contraception for women over 40 Flashcards
in 2008, what was the rate of TOP in women aged 40-44?
4/1000
what is the risk of Trisomy 21 in women aged 43?
1 in 40
what are the UKMEC score for COC, depot and NET in women aged over 40?
UKMEC=2
what are the most commonly used contraceptives in women >40?
sterilisation (her or partner)
pill
male condom
intrauterine methods
which type of contraception may help with peri-menopausal symptoms?
combined hormonal contraceptive (CHC). can tri-cycle.
what benefit does CHC confer for ovarian and endometrial cancer? how long do benefits last?
protective against ovarian, endometrial cancer. Protection continues for >15 years after stopping
how does combined hormonal contraception affect risk of BENIGN breast disease?
reduction in incidence of benign breast disease. reduced risk hospitalisation with fibroadenoma /chronic cystic disease
when does risk of breast cancer reduce back to baseline after stopping CHC?
small increase risk of breast ca with CHC.
reduces back to baseline 10yrs after stopping CHC
what is UKMEC score for CHC if woman has FHx breast ca?
what is the scaore if the woman was carrier of BRCA gene?
UKMEC=1.
no increased risk of breast Ca using CHC.
if BRCA gene carrier- UKMEC=3 for CHC use
what is the risk of cervical cancer when using CHC?
slight increase risk of Cx cancer with increased duration of CHC use. Risk returns to normal after 10 years of stopping
what is the UKMEC recommendation for CHC use if you are >35, smoking >15cigs/day
UKMEC=4. increased risk of cardia/cerebrovascular disesase
what is the UKMEC recommendation for CHC use if you are >35, smoking <15cigs/day
UK MEC= 3
what is the UKMEC recommendation for CHC use if you are >35, ex-smoker of 1 year?
UK MEC= 2
what are the increased risks of CHC if woman suffers with HTN?
increased risk of acute MI, stroke. Not VTE
what is the UKMEC score for CHC use in those suffering with HTN, even if well controlled?
UKMEC=3
if prescribing CHC in women over 40 with HTN, what monitoring should be undertaken?
check BP before and 6 mths after starting CHC.
starting dose of EE should be <30mcg
what are the health benefits of Progesterone only contraception in women over 40?
- may help with vasomotor Sx of menopause
2. may help with dysmenorrhoea (DSG pill/ implant/ depot inj)
what are the risks to bone health with DMPA (depot injection)?
What is the UKMEC score for DMPA in >45
small reduction in bone density. recovers after discontinuation.
UKMEC=2 for DMPA in >45
up tp what age can DMPA be given?
what assessment should be made before prescribing woman >45 DMPA injection
DMPA can be used in age up to 50.
assess for risk factors for osteoprorsis.
review every 2 years to assess benefits/risks
which progesterone contraception has adverse effects on lipid metabolism?
DMPA
what is the UKMEC score for progesterone only contraception for women who have had: stroke/ IHD/ risk factors for cardiovasc disease (smoking/ DM/ obesity/ HTN)
UKMEC= 3
don’t initiate or continue prog. contraception in women who have had stroke/ IHD.
POP/ mirena/ implant can be considered if woman has risk factors only
what percentage women still ovulate when using mirena?
75%
what advice should be given to women <50 using non-hormonal contraception who become amenorrhoeic?
what if she is >50?
if <50- stop contraception after 2 years of amenorrhoea.
if>50- stop contraception after 1 year of amenorrhoea
which contraceptives are not recommended after the age of 50?
CHC, DMPA.
Change to POP/ mirena/ implant until age 55 or menopause confirmed
can FSH be measured whilst still taking progesterone only contraception?
yes.
best to do after age 50 as morelikely to be menopausal
which blood test can be used to confirm menopause?
if amenorrhoeic, check FSH and stop contraception if FSH >30 on 2 occasions more than 6 weeks apart
if woman is using implant/ POP/ mirena over the age of 50, what advice should you give her if she is NOT amenorrhoeic?
continue until age 55.
if not amenorrheic at 55, consider Ix. Continue treatment until amenorrhoea for 1 year.
if mirena was inserted at age45 or above, how long can it stay in for?
up to 7 years / menopause. whichever comes first
if a woman under age 50 wants to stop her DMPA contraception, what advice would you give?
switch to non-hormonal contraception. This can be stopped AFTER 3 YEARS of amenorrhoea (usually 2 years with other hormonal contrceptions) due to potential delay in return to ovulation
if mirena is in situ can estogen only HRT be used?
how frequently should the mirena coil be changed?
yes. estrogen only can be used.
mirena should be changed every 5 years- only provides endometrial protection for 5 years
