Contraception Flashcards
UKMEC 1- for contraception- what is it?
Condition for which there is no restriction for the use of the contraceptive method
UKMEC 2- for contraception- what is it?
advantages generally outweigh the disadvantages
UKMEC- 3- for contraception- what is it?
disadvantages generally outweigh the advantages
UKMEC- 4 - for contraception- what is it?
represents an unacceptable health risk
Examples of UKMEC- 3 conditions where the disadvantages generally outweigh the advantages
more than 35 years old and smoking less than 15 cigarettes/day
BMI > 35 kg/m^2*
family history of thromboembolic disease in first degree relatives < 45 years
controlled hypertension
immobility e.g. wheel chair use
carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
current gallbladder disease
Examples of UKMEC 4 conditions- unacceptable health risk
more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
What is the main injectable contraceptive used in the UK?
Depo Provera- contains medroxyprogesterone acetate 150mg. Given via IM injection every 12 weeks.
What is the main method of action of Depo Provera?
Inhibits ovulation. Secondary effects include cervical mucus thickening and endometrial thinning
Disadvantages of Depo Provera
Once injected, the injection cannot be reversed once given. Potential delayed return to fertility (up to 12 months)
Adverse effects of Depo Provera
irregular bleeding
weight gain
may potentially increased risk of osteoporosis: should only be used in adolescents if no other method of contraception is suitable
not quickly reversible and fertility may return after a varying time
Contraindications of depo provera
Breast cancer: current breast cancer is UKMEC 4- past breast cancer is UKMEC 3
Two methods of emergency hormonal contraception
Emergency pill and morning after pill- levonorgestrel and ulipristal- progesterone receptor modulator
Levonorgestrel MOA
Not fully understood- acts to stop both ovulation and inhibit implantation
Within how many hours of unprotected sexual intercourse (UPSI)
72 hours
What is the dose of levonorgestrel to be taken
single dose of levonorgestrel 1.5mg (a progesterone)
the dose should be doubled for those with a BMI >26 or weight over 70kg
84% effective is used within 72 hours of UPSI
What is Ulipristal?
Selective progesterone receptor modulator currently markets as EllaOne- primary mode of action - inhibition of ovulation
Dose of ulipristal to be taken
30mg oral dose as soon as possible- no later than 120 hours after intercourse
When should contraception with pill, patch or ring be started after taking ulipristal
5 days after- barrier methods should be used during the 5 days
Within how many days of UPSI should IUD be fitted
5 days - if woman presents after more tha 5 days then IUD may be fitted up to 5 days after likely ovulation date
Two types of intrauterine contraceptive
IUDS and IUS
Mode of action of IUD and IUS
IUD: primary mode of action is prevention of fertilisation by causing decreased sperm motility and survival (possibly an effect of copper ions)
IUS: levonorgestrel prevents endometrial proliferation and causes cervical mucous thickening
How long after insertion can IUD be relied upon
immediately - majority effective for 5 years
How long after insertion can IUS be relied upon
after 7 days- Mirena- IUS most common for 5 years
Used as endometrial protection for women taking oestrogen only hormone replacement therapy
Problems with IUDS and IUS
IUD- periods heavier, longer and more painful
IUS- initial frequent uterine bleeding and spotting
Uterine perforation
After which day post partum do women require contraception
Day 21
POP postpartum- when to start
Any time
Combined oral contraceptive pill (COC) points when is it UKMEC 4 and when is it UKMEC2
absolutely contraindicated - UKMEC 4 - if breast feeding < 6 weeks post-partum
UKMEC 2 - if breast feeding 6 weeks - 6 months postpartum*
the COC may reduce breast milk production in lactating mothers
may be started from day 21 - this will provide immediate contraception
after day 21 additional contraception should be used for the first 7 days
How long does the contraceptive patch cycle last
4 weeks
First 3 weeks- patch worn everyday and needs to be changed each week. 4th weeks- patch not worn and there will be withdrawal bleed
Combined oral contraceptive pill mode of action
Inhibits ovulation
Progestogen-only pill (excluding desogestrel) MOA
Thickens cervical mucus
Desogestrel- only pill MOA
Primary: inhibits ovulation
Also: thickens cervical mucus
Implantable contraceptive (etonogestrel)
Primary: inhibits ovulation
Also: thickens cervical mucus
Intrauterine contraceptive device
Decreases sperm motility and survival
Intrauterine system (levonorgestrel)
Primary: Prevents endometrial proliferation
Also: Thickens cervical mucus
Intrauterine contraceptive device
Primary: Toxic to sperm and ovum
Also: Inhibits implantation
Timeline that people who have had UPSI should be advised to get tested for an STI
young people should be advised to have STI tests 2 and 12 weeks after an incident of unprotected sexual intercourse (UPSI)
Epilepsy contraception factors to consider for women with epilepsy
the effect of the contraceptive on the effectiveness of the anti-epileptic medication
the effect of the anti-epileptic on the effectiveness of the contraceptive
the potential teratogenic effects of the anti-epileptic if the woman becomes pregnant
UKMEC points for different methods of contraception in women taking phenytoin,carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine:
UKMEC 3: the COCP and POP
UKMEC 2: implant
UKMEC 1: Depo-Provera, IUD, IUS
UKMEC points for different methods of contraception for lamotrigine
UKMEC 3: the COCP
UKMEC 1: POP, implant, Depo-Provera, IUD, IUS
Implantable contraceptive moa
releases the progestogen hormone etonogestrel
They are typically inserted in the proximal non-dominant arm, just overlying the tricep. The main mechanism of action is preventing ovulation. They also work by thickening the cervical mucus.
What is the most effective form of contraceptive
Implantable contraceptive
Lasts 3 years
Doesn’t contain oestrogen so can be used if past history of thromboembolism, migraine etc
Disadvantages of implantable contraceptive include
the need for a trained professional to insert and remove device
additional contraceptive methods are needed for the first 7 days if not inserted on day 1 to 5 of a woman’s menstrual cycle
Adverse effects of implantable contraceptives
Irregular/heavy bleeding is the main problem: managed used a co-prescription of the COCP
Progestogen effects- headache, nausea, breast pain
Name of implantable contraceptive
Nexplanon
Interactions of nexplanon
enzyme-inducing drugs such as certain antiepileptic and rifampicin may reduce the efficacy of Nexplanon
the FSRH advises that women should be advised to switch to a method unaffected by enzyme-inducing drugs or to use additional contraception until 28 days after stopping the treatment
Contraindications of implantable contraceptives
UKMEC 3*: ischaemic heart disease/stroke (for continuation, if initiation then UKMEC 2), unexplained, suspicious vaginal bleeding, past breast cancer, severe liver cirrhosis, liver cancer
UKMEC 4**: current breast cancer
What time should the POP be taken everyday
should be taken at same time everyday, without a pill free break (unlike the COC)
Missed POP- what to do
if < 3 hours* late: continue as normal
if > 3 hours*: take missed pill as soon as possible, continue with rest of pack, extra precautions (e.g. Condoms) should be used until pill taking has been re-established for 48 hours
Potential other problems of POP
diarrhoea and vomiting: continue taking POP but assume pills have been missed - see above
antibiotics: have no effect on the POP**
liver enzyme inducers may reduce effectiveness
Progestogen only pill: missed pil rule for Traditional POPS
If less than 3 hours late
no action required, continue as normal
If more than 3 hours late (i.e. more than 27 hours since the last pill was taken)
action needed - see below
Missed POP- Cerazette desogestrel rules if late
If less than 12 hours late
no action required, continue as normal
If more than 12 hours late (i.e. more than 36 hours since the last pill was taken)
action needed - see below
COCP potentials harms and benefits
the COC is > 99% effective if taken correctly
small risk of blood clots
very small risk of heart attacks and strokes
increased risk of breast cancer and cervical cancer
