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Women's Health > Contraception > Flashcards

Contraception Flashcards

1
Q

How should the combined contraceptive patch be used?

A
  • for 3 weeks, patch worn every day and changed each week

- no patch 4th week (withdrawal bleed)

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2
Q

What to do if the patch change is delayed at the end of week 1 or 2?

A
  • less than 48 hours: change immediately with no further precautions
  • more than 48 hours: change immediately and barrier contraception for next 7 days, emergency contraception if sex last 5 days
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3
Q

What to do if the patch removal is delayed at the end of week 3?

A
  • remove asap and apply new patch on usual cycle start day
  • even if withdrawal bleed happening
  • no additional contraception
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4
Q

What to do if patch application is delayed at end of patch free week?

A

additional barrier contraception for 7 days following any delay at start of new patch cycle

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5
Q

Advantages of using a COCP:

A
  • highly effective
  • effects reversible upon stopping
  • lighter, less painful periods
  • reduced risk ovarian and endometrial cancer (lasts decades after cessation)
  • protects against PID
  • reduces ovarian cysts, benign breast disease, acne vulgaris
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6
Q

Disadvantages of using a COCP:

A
  • forgetting
  • no protection against STIs
  • increased risk VTE
  • increased risk of breast and cervical cancer
  • increased risk stroke and ischaemic heart disease
  • side effects: headache, nausea, breast tenderness
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7
Q

What are the UKMEC 3 conditions which mean that disadvantages outweigh the advantages when using the COCP?

A

->35yo and smoking <15 cigarettes/day
-BMI >35
-FHx thromboembolic disease in first degree relatives <45yo
-controlled hypertension
-immobility e.g. wheel chair use
-carrier of known gene mutations associated with breast cancer e.g. BRCA1/2
-current gallbladder disease
(diabetes)

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8
Q

UKMEC 4 conditions which represent unacceptable health risk when taking the COCP:

A

->35yo and smoking >15 cigarettes/day
-migraine with aura
-Hx thromboembolic disease or thrombogenic mutation
-Hx stroke or ischaemic heart disease
-breast feeding <6 weeks post partum
-uncontrolled HTN
-current breast cancer
-major surgery with prolonged immobilisation
(diabetes)

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9
Q

How effective is the COCP if taken correctly?

A

> 99%

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10
Q

Is intercourse during the pill free period safe?

A

only if next pack is started on time

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11
Q

When might the efficacy of the pill be reduced?

A
  • vomiting within 2 hours of taking pill
  • medication that induces diarrhoea or vomiting e.g. orlistat
  • liver enzyme inducing drugs
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12
Q

What should be done if 1 pill is missed at any time in the cycle?

A
  • take last pill

- no additional contraceptive protection needed

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13
Q

What should be done if 2 or more pills are missed in week 1?

A

emergency contraception considered if unprotected sex in pill free interval or week 1

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14
Q

What should be done if 2 or more pills are missed in week 2?

A

after 7 consecutive days of taking COCP there is no need for emergency contraception

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15
Q

What should be done if 2 or more pills are missed in week 3?

A
  • finish pills in current pack
  • start new pack next day
  • omit pill free interval
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16
Q

Why might COCP be used for contraception in women >40yo?

A
  • perimenopausal period may help bone mineral density
  • reduce menopausal symptoms
  • <30micrograms ethinylestradiol may be more suitable for women >40yo
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17
Q

Warnings for women >40yo taking depo-provera:

A
  • may be delay in fertility up to 1 year

- associated with small loss in bone mineral density which is recovered after discontinuation

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18
Q

When should non-hormonal contraception be stopped in women?

A
  • <50yo: after 2 years of amenorrhoea

- >-50yo: after 1 year of amenorrhoea

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19
Q

How should the COCP be stopped in older women?

A
  • can be continued to 50 years

- switch to non-hormonal or progestogen only method

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20
Q

How should depo-provera be stopped in older women?

A
  • continue to 50 yo

- switch to non-hormonal method and stop after 2 years of amenorrhoea OR switch to progestogen only method

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21
Q

How should the implant/POP/IUS be stopped in older women?

A
  • continue beyond 50yo

- if amenorrhoeic, check FSH and stop after 1 year if >=30u/L or stop at 55yo

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22
Q

Which contraception method can be used alongside HRT?

A

POP as long as HRT has progestogen component

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23
Q

What is the MOA of the COCP?

A

inhibits ovulation

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24
Q

What is the MOA of the POP and a common side effect?

A
  • thickens cervical mucus

- irregular bleeding

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25
Q

What is the MOA of the injectable contraceptive (medroxyprogesterone acetate) and how long does it last?

A
  • primary: inhibit ovulation
  • thickens cervical mucus
  • lasts 12 weeks
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26
Q

What is the MOA of the implantable contraceptive (etronogestrel), common side effect and how long does it last?

A
  • inhibits ovulation
  • thickens cervical mucus
  • irregular bleeding common
  • lasts 3 years
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27
Q

What is the MOA of the intrauterine contraceptive device?

A

decreases sperm motility and survival

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28
Q

What is the MOA of the intrauterine system (levonorgestrel) and a common side effect?

A
  • primary: prevents endometrial proliferation
  • thickens cervical mucus
  • irregular bleeding
29
Q

MOA of desogestrel only pill:

A
  • inhibits ovulation

- thickens cervical mucus

30
Q

MOA emergency levonorgestrel:

A

inhibits ovulation

31
Q

MOA emergency ulipristal:

A

inhibits ovulation

32
Q

MOA emergency IUD:

A
  • toxic to sperm and ovum

- inhibits implantation

33
Q

What contraceptives are not recommended in patients undergoing testosterone therapy?

A
  • anything containing oestrogen as it antagonises testosterone therapy
  • use progesterone only contraceptives
34
Q

What is the LARC of choice in young people?

A
  • progesterone only implant (Nexplanon)

- concerns about effect of progesterone only injections (depo-provera) on bone mineral density in women under 20yo

35
Q

How does levonorgestrel work as an emergency hormonal contraceptive?

A
  • stops ovulation and inhibits implantation
  • efficacy decreases with time
  • take within 72 hours
  • single dose 1.5mg (double dose BMI >26)
  • 84% effective
  • if vomiting within 3 hours, repeat dose
  • can be used more than once in cycle
  • hormonal contraception can be started immediately
36
Q

How does ulipristal work as an emergency contraceptive?

A
  • selective progesterone receptor modulator (Ellaone)
  • inhibits ovulation
  • 30mg dose no later than 120 hours after
  • may reduce effectiveness of hormonal contraception
  • caution if severe asthma
  • can be used more than once in cycle
  • delay breastfeeding one week after taking ulipristal
37
Q

How does the IUD work as an emergency contraceptive?

A
  • within 5 days
  • can be fitted up to 5 days after likely ovulation date
  • may inhibit fertilisation or implantation
  • 99% effective regardless of when in cycle
  • may be left in situ long term
  • keep at least until next period
38
Q

What are the major clinical indicators of fertility?

A
  • changes in cervical mucus
  • changes in cervix
  • changes in basal body temperature
39
Q

Contraception for women taking phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine:

A
  • UKMEC 3: COCP and POP
  • UKMEC 2: implant
  • UKMEC1 : depo-provera, IUD, IUS
40
Q

Contraception for women taking lamotrigine:

A
  • UKMEC 3: COCP

- UKMEC 1: POP, implant, depo-provera, IUD, iUS

41
Q

Where are implantable contraceptives placed?

A
  • subdermal

- proximal non-dominant arm

42
Q

What do implantable contraceptives do?

A
  • slowly release progestogen hormone etonogestrel
  • prevents ovulation
  • thickens cervical mucus
43
Q

How effective is the implant and how long does it last?

A
  • most effective form of contraception

- 3 years

44
Q

Disadvantages of the implant:

A
  • need professional to insert and remove

- additional methods needed for first 7 days if not inserted on day 1-5 of cycle

45
Q

ADR of implant:

A
  • irregular/heavy bleeding

- progestogen effects: headache, nausea, breast pain

46
Q

What interacts with the implant?

A
  • enzyme inducing drugs e.g. antiepileptics and rifampicin
  • switch to method unaffected by enzyme inducing drugs or use additional contraception until 28 days after stopping treatment
47
Q

Contraindications implant:

A
  • UKMEC3: ischaemic heart disease/stroke, unexplained suspicious vaginal bleeding, past breast cancer, severe liver cirrhosis, liver cancer
  • UKMEC4: current breast cancer
48
Q

What does the injectable contraceptive consist of?

A
  • depo provera
  • medroxyprogesterone acetate 150mg
  • IM injection every 12 weeks
  • can be given up to 14 weeks after last dose without further precautions
49
Q

Disadvantages of injectable contraceptives:

A
  • cannot be reversed once given

- potential delay in return to fertility (up to 12 months)

50
Q

ADR injectable contraceptives:

A
  • irregular bleeding
  • weight gain
  • increased risk osteoporosis: only use in adolescents if no other methods
  • not quickly reversible
51
Q

Contraindications injectable contraceptives:

A

breast cancer

52
Q

What are the intrauterine contraceptive devices:

A
  • IUD - copper

- levonorgestrel releasing system - IUS, mirena

53
Q

Effectiveness intrauterine contraceptive devices:

A

both IUD and IUS more than 99% effective

54
Q

MOA intrauterine contraceptive devices:

A
  • IUD: prevent fertilisation by causing decreased sperm motility and survival
  • IUS: levonorgestrel prevents endometrial proliferation and causes cervical mucus thickening
55
Q

How quickly can you rely on IUD and how long are they effective?

A
  • rely on immediately
  • copper on stem only effective for 5 years
  • some have copper on arms and may be effective up to 10 years
56
Q

How quickly can you rely on IUS and how long are they effective?

A
  • rely on after 7 days
  • most common IUS effective for 5 years
  • used as endometrial protection for women taking oestrogen only hormone replacement therapy
57
Q

How quickly can you rely on IUS and how long are they effective?

A
  • rely on after 7 days
  • most common IUS effective for 5 years
  • used as endometrial protection for women taking oestrogen only hormone replacement therapy (4 years)
58
Q

Problems with intrauterine contraceptives:

A
  • IUD: longer, heavier, more painful periods
  • IUS: infrequent uterine bleeding and spotting
  • uterine perforation 2 in 1000 (higher in breastfeeding)
  • increased ectopic but absolute number reduced
  • infection
  • expulsion 1 in 20 (most likely within first 3 months)
59
Q

New IUS systems:

A
  • Jaydess: 3 years, smaller, narrow tube, less levonorgestrel
  • Kyleena: smaller, 5 years, lower levels levonorgestrel, lower rate amenorrhoea
60
Q

How can the POP be used for post partum contraception?

A
  • can be started any time postpartum
  • after day 21, additional contraception should be used for the first 2 days
  • small amount of progestogen enters breast milk but not harmful to infant
61
Q

How soon after birth do women require contraception?

A

day 21

62
Q

How can the COCP be used as contraception post partum?

A
  • absolutely contraindicated if breast feeding <6 weeks post partum
  • UKMEC 2 if breast feeding 6 weeks - 6 months post partum
  • may reduce milk production
  • may be started from day 21
  • after day 21 additional contraception should be used for first 7 days
63
Q

How soon after childbirth can the IUD or IUS be inserted?

A

within 48 hours or after 4 weeks

64
Q

What is the lactational amenorrhoea method?

A
  • 98% effective in fully breast feeding women

- amenorrhoeic and <6 months post partum

65
Q

What is the risk of an inter pregnancy interval of less than 12 months?

A

increased risk preterm birth, low birthweight and small for gestational age babies

66
Q

Starting the POP:

A
  • if started up to and including day 5, immediate protection, otherwise additional contraceptive methods for 2 days
  • if switching from COCP, immediate protection
  • no pill break
67
Q

What to do if you miss a traditional POP:

A
  • if <3 hours late: continue as normal
  • if >3 hours late: take asap, continue with rest of pack, extra precautions until pill has been reestablished for 48 hours
68
Q

Problems with POP other than irregular bleeding:

A
  • diarrhoea and vomiting
  • antibiotics have no effect on POP unless it alters P450 enzyme system e.g. rifampicin
  • liver enzyme inducers may reduce effectiveness
69
Q

What to do if you miss a cerazette pill (desogestrel):

A
  • less than 12 hours: no action required

- more than 12 hours: extra precautions until reestablished for 48 hours

Women's Health (5 decks)

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