Contraception Flashcards
Contraindications for Combined Hormonal Contraception
Breastfeeding and ≤6 weeks postpartum
Smoker ≥35 year and ≥ 15 cigarettes/day
Presence of multiple risk factors for CVD including older age, smoking, diabetes, hypertension
Hypertension with systolic ≥160mmHg or diastolic ≥95mmHg
Vascular disease
Major surgery with prolonged immobilisation
Current or past history of venous thromboembolism (VTE);
Known thrombogenic mutations * (Factor V Leiden, Prothrombin mutation, Protein S, Protein C and
Antithrombin deficiencies)
Migraine with aura
Current or past history of Ischemic Heart Disease (IHD);
Complicated valvular heart disease
Diabetes complicated by nephropathy, retinopathy or vascular disease
Breast cancer;
Severe Liver disease including cirrhosis hepatocellular adenoma and hepatoma
Raynaud’s with lupus anticoagulant
SLE with antiphospolipid antibodie
Contraindications for IUD
UKMEC 4
Pelvic inflammatory disease or symptoms or signs of chlamydia or gonorrhoea
UKMEC 3
Distortion of uterine cavity (congenital anomalies, fibroids)
Unexplained vaginal bleeding (suspicious for serious condition)
Postpartum 48 hours to four weeks
Current or past breast cancer (hormone-containing IUDs only)
Severe decompensated cirrhosis of liver, liver tumours (hormone-containing IUDs only)
Human immunodeficiency virus with serious immune compromise.
Contraindications to Combined Hormonal Contraceptive
UKMEC 4
Migraine with aura
Current breast cancer
History of venous thromboembolism (VTE), known thrombophilia
Complicated valvular heart disease, cardiac arrhythmia
Ischaemic heart disease or cerebrovascular disease
Age >35 years, smoker of >15 cigarettes daily
Hypertension with blood pressure >160/100 mmHg
Severe decompensated cirrhosis of liver, liver tumours
Postpartum up to three weeks, with additional VTE risks
Breastfeeding and up to six weeks postpartum
UKMEC 3
First-degree relative aged <45 years who has had a VTE; immobility
Strong cardiovascular risks (eg diabetes with renal complications)
Body mass index >35 kg/m2
Past breast cancer
Acute viral hepatitis
Postpartum, not breastfeeding: 0–3 weeks without additional VTE risks or 0–6 weeks with additional VTE risks
Quick Start Contraception
Quick Start refers to starting a method of hormonal contraception outside the usual recommendation of commencing on days 1–5 of a cycle. The principles are:
- start active contraception immediately
- use barriers or abstinence until the method becomes effective (seven days for most methods; 48 hours for progestogen-only pills)
- do a pregnancy test in four weeks.
Quick Start is suitable for all types of contraception except intrauterine devices.
Causes of irregular vaginal bleeding on contraception
pregnancy, medication interactions, cervical cancer, endometrial cancer and endometrial polyps
Management of irregular vaginal bleeding on contraception
Depending on the patient’s wishes and the absence of contraindications to medications, the following management options can be tried:
Wait and see if the bleeding settles
Trial a combined hormonal contraceptive for three months
Trial a five-day course of nonsteroidal anti-inflammatory drugs such as mefenamic acid 500 mg twice to three times daily
Trial a five-day course of tranexamic acid 500 mg twice daily, particularly if bleeding is heavycommence another method and remove the implant once the new method is effective.
Other options with lower levels of evidence for their effectiveness include:
norethisterone 5 mg three times daily for 21 days
levonorgestrel progestogen-only pill, 30 µg twice daily for 20 days
early replacement of implant.
Complications of IUD insertion
infection occurring in the first three weeks after insertion (approximately one in 300 people)
non-insertion (due to excessive pain or technical factors)
perforation of the uterus (1–2 in 1000 people)
malposition of the IUD.
