Contraception Flashcards
Methods` of Contraception
- Daily pill(s)
- IUS/D/vaginal ring
- Injection
- Patch
- Implant
COCP Hormones
ethinyl oestradio + progestin (desogestrel/levongestrel)
COCP MoA
prevents ovulation
COCP regimen
1/day for 3 wks then 1 wk off (withdrawal bleed)
Can tricycle to reduce withdrawal freq.
- preference
- reduces chance of unexpected bleed
If started on first 5 days of cycle (28 day cycle) confers immediate protection (caution shorter cycle length)
Stop >4 wks prior to surgery
COCP Adv+Dis
Adv:
- > 99% effective
- Reversible upon stopping
- Regular less painful periods
- reduced risk of ovarian, endom. bowel ca.
Dis:
- Adherance
- No STI protection
- risk of VTE, breast ca, cervical ca., stroke, IHD
COCP SE profile
Headache, N+V, breast tenderness, choice of ABx my be altered (inform GP)
COCP vomiting?
If within 2 hours take another
COCP absolute CI
- <6 weeks post partum and breastfeeding
- smoker >35 (>15/day)
- HTN (systolic >160 or diastolic >100)
- Current or past Hx VTE
- IHD
- Hx CVA
- Complicated valve dx (pHTN, AF, IE)
- Migraine w/aura
- Breast ca (current)
- DM w/retin/nephropathy
- Severe cirrhosis
- Liver tumer (adenoma or hepatoma)
COCP Missed Pill
1 miss: take last and current, no other contraception needed
2 missed: take last and current and continue taking:
Use condoms until 7d correct pill usage
2 missed in wk 1 consider EC
2 missed in wk 2 no need for EC
2 missed in wk 3 finish pills and start new with no break
POP Hormone and MoA
Desogestrel (cerazette 12hr), levonogestrel or norethistrone
Thicken cervical mucous
NB. desogestrel also stops ovulation
POP how to take?
1 Pill same time every day
NO pill free week
POP protection window
Immediate if in first 5 days
If at any other time use additional methods for 2 days
NB. If switching from COCP immediate protection
POP benefits
Doesn’t have risks of oestrogen pills
POP disadvantages
Adherence daily
Irregular bleeding
osteoporosis
ovarian cysts
POP Missed Pill (3+12hr versions)
<3 hrs late: continue as normal
>3hrs take missed pill ASAP, continue, condom until 48 restablished pill taking
EC if UPSI in 48 hr window
2 or more missed pills: take last and next, condoms for 48 hrs
POP SE profile
Irregular vaginal bleeding acne breast tenderness mood changes headache
Combined hormonal transdermal patch: Hormones and regime, brand name, risk of clot?
Norelgestromin + ethinyl oesteadiol
Applied for 3 wks (new patch per wk), then withdrawal bleed - tricycling possible
Evrapatch
No increased risk of clot
CHTP missed patch
<48 hr: change with no precautions
>48 in wk 1 or 2: change and use barrier for 7d (if UPSI within 5d prev. or during patch free consider EC)
>48hr in wk 3: remove and apply next patch on normal date
Delayed at end of withdrawal: barrier for 7d
Combined hormonal ring
inserted PV
Novaring
Worn 21d then 7d break
Mirena (LNG-IUS): Hormone? MoA? Duration?
Levonorgestrel
Thins endometrium and prevents implantation
3-5 years
Menses using LNG-IUS
tend to be less painful and lighter
however initially bleeding my be heavier
Additional contraception after LNG-IUS insertion?
Needed for 7d unless inserted within first 7d of cycle
SE profile of LNG-IUS
Acne
Breast tenderness
Mood disturbance
Headache
Indications for LNG-IUS
Emergency contraception
HMB
Part of HRT
