Contraception Flashcards
Progesterone: Action
Suppresses ovulation
thickens endometrium
thickens cervical mucus
Progesterone: Time
Take one tablet once a day at roughly same time
Desogestrel: 12 hour window each day
LNG, norethisterone: 3 hours
If you miss a dose, take it as soon as you remember even if you end up taking 2 pills in one day. dont take more than 2 though!! then use barrier protection if window missed
No breaks, take every day
Progesterone: SE
irregular bleeding
breast tenderness
acne
libido
Progesterone: Complications
Breast cancer (current or past)
liver cirrhoos
CYP450 inducers:
COCP: Action
suppresses ovulation
thins endometrium
thickens cervical mucus
COCP: Timing, Length of time, effect start in…
take one tablet once a day, doesnt matter when
take for 3 weeks then 1 week off
start day 1- 5 of cycle
If after day 5, use condoms for a week
missed pill:
One (over 24 hours)- take missed pill asap, even if it means taking two in one day
Two or consecutive (48+hours) - take last pill you missed, miss out earlier ones.
Use condom for 7 days.
day 1-7: use emergency contraception
day 8 -14: no need for additional protection, use condoms
day 15- 21: take the following pill back straight away without pill- free break.
COCP: SE
Mood swings Headaches Reduced libido Breast tenderness and enlargement Nausea and bloated feeling IMPORTANT- red, hot swollen leg may be a VTE
COCP: contrindications
increased risk of breast cancer and cervical cancer
BMI >40 breastfeeding: can't use for first 6 weeks. Smoking 15+ if age >35 Hypertension: 160/ 110 Migraine with aura Current breast cancer VTE risk: history of CVD, stroke, AF
POP implant- Nexplanon. Action
Prevents ovulation
thickens cervical mucus
Thins endometrium
POP implant- Timings
lasts for 3 years
inserted day 1- 5 of cycle: Effective immediately
after day 5- abstain or use condom for next 7 days
POP: SE
Infrequent bleeding (<1/4 have regular bleeding) but this should resolve
Progesteron effects: headache, nausea, breast pain, acne
brusing and infecting at site of implantation
POP: Contraindications
Enzyme inducers
past/ current breast cancer, liver cirrhosis, liver cancer
Depot injection : progesterone. Action
Prevents ovulation
Thickens cervical mucus
Thins endometrium
Depot injection: how to take
IM injection into buttocks, arm, leg or abdomen
Depot injection: timings
every 12 weeks
if inserted day 1- 5: effective immediately as contraception, if inserted after day 5, use condoms for next 7 days
Depot injection: SE
Only contraception with proven link to weight gain
Irregular bleeding (70% become amenorrhoeic)
Risk of osteoporosis
When you stop taking it, periods do not return for 6 months
Depot injection: contraindications
Any other risk factors for osteoporosis: Vit D deficient Hyperparathyroidism Hyper thyroidism Low oestrogen levels Rheumatoid arthritis, Hep C
Mirena
Thickens cervical mucus
Thins endometrium- acts locally
Does not prevent ovulation
Mirena: Timings
Lasts 3- 5 years.
effective 7 days after insertion
Mirena: SE
Irregular bleeding Headahce Breast tenderness Nausea Acne
Mirena: Contraindications
Expulsion in first 3 months Uterine perforation (1/1000) Ectopic pregnancy (1/ 2000)
IUD, Copper coil: action
prevents egg implanting in womb, spermotoxic
IUD, copper coil: timings
lasts 5- 10 years
wait 4 weeks after giving birth to have it fitted
Effective as emergency contraception upto 120 hours after UPSI
Can be fitted 5 days after ovulation
IUD, SE
heavier, longer more painful periods
higher risk of ectopic (1/20)
IUD, Contraindications
bleeding, cervical/ uterine cancer, PID
Emergency Contraception: types
Levernotgestrol- progesterone pill
Copper Coil
Ulipristal acetate (UPA)- pill
Emergency contraception: Progesterone
72hours after UPSI.
very safe can double dose- for fat people
If vomiting occurs within 2 hours of ingesting- need to repeat dose
Should be used for woman on COCP who have forgotten to take for the last few days
Less effective than UPA
action: inhibits ovulation in early cycle
Contraindications of POEP:
Acute porphyria, severe liver disease, malabsorption
UPA: Timing benefits and con
Can be taken up to 5 days after UPSI
Very few side effects
Con: Some people feel N and V. if you vomit within 3 hours come back as you might need another one
changes to period, if don’t have period of within one week of when you expect take preggers test
Copper coil:
Can be implanted up to 5 days after UPSI
Also the only one that is effective after ovulation
Has inhibitory effect on both implantation and fertilisation
Cons: irregular and heavy bleeding and painful.
Painful insertion
Risk of infection
Ectopic pregnancy
Expulsion of IUD
Damage to the womb
Patients who have not had a normal period within 7 days of their next expected period date .
