Contraception general Flashcards
Contraception general:
Rhythm methods key points?
Predicted ovulation using
- temperature spike after ovulation
- thickening of mucous around ovulation (day 13, 14, 15)
- urine LH testing (surge results in ovulation)
Relies on a regular cycle and lots of detail
High failure rate
76 - 93% effective
Contraception general:
Lactation amenorrhoea key points?
98% effective IF
- ≤6 months post partum
- regular 3 -4 hourly breastfeeding/pumping during the day and 6 hours at night
- remain amenorrhoeic
the catch is that any return of ovulation will occur 2 weeks prior to first period so is unpredictable
Contraception general:
COCP key points?
prevent ovulation AND changes cervical mucous
Contraindicated:
- ≤6 weeks post partum for breastfeeding and VTE risk
- smoker ≥15/day and ≥35yo (even if cessation in last 12 months)
- BMI ≥ 35
- migraine with aura
- multiple CVD risk factors
- HTN
- vascular disease
- IHD/CVA
- VTE history of first degree relative with VTE ≤45yo
- prolonged immobilisation (including post surgical)
- thrombophilia
- arrhythmia
- breast cancer associated gene carrier
- breast cancer (past or present)
- decompensated liver cirrhosis
- any HCC
- positive antiphospholipid antibodies
7 days consecutive required for contraception
If missed for 2 days contraception lost
93 - 99.5% effective
Benefits:
- lighter and less painful periods
- bleeding timing control
- reduce the chance of uterine cancer, ovarian cancer, benign breast disease, endometriosis and ovarian cysts
- usually improves acne
Negatives:
- headaches (more than normal)
- an increase in appetite
- nausea
- sore breasts
- changes in mood
57% of first cycle post pill will be ovulatory -menses should return 2-4 weeks after stopping and become regular in up to 6 months
Vaginal ring the same as above but possibly with less systemic side effects
Contraception general:
POP key points?
prevent ovulation AND changes cervical mucous AND tubal motility
Contraindicated:
- breast cancer (past or present)
- IHD/CVA
3 days consecutive required for contraception
Must be taken at same time
If any delayed or missed pills contraception can be lost
93 - 99.5% effective
Benefits:
- less likely to have mood or hormone side effects
- 20% get no bleeding
Negatives:
- 40% get irregular bleeding
- headaches (more than normal)
- nausea
- sore breasts
Drospirenone:
4mg
24 days on 4 days off
24 hour missed pill window
99% effective contraception (93% in real world)
Rapid return to fertility
Anti-gonadtrophic
Anti-androgenic
Anti-mineralocorticoid (Theoretical hyperkalaemia - needs monitoring)
-reduced ovulation
-thickens mucous
-thins endometrium
-reduces headaches/migraine
-reduces dysmenorrhoea
-reduced pain post endometriosis pain
Approximately 45% ammenorrhoeic by 9 months
safe if breast feeding
no impact on bone density
MEC 4 if current breast cancer
impacted by liver enzyme inducing medication
Not indicated for endometrial protection in menopause
Adverse reactions
-No VTE risk
-mild acne 5%
-abnormal bleeding 3%
-headache 1.5%
-libido 1.4%
Bleeding:
-3% drop out in trials due to bleeding days
-days of bleeding reduced to 5.5 days from 8.8 days after 12months
Contraception general:
Progestogen depot key ponts?
Inhibits ovulation AND alters cervical mucous
Contraindicated:
- multiple CVD risk factors
- vascular disease
- IHD/CVA
- breast cancer (past or present)
- decompensated liver cirrhosis
- any HCC
3 monthly IM dosing
allow 7 days to become effective if not administered in first 5 days of menstrual cycle
Delay of up to 18months in fertility returning
96 - 99.8% effective
Benefits:
-continued use usually results in amenorrhoea
Negatives:
- if side effects occur they will last 3 months
- irregular bleeding (Heavy or continuous bleeding rarely occurs)
- increased appetite
- sore breasts
- headaches
- mood changes
