CONTRACEPTION Flashcards
Women who have side effects such as acne, headache, depression, breast symptoms and breakthrough bleeding with other progestogens, which progestogens may be more suitable ?
desogestrel,
drospirenone,
gestodene
How should women start taking combined oral contraceptive pill ?
start any time in menstrual cycle; if started on day 6 or later use protection for 7 days
For which patient group is phasic combined contraception reserved ?
for women who do not have withdrawal bleeding or have breakthrough bleeding with monophonic preparations
what is the difference between standard strength and low strength hormonal preparations ?
low strength: ethinylestradiol 20 mcg
standard strength: ethinylestradiol 30 or 35 mcg
When would it be suitable to recommended low strength combined oral contraceptive over standard strength ?
for women with risk factors of circulatory disease
Combined oral contraceptive increases risk of VTE and arterial thromboembolism, name risk factors that further increase the risk of having VTE and ATE?
- type of progestogen: desogestrel, gestodene, drosperinone
- obesity BMI >30
- Smoking
- Primary relative under 45 with VTE
- superficial thrombophlebitis
- long-term immobilisation
- age >35 years
NICE: Any two or more of the following risk factors are present:
Obesity (body mass index ≥ 30 kg/m2).
Smoking.
Diabetes mellitus.
Family history of arterial disease in first degree relative aged under 45 years.
Hypertension—blood pressure above systolic 140 mmHg or diastolic 90 mmHg.
Migraine without aura.
ATE risk factors: DM, hypertension, migraine with aura
Avoid combined contraceptive if 2 or more risk factors present.
GP phoned you to ask regarding combined contraception and surgery so that he can advise his patients appropriately ?
Oestrogen containing contraceptives: stop 4 weeks before major elective surgery and all surgery to legs or surgery which involves prolonged immobilisation of a lower limb.
When can patients restart combined pill after stopping it due to surgery ?
at the first menses occurring at least two weeks after full mobilisation or alternatively then they can use progestogen only pill
Patient is due to have emergency surgery and they have been on combined pill, what action should be taken ?
thromboprophylaxis with unfractioned or low molecular weight heparin and graduated compression hosiery is advised.
What are the reasons to stop COC ? ( 9 points)
- sudden severe chest pain ( even if not radiating to left arm)
- sudden breathlessness ( or cough with blood stained sputum)
- unexplained swelling or severe pain in calf of one leg
- severe stomach pain
- serious neurological effects
- hepatitis, jaundice, liver enlargement
- blood pressure above systolic 160 or diastolic 95
- prolonged immobility after surgery or leg injury
- detection of a risk factor which contraindicates treatment
What type of serious neurological reactions would warrant to stop COC ?
-unusual severe prolonged headache especially if first time or getting progressively worse or sudden partial or complete loss of vision or sudden disturbance of hearing or other perceptual disorders or dysphasia or bad fainting attack or collapse or first unexplained epileptic seizure or weakness, motor disturbances, very marked numbness suddenly affecting one side or one part of the body
When would COC be contraindicated ?
Any one of the following risk factors are present:
Obesity — body mass index ≥ 35 kg/m2 (unless there is no suitable alternative).
Smoking — 40 or more cigarettes daily.
Diabetes mellitus — if complications are present.
Family history of arterial disease in first degree relative aged under 45 years — if atherogenic lipid profile.
Hypertension —blood pressure above or equal to systolic 160 mmHg or diastolic 100 mmHg.
Migraine — with aura (focal symptoms), or severe migraine frequently lasting over 72 hours despite treatment, or migraine treated with ergot derivative.
How does POP work ?
thickens the mucus in the cervix, prevents sperm reaching an egg
Menstrual irregularities; heavy or light periods are more common with COC or POP ?
POP
How should you counsel a patient regarding starting to take POP for the first time ?
- take one tab daily on a continuous basis, starting on day 1 of cycle and taken at the same time each day.
- if started after day 5 of menstrual cycle, additional precautions are required for the next two days.
