn’t protect against STIs
Breakthrough bleeding and spotting common at first
Has been linked to an increase risk of VTE, cervical cancer and breast cancer
Medications that can interact certain contraceptives
Rifampicin and Rifabutin
Antiepileptics
St Johns Wort
Antiretrovirals
Barrier contraception options
Male condoms
Female condoms
Diaphragm/cap
How long does the contraceptive implant last for
3 years
Advice about having the contraceptive implant after birth
Any time
If < 3 weeks after giving birth you’re immediately protected. If > 3 weeks after giving birth you need to use condoms for 7 days
Its safe in breastfeeding
Contraindications to the contraceptive implant
Unexplained IMB or PCB
Hx of heart disease or stroke
Liver disease
Hx of breast cancer
How long does the contraceptive injection last for
13 weeks
What are the rules regarding which day of your cycle you start the contraceptive injection/implant/COCP/patch on
If its within the first 5 days of your cycle you’re immediately protected. If its > 5 days into your cycle you’ll need to use condoms as well for 7 days
Advice about having the contraceptive injection after giving birth
Can be started any time
If within the first 21 days you’re immediately protected
If > 21 days then you need to use condoms for 7 days
Contraindications for the contraceptive injection
Wanting a baby within the next year Unexplained IMB or PCB Hx of heart disease or stroke Liver disease Breast cancer Risk of osteoporosis
What counts as a missed pill for POP
More than 3 hours late (or 12 hours if Desogestrel)
Advice regarding What are the rules regarding which day of your cycle you start the POP on
If within the first 5 days you’re protected straight away
If >5 days (or you have a shorter cycle) then need to use condoms for the first 2 days taking the pill
Advice about starting the POP after giving birth
Can be started any time
If its been more than 3 weeks since giving birth you’ll need to use condoms for 2 days as well
Advice regarding missed pills for POP
Take 1 when you remember and 1 at the usual time
Use condoms for 2 days or dont have sex for 2 days
How does the POP work
Mainly by thickening cervical mucus. Some also stop ovulation.
Advice for POP when you vomit or have diarrhoea
If vomit within 2 hours of taking it then just take another one
If >3 or >12 then treat it as a missed pill (i.e. take another and use condoms for 2 days)
If continually ill then use condoms while you’re ill and for 2 days after
If 6-8 watery stools a day then use condoms while you’re ill and for 2 days after recovering
Contraindications to the POP
Unexplained IMB or PCB
Arterial/heart disease or stroke
Liver disease
Breast cancer
Ovarian cysts are a risk associated with which contraceptive
POP
How long does the contraceptive patch last for
1 week
You change it every week for 3 weeks then have a weeks break
Advice for if the contraceptive patch comes off
If its been off for <48 hours and it had already been on for 7 days then just stick it back on and you’re protected straight away
If its been off for > 48 hours or if it hadn’t already been on for 7 days then stick another on and use condoms for 7 days
Advice regarding which day of the cycle to start using the vaginal ring
If you insert it on day 1 then you’re protected. If its on any other day of the cycle you need to use condoms for 7 days as well
How long does the contraceptive vaginal ring last for
21 days
You leave it in for 21 days, have a 7 day break then insert a new one
Advice regarding the contraceptive vaginal ring after giving birth
Can use it 3 weeks after (ON day 21)
If its later than day 21 use condoms for 7 days
Don’t use if breastfeeding <6 months (can reduce flow of milk)
How long does the IUD last for
5-10 years
How long after insertion of the IUD are you protected
Straight away
How long after IUD insertion is a follow up
3-6 weeks
Contraindications to IUD
Untreated STI or PID
Problems with cervix or uterus
Unexplained IMB or PCB
How soon after birth can the IUD be fitted
Either within the first 48 hours - if not then after 4 weeks
Safe in breastfeeding
How long does the IUS last
3-5 years
Which contraceptives are progesterone only
POP
Injection
Implant
IUS
Which contraceptives are combined hormones
COCP
Vaginal ring
Patch
Advice regarding which day of the cycle you have the IUS fitted
If within the first 7 days then protected straight away
If > 7 days then need to use condoms for 7 days
If women are going to have their IUD/IUS removed, what is important to tell them if they don’t want to get pregnant
Need to start using condoms 7 days before you get it removed if you’re not having another one put in straight away
Contraindications to the IUS
Breast cancer Cervical cancer Endometrial cancer Liver disease Unexplained IMB or PCB Arterial/heart disease or stroke Untreated STI or PID Problems with cervix or uterus
How long after birth can the IUS be fitted
Within 48 hours or after 4-6 weeks
Safe in breastfeeding
If a women has given birth and wants the IUD/IUS inserted after 4 weeks, what do advice her regarding contraception in the meantime
21 days after birth you need to start using contraception until the IUD/IUS can be fitted
Risk of infection is highest within how many days of IUD/IUS insertion
The first 20 days
Which contraceptives can increase the risk of ectopic if you do become pregnant on them
IUD and IUS
Which forms of contraception can be used as soon as you want after giving birth
Male condoms Female condoms Implant Injection POP
IUD + IUS (if within 48 hours - if missed this window need to wait until its been 4 weeks)
Which contraceptives can’t be used until 6 weeks after giving birth if you’re breastfeeding
COCP
Vaginal ring
Patch
Also have to wait 6 weeks to use the diaphragm/cap but its safe to breastfeed
Which contraceptives do you have to wait 3 weeks before using after giving birth
COCP
Vaginal ring
Patch
(All of which you can’t use until 6 weeks if you’re breastfeeding, but fine to use at 3 weeks if you’re not)
Which contraceptives are safe in breastfeeding
Condoms Implant Injection POP IUS IUD Cap
