Contraception and HRT Flashcards
Combined/oestrogen containing contraception increases a person’s risk of which 2 cancers?
- breast
2. cervical
Combined/oestrogen containing contraception reduces a person’s risk of which 2 cancers? Why?
- endometrial
- ovarian
reduces endometrial thickness and prevents ovulation so less proliferation of these tissues (hence fewer proliferation cycles for something go wrong)
How often is the contraceptive patch changed?
At the end of every week for 3 weeks. Not worn on week 4
Name 3 circumstances associated with the contraceptive patch in which will require additional contraception
- delay in changing of >48 hours in week 1
- delay in changing of >48 hours in week 2
- delay in changing if >24 hours in week 4
What is needed if COCP are missed at the following times:
- 1 pill missed at any point
- > 2 pills missed in week 1 or 2
- > 2 pills missed in week 3
- Take missed pill. No extra precautions
- take last missed pill. extra/emergency contraception
- omit pill free week
Name the situations that fall under UKMEC 3 (7)
- > 35, smoking <15 cigs per day
- BMI >35
- VTE in a first degree relative under 45
- controlled HTN
- immobility
- carrier of breast cancer mutations
- current gall bladder disease
Name the situations that fall under UKMEC4 (8)
- > 35, smoking >15 cigs per day
- hx of migraine with aura
- hx of VTE/known thrombogenic mutation
- hx of stroke/IHD
- breast feeding >6 weeks post partum
- uncontrolled HTN
- current breast CA
- major surgery with prolonged immobilation (stop 4-6 weeks before)
How does the progesterone only pill work?
thickens cervical mucous
also inhibits ovulation
What is a common side effect of the contraceptive implant?
irregular heavy bleeding
Name some side effects associated with progestogen containing contraception
headaches
nausea
breast pain
mood changes
Why is depo provera contraindicated in young people?
risk of osteoporosis
Which is the most effective form of contraception?
implant
which form of contraception is also indicated for menorrhagia?
progestogen IUS
Which form of contraception has been shown to cause weight gain?
depo provera
Within what time period following UPSI can the following be used as emergency contraception:
- Copper IUD
- Levonorgestrel
- Ulipristal (EllaOne)
- 5 days
- 72 hours
- 5 days
What other forms of contraception does EllaOne reduce the efficacy of?
Progesterone containing
- all combined methods
- POP
- Depo injection
- Implant
You are counselling a patient for emergency contraception. A hx of which chronic condition would be a contraindication for Ulipristal (EllaOne)
Severe asthma
Name 2 indications of HRT
- troublesome vasomotor symptoms in perimenopausal and post-menopausal women
- premature or early menopause - continue therapy until age of 51
Name 6 benefits of HRT
- reduction in vasomotor symptoms
- improvement in QoL
- improvement in mood
- Improvement in urogenital symptoms
- reduced osteoporosis risk
- reduced cardiovascular risk
Name 4 risks associated with HRT
- thromboembolic disease
- stroke
- breast and endometrial CA
- gallbladder disease
Name 10 contraindications to HRT
- hx of breast CA
- known or suspected oestrogen dependent CA
- undiagnosed abnormal vaginal bleeding
- untreated endometrial hyperplasia
- previous idiopathic or current VTE and not anticoagulated
- active or recent arterial thromboembolic disease (e.g. angina, ACS)
- active liver disease
- pregnancy
- thombophillic disorder
- age >60
In which women should serum FSH be performed before starting HRT? (5)
- women not taking COCP/HRT
- aged >45 but with atypical symptoms of menopause
- aged between 40 and 45 with menopausal symptoms
- <40 with ?premature ovarian insufficiency
- > 50 using progesterone only contraception
- Describe the two COMBINED CYCLICAL REGIMENS of HRT
2. which women are these regimens used for?
- monthly - daily oestrogen. progestogen given for last 10-14 days
three monthly - daily oestrogen. progestogen given for 14 days every 13 weeks - perimenopausal women, still having periods.
- Describe the CONTINUOUS COMBINED regimen of HRT
2. which women are these regimens used for?
- daily oestrogen and progestogen
2. post menopausal women (no periods) with intact uterus
