Contraception non-LARC Flashcards
Failure rates for CHC are perfect use 0.3% and typical use 8%. What are three available choices for Combined Hormonal Contraception and what is their method of contraception? (CHC)
ring, patch and pill - STOP ovulation
When can you start the COC?
Start in first 5 days of period OR at any time during cycle when reasonably sure you’re not pregnant BUT use condoms for first 7 days!
How do you take the COC? (licenced and off licence)
Take it for 21 days followed by 7 day break (licensed) OR (off licence) tricycling - take 3 packets straight through then stop for 7 days OR (off licence) continuous use and if you bleed for 4 days or more stop for 4 days then start again
What are 3 factors that may affect effectiveness of CHC?
impaired absorption (COC), increased metabolism (e.g. liver enzyme induction, drug interaction), forgetting
What are 3 risks of CHC?
venous thrombosis, arterial thrombosis and slight increased risk of breast and cervical cancer (reduces 10yrs after stopping pill)
There is a small additional risk of VTE in COC users that varies according to oestrogen dose and progesterone type. Risk in population is 2/10,000, risk on levonorgestrel is 5-7/10,000. and risk on drospirenone is 9-12/10,000. True/false?
True
COC may increase blood pressure in some individuals. Under what BP is ok to start COC and when should it be checked?
Under 140/90. Should be checked initially, at 3 months, then annually
Why must you be cautious when prescribing COC to smokers, people over age 35 and people with hypertension?
It can increase risk of MI due to arterial disease
Why must you be cautious when prescribing COC to smokers, people over age 35 and people with hypertension?
It can increase risk of MI due to arterial disease
Why can’t you prescribe COC to patients who experience migraine with aura?
Increases risk of ischaemic stroke
What is a migraine with aura?
Migraine that is preceded by an aura which is a change occurring 5-20 minutes before headache onset. Visual: often scotoma, altered sensation, smell or taste, hemiparesis
What exams are carried out before prescribing CHC?
BP, BMI, cervical smear if appropriate & UKMEC
Up to what age can CHC be used?
up to 50yrs if no risk factors
All CHC can show a beneficial effect on acne. Which pills in particular show this?
Oestrogen/cyproterone acetate (dianette) because is antiandrogen
What are 6 non-contraceptive benefits of CHC?
protection against ovarian and endometrial cancer, improves acne, less bleeding, fewer functional ovarian cysts, helps with PMS helps PCOS
What are 4 side effects of CHC?
nausea,
break-through bleeding,
worsening spots,
breast tenderness
Desogestrel (brand cerelle) is main progesterone pill prescribed. The perfect failure rate is <1% and typical failure rate is 9%. What is the mode of action?
inhibits ovulation
How to start progestogen only methods? POP, subdermal implant and DMPA
Day 1-5 of period
OR
anytime if reasonably sure not pregnant with condoms for 7 days.
Only need condom for 2 days with POP
Subdermal implants and POP are safe to use in most circumstances and have little effect on metabolism. However they are UKMEC 4 for what condition?
Current breast cancer
List 4 potential side effects of POP
nausea,
bleeding,
spots
headaches
List 4 potential side effects of POP
nausea, irregular bleeding (common), spots and headaches
How do you take POP?
Take at same time every day and if more than 12 hours late it won’t work for 2 days
What is the difference between Depo provera and Sayana Press?
Depo provera is administered by doctor/nurse whereas sayana press is self administered
Typical use failure rate DMPA is 3% and perfect use is 0.3%. How does DMPA work?
lowers oestrogen and suppresses FSH so wipes out menstrual cycle
DMPA cannot be used in those on enzyme inducing drugs, especially epileptics. True/false?
False - opposite! Particularly useful in those
List 5 side effects of DMPA?
nausea, spots, headaches, weight gain (quite common), irregular bleeding for first few months
What can DMPA have a negative effect on?
Bone health because suppressing oestrogen so cautious about using it in teenagers as may lower peak bone mass or people with risk factors for osteoporosis e.g. poor calcium absorption or FH
At what age is DMPA recommended stopping?
close to menopause, around late 40s
How effective is the diaphragm with typical use?
71-88%
How does diaphragm work?
Put in vagina before sex and leave in vagina for 6hrs after to allow spermicide to work
Vasectomy can be done under local or general anaesthetic. Vasectomy failure rate?
0.1%
Vasectomy can be done under local or general anaesthetic. Vasectomy failure rate?
0.1%
List 4 potential side effects of vasectomy?
anaesthetic,
pain,
infection,
bleeding/haematoma
What is usual reason for failure of vasectomy?
early non-compliance - don’t come get semen analysis
Female sterilisation has failure rate of 2-3/1000. This makes it not actually that effective compared to other LARCs and depo. True/false
True
What is effective rate of natural family planning?
76%
Transgender men assigned female at birth need contraception if sexually active. Which methods are unsuitable and why?
Combined hormonal methods (CHCs) are unsuitable as can counteract masculinising effect of testosterone
Transgender men receiving testosterone do not need contraception as it acts as one. True/false?
False - testosterone is NOT a contraceptive method and is teratogenic
