Contraception Flashcards
What contraceptives are appropriate in IBD?
Parenteral due to poor absorption. Not depo-provera due to osteoporosis risk.
What contraceptives are appropriate when breast-feeding?
Breastfeeding full time is >98% effective for the first 6m.
Not COCP - affects breast milk volume.
Progestogen only pills have no effects on milk.
IUD can be used from 4wks postpartum.
What contraceptives advice should be given around the menopause?
Should continue contraception for 2y after last period <50 and 1y >50.
Any contraceptive is appropriate.
How do combined oral contraceptives work?
Oestrogen and progesterone provide Negative feedback on gonadotrophins, also thickening of cervical mucus and endometrial thinning.
How long do you take the COCP for?
3 weeks on, 1 week withdrawal bleed.
Can go back-to-back for 3 cycles.
What are the oestrogenic S/E of contraception?
Nausea.
Headache.
Increased mucus.
Fluid retention.
Occasional HTN.
Breast tenderness and fullness.
Bleeding.
What are the progestogenic S/E of contraceptives?
Depression.
PMS.
Bleeding / amenorrhoea.
Acne.
Breast discomfort.
Weight gain.
Reduced libido.
What are the indications for hormonal contraception?
Contraception in all ages.
Menstrual symptom control.
Menorrhagia.
PMS.
Dysmenorrhoea
Acne / hirsutism.
Prevention of recurrent ovarian cysts.
What advice do you need to give someone being given the pill?
Diarrhoea: Continue taking the pill, follow missed pill instructions.
Vomit w/in 2h of pill: take another or missed pill instructions.
Abx: continue, but use condoms during and 7d after.
Liver-enzyme inducers: may need to increase oestrogen.
Missed pill - one is ok. Two is ok on 30-35ug. Take missed pill as soon as possible. If more than 1/2 missed, use condoms for 7d. If within last week, run straight into next pack.
What are the complications of the contraceptive pill?
Major: Venous thrombosis, MI (worsened by smoking, obesity, age). Also stroke, migraine, HTN, jaundice, carcinoma liver, breast, cervix.
Minor: Nausea, headache, breast tenderness. Breakthrough bleeding in the first few months.
What are the contraindications to the COCP?
Absolute contraindications:
Hx venous thrombosis.
Hx Stroke, IHD, severe HTN.
Migraine with aura.
Active breast / endometrial cancer.
Inherited thrombophilia.
Pregnancy.
BMI>40
Age>35+smokes>15/day.
DM with vascular complications.
Active / chronic liver disease.
Relative:
Smoking.
Chronic inflammatory disease.
Renal impairment.
DM.
Age >40y.
BMI 35-40.
Breastfeeding up to 6m postpartum.
What are the secondary benefits to the COCP, other than contraception?
More regular, lighter, less painful periods.
Protective against ovarian cysts, benign breast cysts, fibroids, endometriosis.
Hirsutism and acne may improve.
How do you take the progesterone only pill?
Every day without a break, at the same time +-3h.
Cerazette can be taken +-6h.
How does the progestogen only pill work?
Makes cervical mucus hostile to sperm and in 50% prevents ovulation.
Less effective than COCP.
What is the progestogen only pill good for?
All situations where COCP is contraindicated.
