Contraception + infertility Flashcards
What are the methods of contraception (9)?
- Natural family planning
- Condoms/ other barrier
- COCP
- Progestogen only pills (POP)
- Coils
- Progestogen injection
- Progestogen implant
- Surgical sterilisation
- Emergency contraception pill
What guidelines outline the risks of using different contraceptions?
UK medical eligibility criteria (UKMEC)
What are the 4 levels of UKMEC?
- 1 = no risk
- 2 = benefits outweigh the risks
- 3 = risks outweigh benefits
- 4 = unacceptable risk, contraindicated
What should you be aware of when prescribing contraception for older women (5)?
- Women < 50 + last period = contraception for 2 years
- Women > 50 +last period = contraception for 1 year
- HRT is not contraception (need another method)
- COCP can’t be used after 50
- Progesterone injection can’t be used after 50 (due to osteoporosis risk)
When are pregnant women considered fertile after birth?
21 days after
Can women get pregnant when breastfeeding?
Lactational amenorrhoea (breastfeeding and no periods) is 98% effective as contraception
What are some important things to note when giving contraception to women who have given birth (3)?
- Progesterone only pill/ implant can be started at any time
- COCP when breastfeeding is UKMEC 4 (contraindicated) if <6 weeks and UKMEC 2 if >6 weeks
- IUD/ IUS must be inserted within 48 hours or after 4 weeks
What contraception should be avoided in breast cancer?
Any hormonal contraception
What contraception should be avoided in cervical or endometrial cancer?
IUS
What contraception should be avoided in Wilsons disease?
IUD
What is in the COCP?
Oestrogen and progesterone
How effective is the COCP?
99% with perfect use (91% with standard use)
What age can COCP be used until?
50 years
How does the COCP prevent pregnancy (3)?
- Prevents ovulation (prevents LH surge)
- Thickens cervical mucous
- Inhibits proliferation of endometrium preventing implantation
How does COCP prevent ovulation?
Oestrogen and progesterone surpress LH and FSH preventing ovulation
How should the COCP be taken?
Traditionally taken for 21 days, the stopped for 7 to allow for breakthrough bleed, however there is no medical benefit to having a breakthrough bleed, so COCP can be taken continuously
What are the benefits of COCP (3)?
- Decreased risk of endometrial + ovarian cancer
- Rapid return to fertility after stopping
- No menstruation
What are the disadvantages of COCP (6)?
- May forget to take pill
- Unscheduled bleeding
- VTE risk
- No STI protection
- Increased risk of breast + cervical cancer
- Mood changes, breast tenderness, headaches
What are some absolute (UKMEC 4) contraindications to the COCP (8)?
- Uncontrolled hypertension (160/100)
- Migraine with aura
- History VTE
- Over 35 + smoking (15 fags)
- Major surgery with immobility
- Vascular disease/ stroke/ IHD/ AF
- Liver cirrhosis/ tumours
- SLE/ APL
What is an important UKMEC 3 to be aware of for COCP?
BMI > 35
What is the advice given when starting the COCP (2)?
- If < day 5 of period = immediate protection
- If > day 5 of period = barrier contraception for 7 days
What is the advice if 1 missed pill of COCP (i.e. their last pill was taken 48-72 hours ago) (2)?
- Take missed pill as soon as possible even if 2 pills taken in 1 day
- No additional contraception needed
What is the general advice if 2 or more pills of COCP are missed (i.e. their last pill was taken more than 72 hours ago) (2)?
- Take missed pill ASAP even if this means 2 pills on one day
- Barrier contraception needed for 7 days
What is the additional advice if 2 or more missed pills in day 1-7 of the packet?
They need emergency contraception if they have had sex
What is the additional advice if 2 or more missed pills in day 15-21 of the packet?
- No emergency contraception
- However need to skip pill free interval (7 days) - back to back with next box of pills
What is the additional advice if 2 or more missed pills in day 8-14 of the packet?
No emergency contraception, can still have pill free interval
What are two important things to make patients prescribed COCP aware of?
- Vomiting < 2 hours after pill = equivalent to missed pill
- Some antibiotics e.g. rifampicin inhibit COCP
What are the two types of progesterone only pill?
- Traditional POP (levonorgestrel)
- Desogestrel-only-pill
How do the progesterone only pills work?
- Thicken cervical mucous
- Alter endometrium (make it less implantable)
- Reduce ciliary action in fallopian tube
What extra way does desogestrel work as a contraception?
Prevents OVULATION