Contraception + HRT Flashcards
Menopausal woman - how long should contraception be continued from the last period - if > 50 years old
12 months after the last period
Menopausal woman - how long should contraception be continued from the last period - if < 50 years old
24 months after the last period
Traditional POP (Micronor, Noriday) - forgot to take pill, <3hr late
Take pill now, no further action
Traditional POP (Micronor, Noriday) - forgot to take pill, >3hr late
Take (one) missed pill now
Take next pill at usual time
Extra protection for 48hr
Progesterone injectable contraceptive - what factor is a UKMEC 4 contraindication?
Current breast cancer
Progesterone injectable contraceptive - what factor is a UKMEC 3 contraindication?
Past breast cancer
Levornogestrel emergency contraception dose
1.5mg
3mg if >70kg or BMI >26
Progestogen implantable contraceptive (Nexplanon) - UKMEC3 contraindication to starting
IHD/stroke Unexplained PV bleeding Past breast cancer Liver cancer Severe liver cirrhosis
Progestogen implantable contraceptive (Nexplanon) - UKMEC4 contraindication
Current breast cancer
COCP reduces risk of which cancers
Bowel
Endometrial
Ovarian
COCP increases risk of which cancers
Breast
Cervical
COCP
>35y + smokes >15/day
UKMEC 4
COCP
>35y + smokes <15/day
UKMEC 3
COCP
BMI >35
UKMEC 3
COCP
Controlled hypertension
UKMEC 3
COCP
Thromboembolic disease in 1st degree relative <45y
UKMEC 3
EllaOne (ulipristal acetate) dose
30mg
EllaOne (ulipristal acetate) mechanism of action
Inhibition of ovulation
EllaOne (ulipristal acetate) can be used up to
120 hours after UPSI
Oestrogen-containing contraceptives and major surgery
Stop 4 weeks before
Restart once mobilising
Levornogestrel emergency contraception must be taken within
Within 72 hours of UPSI
Current breast cancer is UKMEC 4 contraindication for
All hormonal contraceptives
Medications which may reduced efficacy of implantable contraceptive (Nexplanonon = etonorgestrel)
Enzyme inducers (rifampicin, carbemazepine)
Extra precautions - If Levornogestrel-IUS (Mirena) is inserted on day 1-7 of cycle
No additional contraception required
Extra precautions - If Levornogestrel-IUS (Mirena) is inserted outside day 1-7 of cycle
7 days additional contraception
Quickstarting contraception after EllaOne (ulipristal acetate)
Start 5 days after EllaOne
Emergency contraception option contraindicated in patient with severe asthma
Ulipristal acete (EllaOne)
Breastfeeding and levornogestrel EC
No restrictions
Breastfeeding and ulipristal EC
Breastfeeding should be delayed for 1 week after taking
Copper IUD may be used as EC up to
5 days after UPSI
or
5 days after likely ovulation date
COCP and missed 2 pills
Missed in week 1 (days 1-7)
Use condoms for 7 days
Consider EC
COCP and missed 2 pills
Missed in week 2 (days 8-14)
Use condoms for 7 days
No need for EC
COCP and missed 2 pills
Missed in week 3 (days 15-21)
Use condoms for 7 days
Omit pill-free interval
Cerazette POP (desogestrel) Forgot to take pill <12hr late
Take pill now
No action needed
Cerazette POP (desogestrel) Forgot to take pill >12hr late
Take missed pill now
Take next pill at usual time
Condoms for 48hr
Mirena IUS as contraception - licensed for
5 years
Mirena IUS as endometrial protection in HRT - licensed for
4 years
Kyleena contains
19.5 mg levonorgestrel
Mirena contains
52 mg levonorgestrel
Jaydess contains
13.5 mg levonorgestrel
Jaydess IUS - licensed for
3 years
Premature menopause =
Definitve loss of ovarian function <40y
Premature ovarian insufficiency =
Transient/permanent loss of ovarian function <40y
Early menopause =
Cessation of ovarian function 40-45y
QS CHC (COCP/patch/ring) day 1-5 of cycle
No precautions required
QS CHC (COCP/patch/ring) on day 6 or later
Precautions for 7 days
QS POP day 1-5 of cycel
No precautions required
QS on day 6 onward
Precautions for 2 days
QS progestogen depot day 1-5 of cycle
No precautions required
QS progestogen depot day 6 onward
Precautions for 7 days
QS progestogen implant day 1-5 of cycle
No precautions required
QS progestogen implant day 6 onward
Precautions for 7 days
QS levornogestrel IUS day 1-7 of cycle
No precautions required
QS levornogestrel IUS day 8 onwards
Precautions for 7 days
QS copper IUD
No requirements at any point of cycle
LNG-EC - how long until you can quick-start HC?
Can QS immediately
will not effect LNG effectiveness
UPA-EC - how long until you can quick-start HC?
5 days (120hrs)
