Contraception and Abortion Flashcards
What is a LARC?
Long Acting Reversible Contraception
Requires administration less than once per month
What are examples of LARC?
Implant:
- progesterone only implant
IU:
- Cu IUD
- LNG-IUS
Injection
Without contraception, what percentage of couples will conceive in a year?
85%
What criteria are used for suitability to contraception?
MEC criteria
Medical Eligibility Criteria
What are the MEC categories?
1 - no contraindication
2- benefit outweigh risk
3 - risk outweigh benefit
4 - ABSOLUTE CONTRAINDICATIPN
What are side effects to hormonal contraceptive methods?
Unexpected bleeding Weight gain Headache Mood swing Loss of libido
What should you do if a woman has headaches in pill free week on COCP?
Tell her to run the packs together
What should you do if COCP causes migraines?
STOP AND CHANGE
What are formulations of combined hormonal contraception?
Pill
Transdermal patch
Vaginal ring
How do combined hormonal contraceptive methods work?
Inhibit ovulation via negative feedback of oestrogen and progestogen on the pituitary, causing suppression of LH, FSH
What is the main form of oestrogen contained?
ethinyl estradiol
What are most pill preparations like?
21 pills followed by 7 days pill free interval OR 7 placebo tablets
preparations are monophonic (same dose of hormone)
How does the patch / ring work?
Patch:; change every week for 3 weeks (21 days), then break for 7
Ring: keep for 21 days, then break for 7
What do you do if you missed ONE Pill?
Take it as soon as you remember
Continue remaining pills at usual time
What do you go if you missed TWO or MORE pills in 48h?
Take most recent one as soon as you remember, continue with the rest
If pills missed were in first week, you need EC
If pills were in last week, omit pill free interval and start the new pack right away
When should additional precaution be taken with the patch?
If patch was NOT APPLIED for 48h
When should additional precautions be taken with the ring?
If ring was NOT INSERTED for 3h
What is the cancer risk like for COCP user?
INCREASED breast cancer (for 10 years after stopping, then normal)
REDUCED colorectal, endometrial, ovarian cancer
What are two absolute contraindications for CHC?
> 35 years AND smoker
Migraine with aura
How does the progesterone only contraceptive methods work?
Desorgestrel: Inhibit ovulation
All others: thicken cervical mucous
How does the LNG-IUS work?
It causes endometrial atrophy (prevents endometrial proliferation and implantation)
How often does the POP need to be taken?
Every day, no breaks
What are side effects of the POP?
Irregular bleeding
Acne
What must you do if you forget to take the POP?
Emergency contraception
Use protection
What is the progesterone implant called?
Nexplanon
How long does Nexplanon last?
3 yearsq
Where is nexplanon inserted?
8cm above the medial epicondyle in the non dominant arm
SUBCUTANEOUS
What is the progesterone only injectable called?
IM depoprovera
SC Sayana press
What is the injection interval for progesterone only injectable
12-14 weeks
What occurs if you want to have a baby right after the injectable?
DELAY in FERTILITY of up to 1 year after discontinuation
What are SE of the progesterone only injectable?
Weight gain
Osteoporosis
What is the LNG-IUS called?
Mirena
How long does mirena last?
5 years
What are side effects of mirena?
acne
breast tenderness
mood disturbance
headache
What is a unique benefit of Cu IUD?
Can be used as CONTRACEPTION if within 5 days from UPS
What is the bleeding pattern with LNG-IUS?
lighter, less painful
What is the bleeding pattern with Cu-IUD?
heavier, painful
What medication can you give to help reduce blood loss in Cu-IUD?
Tranexamic acid
When must you remove an IUD if a woman is pregnant?
BEFORE 12 week gestation
What are potential risks of IUD?
Perforation
Expulsion
infection
What types of female sterilisation are available?
Laparoscopic sterilisation - occlude the Fallopian tubes using Filshie clips
Hysteroscopic sterilisation - expanding springs inserted in the tubal ostia via hysteroscope, infusing fibrosis
What are the types of oral Emergency Contraception?
Levonorgestrel 1.5mg
Ulipristal 30mg
How long after UPS is levonorgestrel used for?
72h
How long after UPS is ulipristal used for?
5 days (120 h)
WHAT IS THE effectiveness of oral EC methods?
2/3
Cu IUD is WAY MORE EFFECTIVEq
What are the two medications given for a medical abortion?
Mifepristone (progesterone receptor modulator)
FOLLOWED BY
Misoprostol (prostaglandin analogue)
How do mifepristone and misoprostol work?
Mifepristone increases uterine contractility and sensitises uterus to prostaglandins
Misoprostol causes the expulsion
When is the effect of mifepristone maximal, so when should misoprostol be administered?
Mifepristone is max at 48 h
So give misoprostol at 24-48 h
How does medical abortion change based on gestation?
<9 weeks: give medications at home with oral analgesia
will bleed for about 2 weeks
9-21 weeks: same drugs, but give misoprostol every 3 hours until expulsion occurs. Should be done in clinical setting as increased discomfort, bleeding, passage of larger foetus.
How long is the average abortion time for medical abortion in second trimester?
7hours
How do you abort a foetus medically after 21 weeks?
Intracardiac injection of potassium chloride
What are methods of surgical abortion based on gestation period?
Vacuum aspiration < 14 weeks
Dilatation and evacuation > 14 weeks
How does vacuum aspiration occur?
Consider pre-treatment misoprostol in nulliparous /adolescent / previous cervical cancer or past 12 week gestation
This will dilate the cervix
Then gently dilate the cervix with gradual dilators
Evacuate the cavity with gentle suction
How long does vacuum aspiration take’
less than 10 mins
Whart medication should you give after vacuum aspiration
Prophylactic antibiotics - reduce risk of postabortal infection
How does dilatation and evacuation work?
Use osmotic dilators, misoprostol and mifepristone
Remove contents of uterus with aspiration and extraction of foetal tissues
Perform ultrasound to confirm evacuation
What are complications of abortion
failure to end pregnancy
Incomplete abortion requiring evacuation
Haemorrhage
Infection
How soon after abortion should you start postabortal contraception?
IMMEDIATELY
Why does the. COCP cause a withdrawal bleed?
Oestrogen and progestogen cause a slight thickening of the endometrium
During the pill free week, the lack of progestogen causes the breakdown of th endometrium
What are thee types of LNG-IUS
Mirena -52 mg progestogen
Jaydess - 13.5mg
Kyleena - 19mg
How long do the three LNG IUS last for
Mirena: 5 years
Jaydess: 3 years
Kyleena: 5 years
What is the benefit of Mirena over the other two?
High dose of progestogen
Good for PCOS, endometriosis, STIs
How long can a Copper IUD last for?
5 years (if copper only on stem - usual one) 10 yrs (if copper also on arms )
How does the Copper IUD work?
Copper causes aseptic inflammation of the endometrium, so implantation cannot occur
Inflammation however also means that blood vessels in the uterus become hyperaemic > increased bleeding
What are the risks of perforation. of an IUD?
1:1000
What are the kinds of infection that can be caused by an IUD?
Ascending infection
So if the patient has an STI in the Lower genital tract, insertion of the IUD will push it up into the upper genital tract
What is advice you should give for emergency contraception=?
If vomiting/diahrroea within 2 hours, you need to take another one
Period could be delayed/anticipated by a week
If next menstrual period is delayed by >2 weeks take a pregnancy test
What is the prandf name for levonorgestrel 1.5 emergency contraception?
Levonelle
What is the brand name for Ulipristal 30mg emergency contraception?
EllaOne
What are MEC3 criteria for the COCP
>35 yo and smoker (<15xday) migraine, no aura FH DVT/PE <45 Controlled HTN Immobility e.g. wheelchair
What are MEC4 criteria for COCP
>35yo and smoker (>15xday) migraine with aura PMH DVT/PE <45 PMH stroke /IHD Uncontrolled HTN Breast cancer Breast feeding & <6 weeks PP recent major surgery with prolonged immobilisation
