contraception - methods Flashcards
mechanism COCP prevents pregnancy
inhibits ovulation
when should you start taking COCP
if started within 1st 5 days of cycle no additional contraception needed // if started any later use condoms for 7 days
how should you take COCP
same time every day // no need for withdrawal bleed (take continuously, take 3 packs then a break)
which medications may reduced efficiency of the COCP
liver enzyme inducing eg rifampicin
advantages of COCP (esp cancer)
lighter periods // reduced ovarian, endometrial and colorectal cancer!!!
increased risks with COCP
VTE // breast and cervical cancer // stroke and IHD (esp smokers)
SE COCP
headache, nausea, breast tenderness
what to do with 1 missed pill COCP
take pill at any time you remember, even if that means taking 2 in a day
advice if 2 COCP pills are missed in week 1 of cycle
consider emergency contraception
advice if 2 COCP pills are missed in week 2 of cycle
if she has taken pill for 7 consecutive days there is no need for emergency contraception
advice if 2 COCP pills are missed in week 3 of cycle
finish pills in her back and start new pack (miss pill free interval)
UKMEC 3 COCP
35 + smoke <15 // BMI >35 // FH VTE <45 // hypertension // immobile eg wheel chair // BRCA // gallbladder disease
UKMEC 4 COCP
35+ smoke >15 // migraine with aura // PMH VTE (or mutation) // stroke or IHD // breastfeeding <6weeks // uncontrolled hypertension // breast cancer // surgery + immobile // antiphospholipid antibodies eg SLE or APS // diabetes >20 years ago
UKMEC 4 COCP
35+ smoke >15 // migraine with aura // PMH VTE (or mutation) // stroke or IHD // breastfeeding <6weeks // uncontrolled hypertension // breast cancer // surgery + immobile // antiphospholipid antibodies eg SLE or APS
how should the combined patch be used
wear a patch for 3 weeks (change each week), 4th week no patch
advice if there is a delay in changing combined patch for in week 1 or 2
if <48 hours change immediately // if >48 hours then change immediately and use condoms for 7 days (or emergency contraception is needed)
advice if there is a delay in changing combined patch for in week 3
remove ASAP and apply patch on usual start day for next cycle (ie have withdrawal bleed, no need for condoms)
advice if there is a delay in applying new combined patch at end of week 4 (patch free week)
condoms for 7 days
mechanism POP (not desogesterol)
thickens cervical mucus
mechanism POP desogesterol
inhibits ovulation (and thickens mucous)
most common SE POP
irregular vaginal bleeding
advise about starting POP
if started up to day 5 of period safe to start // if after use condoms for 2 days
what to do if missed pill with POP
<3 hours take as normal // >3 hours use condoms for 48 hours // if deosgestrel (cerazette) a 12 hour window
mechanism implant
inhibits ovulation + thickens mucous (progesterone)
how long does implant last
3 years (most effective form of contraception)
when should implant be inserted
if applied on day 1-5 no extra needed // if outwith that then 7 days needed
biggest SE implant
irregular or heavy bleeding // progesterone side effects eg headache, nausea, breast pain
how can irregular bleeding be controlled with implant
COCP
what medications can reduce effectiveness of implant
some anti-epileptics and rifampicin
UKMEC 3 implant
IHD, stroke, vaginal bleeding, past breast cancer, liver cirrhosis or cancer
UKMEC 4 implant
current breast cancer
mode of action IUD
copper - decreases sperm motility and survival
how long to IUDs last + when should they be inserter
effective as soon as inserted // last 5-10 years
mechanism IUS
(mirena) - thickens mucous and prevents endometrial proliferation
how long does IUS last and when is it effective
after 7 days // up to 5 years
SE IUD
heavy, painful period
SE IUS
initial frequent bleeding and spotting which decreases over time
risks of intrauterine implants
perforation, PID, expulsion
methods of emergency contraception
levonorgestrel (levonelle), ulipristal (ellaone), IUD
mechanism Levonorgestrel (levonelle)
inhibit ovulation + implantation (progesterone)
window for Levonorgestrel
72 hours
dose Levonorgestrel
1.5mg (double if BMI >26 or weight >70kg)
what to do if vomiting after Levonorgestrel
if within 3 hours repeat dose
how many times can Levonorgestrel be used in a cycle + when can contraception be started
more than once of indicated - start contraception straight away
when can ellaone be taken + dose
30mg within 120 hours
other contraception + ellaone
reduced effectiveness of pill, patch, and ring for 5 days // use condoms for that time
what condition needs caution with ellaone
asthma
how many times can emergency contraception be given in a cycle
more than once
most effective emergency contraception
copper IUD - 99% effective at any time in cycle
when can copper coil be inserted for emergencies
up to 5 days after ovvulation date
clinical indication family planning
temperature, changes in mucous, changes in cervix
