Contraception and STIs Flashcards
IUD mechanism? time until effective? Advantages? Disadv?
MECHANISM
Primary mode of action is prevention of fertilisation by causing decreased sperm motility and survival. Also foreign body reaction in the endometrium prevents implantation.
TIME UNTIL EFFECTIVE Immediate
ADVANTAGES Immediate effect, can be used for emergency and long term contraception, not affected by medication
DISADVANTAGES/RISKS
Ectopic pregnancy, HMB, avoid in women with structural disease
IUD complications?
Irregular PV bleeding, especially first 3–6mths.
• Risk of infection: screen for Chlamydia prior to insertion.
• IUCD expulsion: most common in the first 3mths after insertion.
• Perforation: poor insertion technique or <4wks post-partum.
• Dysmenorrhoea.
Timing of insertion normally, post-partum, following TOP of IUD
I nsert any time during cycle (as long as pregnancy excluded).
• Post-partum: safe to insert IUCD from 4wks after delivery.
• Following TOP: insert within first 48h after termination.
CIs of IUD?
P regnancy.
• U ndiagnosed genital tract bleeding.
• A ctive genital tract infection or PID.
• U terine anomalies or fi broids distorting cavity.
• C opper allergy.
How to use IUD as emergency contraception?
must be inserted within 5 days of UPSI, or
if a women presents after more than 5 days then an IUD may be fitted up to 5 days after the likely ovulation date
may be left in-situ to provide long-term contraception. If the client wishes for the IUD to be removed it should be at least kept in until the next period
Emergency hormonal contraception choices? Timing? SEs?
Levonorgestrel: Must be taken within 72hrs of UPSI
single dose of levonorgestrel 1.5mg (a progesterone)
the dose should be doubled for those with a BMI >26 or weight over 70kg
SEs: Disturbances of current menstrual cycle, vomiting (if occurs within 3hrs then dose should be repeated)
can be used more than once in a menstrual cycle if clinically indicated
Ullipristal = a selective progesterone receptor modulator
Use no later than 120hrs after intercourse
- may reduce the effectiveness of hormonal contraception. Contraception with the pill, patch or ring should be started, or restarted, 5 days after having ulipristal. Barrier methods should be used during this period
- Caution using ullipristal in patients with severe asthma
breastfeeding should be delayed for one week after taking ulipristal. There are no such restrictions on the use of levonorgestrel
Mechanism, time until effective, adv, disadv of mirena coil?
MECHANISM levonorgestrel prevents endometrial proliferation and causes cervical mucous thickening
TIME UNTIL EFFECTIVE
7 days
ADVANTAGES
Stays in for 5 years, treats menorrhagia, can be used for HRT in post-menopausal women
DISADVANTAGES/RISKS Initially – frequent uterine bleeding and spotting (first 3-4mnths)
Hormonal symptoms: nausea, headache, breast tenderness, bloating
uterine perforation
PID
expulsion
increased risk of ectopic
How many years can IUS be left in for?
the most common IUS (i.e. Mirena® - levonorgestrel 20 mcg/24 hrs) is effective for 5 years
if used as endometrial protection for women taking oestrogen-only hormone replacement therapy they are only licensed for 4 years
Ix for lost threads? Causes? Check?
- Exclude pregnancy
- USS
- If ultrasonography cannot locate the device, and pregnancy has been excluded, arrange for an abdominal and pelvic X-ray. – If cannot find on X-ray – its been expelled
- if it is in abdomen - confirms perforation - arraneg elective laparoscopic removal - offer reinsertion min 4wks after perforation
Causes:
- Device has moved superiorly into the uterus
- Pregnancy
- Perforation
- Expulsion
After insertion – thread check at 3-4wks
POP mechanism, time until effective, Adv, Disadv?
MECHANISM Prevents ovulation, thickens cervical mucus, thins endometrium (prevents implantation)
TIME UNTIL EFFECTIVE
if commenced up to and including day 5 of the cycle it provides immediate protection. If started any other time – use additional contraception for 48hrs after starting pill.
ADVANTAGES
No oestrogen
Can give trial of POP before infection/depot to see how well SEs are tolerated
very effective when taken correctly and is more effective than barrier methods of contraception
DISADVANTAGES/RISKS Irregular menstrual bleeding, other systemic progesterone SEs
Systemic progesterone SEs?
Irregular bleeding
Mood swings, low mood, headaches, poor sleep, fatigue
Acne, oily skin
Tender swollen breasts
Food cravings, abdo bloating, Constipation, diarrhoea
Menstrual cramps, decreased libido
When should POP be used over COCP?
where COCP is CI - D uring lactation—has no effect on quality or quantity of milk.
• Sickle cell disease.
• SLE and other autoimmune diseases.
POP CIs?
P regnancy. • U ndiagnosed genital tract bleeding. • S evere arterial disease. • A ctive hepatic disease. • H istory of recurrent follicular cysts.
How to switch from COCP to POP?
if switching from a combined oral contraceptive (COC) gives immediate protection if continued directly from the end of a pill packet (i.e. Day 21)
Missed POP?
Traditional POP (Micronor, Noriday, Nogeston, Femulen) 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
Cerazette (desogestrel):
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)
- take the missed pill as soon as possible. If more than one pill has been missed just take one pill. Take the next pill at the usual time, which may mean taking two pills in one day
continue with rest of pack
extra precautions (e.g. condoms) should be used until pill taking has been re-established for 48 hours
