Contraception and abortion Flashcards
Which drugs contraindicate the pill
Anything that affects liver enzymes
Anticonvulsants, antibiotics
NB - efficacy of COCP isn’t affected by broad spectrum Abx
How does oral contraceptive work
Increased O+P increase neagtice feedback on pituitary so they stop LH and FSH
Three preparations of COCP
21 days on 7 off (withdrawal bleed)
24 on 4 off
monophasic - take constantly
If woman complains of headaches and dysmenorrhea in pill free period
tricycle
What to do if 1 COCP pill has been missed
If missed by 24 hours (up to 48) take it and the next and continue as normal even if you have to take 2 in 1 day
If you’ve missed any others in last week use emergency contraception
If 2 or more pills missed (more than 48 hours late) in a week
Take last pill and current pill (2 in 1 day) and continue
USE CONDOMS until pill has been taken correctly for 7 days
if in week 1: emergency contraception
if in week 2: no need for emergency contraception
if in week 3: finish pack and then start the new one without the pill free break
Effect of COCP on cancer incidence
decreased risk of colorectal, endometrial, ovarian
increased risk of breast and cervical
Absolute contraindications for COCP
< 6 weeks pospartum smoker >35 HTN (>160 SBP) current/past hx of VTE IHD Hx of cerebrovascular accident complicated valvular heart disease (pulmonary HTN etc.) migraine w/ aura breast cancer diabetes w/ nephro/neuro/retinopathy cirrhosis liver tumour
S/E of POP
Acne, irregular bleeding, persisten ovarian follicles (simple cysts)
what to do if POP missed
< 3 hours late: continue as normal
3+ hours late - take missed pill, continue and use extra protection for 48 hours. If you’ve missed 2 or more, take the last missed pill, the next and use extra precaution for 48 hours, if not use emergency contraception
Ectopic counselling for coil
risk of ectopic is lower than with no contraception but if you do get pregnant on contraception then your risk of ectopic is greater
How long after sex can Cu-IUD be inserted
5 days after sex ALSO 5 days after ovulation
What emergency contraceptives are available
Cu-iud - 5 days after sex (or if they present 5 days after sex IUD must be fitted up to 5 days after likely ovulation date)
Levonorgestrel - 3 days (inhibits ovulation) - if vom occurs within 2 hours of dose repeat
ulipristal - up to 5 days (progesterone receptor modulator - inhibits ovulation - don’t use with levonorgestrel) start using barrier contraception after 5 days.
Take caution w/ asthma
If weight >70kg or BMI >26
need different contraception
which pre-abortion investigations should be done
Gestational assessment (US and clinical) Rhesus status
What is given in a medical abortion
mifepristone for sensitisation (progesterone receptor modulator) maximum activity is after 48 hours so should aim for misoprostol then
misoprostol for expulsion (prostaglandin analogue)
Medical abortion at different stages
<9 weeks - mifepristone and misoprostol 24-48 hours later), can do this at home, advise that they’ll bleed for 2 weeks
Pregnancy test after 3 weeks
9-21 weeks - mifepristone then repeated doses of misoprostol every 3 hours til expulsion. Do in hospital because of pain and blood
>21 weeks - give feticide (amniotic digoxin or intracardial KCl)
Surgical TOP
<14 weeks - vacuum TOP
give misoprostol if nulliparous, adolescent or previous surgery
> 14 weeks
dilation and evacuation
DILATE TO >20mm
Dilate using misoprostol 3 hours prior to surgery
USS to confirm termination
Advice after emergency contraception
STI screen
take pregnancy test if next period is late
Long vs short acting contraception
Long: IUD, implant, injectable
Short: pill (COCP, POP), patch, ring
Advice for MIRENA
Need to use other form of contraception for first 7 days unless you insert it at the start of the cycle
Advice for implant
works for 3 years
Progesterone s/e
additional contraception if not inserted in day 1-5 of cycle
antiepileptics and rifampicin can reduce effectiveness
fertility returns after you remove it
Advice for injection
12-14 weeks
additional contraception for a week if not inserted in day 1-5 of cycle
s/e can cause weight gain and reduced bone density
Fertility takes 6-12 months to return after last injection
What hormones are in COCP
ethinyl oestradiol + progestin
Pros and cons of COCP
Pros:
effective
reversible
makes periods lighter, less painful and more regular
reduced risk of ovarian, endometrial and bowel Ca
Cons:
no protection against STI
increasedrisk of VTE, cervical, breast ca, stroke, IHD
s/e
headache, nausea, breast tenderness
How does POP work
thickens cervical mucous (and desorgestrel stops ovulation)
How to take POP
1 pill every day with no pill free week
if started in first 5 days of cycle don’t need any other contraception, if not you need other contraception for 2 days
Pros and cons of POP
pros doesn't have risk of oestrogen pills cons take everyday irregular bleeding osteoporosis (no oestrogen) ovarian cysts
How does combined hormonal transdermal patch work
Apply for 3 weeks and have week off
What to do for missed patch
Delayed change <48 hours: change immediately w/ no further protection
delayed change >48 hours in week 1 or 2: immediate change and use barrier contraception for 7 days
delayed removal >48 hours in week 3: remove and start next patch at normal time
delayed at end of patch free week: apply and use barrier contraception for 7 days
How does combined hormonal ring work
wear for 21 days, 7 days off
