Contraception Non- LARC Flashcards
In what three ways is CHC available
COC 20-35ug EE
patch 33ug EE
ring - 15ug EE
what is the main component of CHC
ethinyl estradiol
How effective is the CHC
perfect use - 0.3 percent
typical use 9 percent
for the patch if a woman weighs more than 90kg- decreased efficacy
what is the primary mode of action of chc
inhibits ovulation by reducing LH and FSH
also alters cervical mucous and endometrium
describe how the pill regime results in anovulation
first 7 pils inhibit ovulation
remain 14 maintain anovulation
after home many omitted pils can follicular activity resume
9
what is the standard patch regime
One patch is applied and worn for 1 week to suppress ovulation. Thereafter the patch is reapplied weekly for a further 2 weeks. The fourth week is patch-free to allow a withdrawal bleed. A new patch is applied after 7 patch-free days
what is the standard ring regime
A ring is placed into the vagina and left continuously for 21 days. After a ring-free interval of 7 days to induce a withdrawal bleed, a new ring should be inserted
What factors may affect the efficacy of CHC
GI conditions(Coc) increased metabolism drug interactions
What are the risks of taking the CHC
venous thrombosis
arterial thrombosis
increased risk of some cancers
How is EE thrombogenic
Alteration in clotting factor levels induced by EE may be thrombogenic eg reduces levels of antithrombin III and protein S
In patients with significant arterial wall disease EE may also promote superimposed arterial thrombosis
There is increased fibrinolytic activity but reversed in heavy smokers
what are the risk factors for VTE
obesity smoking age known thrombophilia VTE in 1st degree relative less than 45 yrs up to 6 wks post natal trekking >4,500m for >1 wk long haul flights reduced motility antiphospholipid syndrome
which product have the lowest risk of VTE
levonorgestrel, northisterone, norgestimate
When is CHC contraindicated
migraine with aura
personal history of breast cancer
What things are a UKMEC 3
BRACA gene
What cancers are at an increased risk when using chc
breast
cervival - with long term use, returns to baseline 10yrs after stopping
What are the non contraceptive beneftis of CHC
reduced ovarian cancer
reduced endometrial cancer
acne- cyproterone acetate liscenced for acne and not contraception but does both
lighter periods - don’t need to have period at all
functional ovarian cysts
PMS
PCOS
what are the side effects of CHC
unscheduled bleeding - don’t change before 3 mths as usually settles
mood changes
weight gain
When can CHC be started
Standard Advice – COC’s can be started up to and including Day 5 of the cycle without the need for any additional contraception
Beyond Day 5 a woman can start the COC at any other time (off licence) provided she is ‘reasonably certain’ she is not pregnant and use condoms/abstinence for 7 days – ‘quick start
