Contraception Flashcards
What are the methods of combined hormonal contraception?
COCP
Combined transdermal patch
Combined vaginal ring
How do the combined contraceptions work?
Inhibit ovulation (progesterone also inhibits endometrial proliferation and increases thickness of cervical mucus)
What are the guidelines on starting the COCP + condom use?
If started within first 5 days of cycle –> effective immediately
After day 5 –> condoms for 7 days
What are the guidelines on starting the COCP postpartum?
If started by day 21 post partum –> effective immediately
After day 21 –> condoms for 7 days
What should you do if taking the COCP and miss 1 pill?
Take the last pill, even if 2 taken in 1 day
No additional protection required
What should you do if taking the COCP and miss 2 pills?
Take last pill even if 2 taken in 1 day (omit any earlier missed pills)
Use condoms until pill has been taken 7 days in a row
If pill missed in week 1 –> emergency contraception
Which cancers are reduced by taking the COCP?
Ovarian
Endometrial
Colorectal
What are the negative effects of the COCP?
Increased risk of: - cervical + breast cancer - VTE - stroke + IHD Interacts with anti-epileptics Hormonal side effects: - headaches - nausea - mood changes - breast tenderness - low libido Irregular bleeding
What are the absolute contraindications for the COCP?
> 35 years old and smoking > 15 per day
Migraine with aura
History of thromboembolic disease or thrombogenic mutation
History of stroke or IHD
Uncontrolled HTN
Current breast cancer
Major surgery with prolonged immobilisation
What are the relative contraindications for the COCP?
> 35 and smoking < 15 per day BMI > 35 FHx of thromboembolic disease in 1st degree relative < 45 years Controlled HTN Immobility BRCA 1/2 Ongoing gallbladder or liver disease Complicated diabetes
What are the progesterone only methods of contraception?
Depo-provera injection
POP (desogestrel)
Nexplanon implant
How is Depo Provera administered and how does it work?
IM injection every 13 weeks
Inhibits ovulation + thickens mucus
Do condoms need to be used after Depo injection given?
Contraception effective immediately if given in first 5 days of cycle
After day 5 –> use condoms for 7 days
What are the negative effects of Depo Provera?
Injection cannot be reversed once given Delayed return to fertility (up to 12 months) Irregular bleeding Potential for weight gain Risk of osteoporosis Hormonal side effects
How does the POP work?
Prevents ovulation + thickens mucus
How is the POP taken?
Take at same time every day without a pill free break
Do condoms need to be used when commencing the POP?
If started in first 5 days of cycle –> effective immediately
After day 5 –> use condoms for 2 days
What should you do if taking the POP and miss a pill?
If < 12 hours later than usual time –> take pill as normal
If > 12 hours –> take missed pill asap and continue with rest of pack
–> use condoms until pill has been taken for 24 hours
What are the negative effects of POP?
Irregular bleeding
Diarrhoea + vomiting (assume missed pill)
Liver enzyme inducers may reduce effectiveness
Cannot be used if history of breast cancer or active liver disease
How long does the Nexplanon implant last?
3 years
What are the negative effects of the implant?
Irregular bleeding
Headache
Nausea
Breast pain
Skin changes
Efficacy reduced by enzyme inducers e.g. anti epileptic, rifampicin
Contraindicated in current breast cancer + active liver disease
What is the IUS and how does it work?
Levonorgestrel-releasing coil (system)
Prevents endometrial proliferation + thickens mucus
When does the IUS become effective?
After 7 days of insertion (immediate if within first 5 days of cycle)
What are the negative effects of the IUS?
Spotting after insertion Uterine perforation Increased risk of ectopic (but lower than if not on contraception) Risk of PID in first 20 days Risk of expulsion in first 3 months
How long does the IUS last?
Mirena - 5 years
Jaydess - 3 years
How does the copper IUD work and how quickly does it work?
Decreases sperm motility and survival
Effective immediately on insertion
When can the IUD be used for emergency contraception?
If inserted within 5 days of UPSI
Or up to 5 days after expected day of ovulation in regular cycle
What are the disadvantages of the IUD?
Heavier, longer, more painful periods within first 3-6 months
Spotting/bleeding between periods
Insertion related risks as with IUS
What are the options for emergency contraception?
IUD (most effective)
Levonorgestrel
Ulipristal (EllaOne)
What is the dose of Levonorgestrel?
Single dose 1.5mg
Should be doubled for BMI >26, over 70kg, taking enzyme inducing drugs
When does Levonorgestrel need to be taken?
Within 72 hours of UPSI (efficacy reduces with time)
What are the side effects of levonorgestrel?
Disturbance of menstrual cycle Nausea and vomiting --> repeat dose if within 3h of taking pill Dizziness Diarrhoea Breast tenderness
When can EllaOne be taken?
Within 120 hours of UPSI (no reduction in efficacy over time)
When should EllaOne be avoided?
If already taken in this menstrual cycle
Severe asthma
If taking regular antacids
What are the side effects of EllaOne?
Reduced effectiveness of hormonal contraception
Nausea + vomiting (repeat if within 3 hours)
Headache
Dizziness
Breast tenderness
How do the oral emergency contraceptions work?
Inhibit/prevent ovulation
do not work in second half of cycle - ovulation has occurred
What is Lactational Amenorrhoea Method (LAM) of contraception?
Breastfeeding as protection against unwanted pregnancy
- very effective if done properly
What are the criteria for LAM to work effectively?
- only effective up to 6 months postnatally
- must be exclusively breastfeeding at least every 4 hours during day, every 6 hours at night
- must be fully amenorrhoeic
Which hormonal contraceptions can be used immediately after childbirth?
All except COCP (or other combined methods)
When can the COCP be started after childbirth?
3 weeks postpartum
6 weeks if breastfeeding or other VTE risk factors
Which method of progesterone only contraceptions shouldn’t be used if breastfeeding?
Depo provera
