Contraception non-LARC

Question 1

what reasons other than contraception might someone use CHC

Answer 1

heavy periods
painful periods
acne
irregular periods
premenstrual symptoms 
endometriosis
menstrual migraine (no aura)

Question 2

what do CHC contain

Answer 2

estrogen and prog

Question 3

types of CHC

Answer 3

combined oral contraceptive pill 20-35 ug EE
combined transdermal patch 33ug EE
combined vaginal ring 15 ug EE

Question 4

CHC mode of action

Answer 4

inhibiting ovulation via hypo-pit axis to reduce LH and FHS

endometrium and mucous affected

Question 5

CHC failure rate

Answer 5

0.3% perfect

9% typical

Question 6

how is COC taken

Answer 6

taken for 21 days then stopped for 7 days - withdrawal bleed due to shedding of endometrium
first 7 pills inhibit ovulation the rest 14 maintain an ovulation
follicular activity resumes after 9 pills have been omitted

Question 7

CTP application

Answer 7

1 patch per week for 3 weeks
1 week off for withdrawal bleeding
suppress ovulation

Question 8

CVR regime

Answer 8

placed and left for 21 days
7 days off to induce withdrawel bleed
new ring

Question 9

what factors affect CHC

Answer 9

impaired absorption - GI conditions for COC

impaired metabolism - liver enzyme induction, drug interaction

forgetting

Question 10

missed pills protocol

Answer 10

take the missed pill as soon as remembered - over 24 hours less than 48 hours

2 or more pills - take the recent missed pill, take the rest at correct times, use condoms/abstain till 7 pills have been taken consecutively

Question 11

more than 48 hours without pills

Answer 11

days 1-7 consider EC
days 8-14 no extra instructions
days 15-21: omit pill free interval

Question 12

patches
removal
how long can it be worn
how long can it be off

Answer 12

can remain off for 2 days
can be worn for 9 days
can be extended till 9 days

for all 3 EC or extra precautions may be needed

Question 13

TVR
how long can it be left out
how long can ti be worn
how long can the ring free interval be

Answer 13

48 hours
4 weeks
9 days

Question 14

risks of CHC

Answer 14

venus thrombosis
arterial thrombosis
adverse effect on some cancers

Question 15

metabolic affect of CHC

Answer 15

alteration in clotting factor levels induced by EE may be thrombogenic
in px with significant arterial wall dx EE may also prove superimposed arterial thrombosis
increased fibrinolytic activity but reversed in heavy smokers

Question 16

unwanted circulatory effects in CHC and risk factors for it

another unwanted affect and the monitoring for it

another one

Answer 16

venous thromboembolism
obesity, smoking, age, known thrombophilia, VTE in first degree relative <45 years, up to 6 weeks post natal

trekking, long haul flights, reduced mobility, anti phospho syndrome, other conditions causing VTE risk

systemic hypertension
check initially and then 3 months then annually

arterial disease - MI esp in smokers - those who take COC

Question 17

what can work as a contraceptive but is not licensed as one and what is it licensed for

Answer 17

cyproterine acetate

acne and hirsutism treatment

Question 18

migraine and link to CHC

Answer 18

migraines with aura increase the risk of ischeamic stroke

CHC use in individual with migraine with aura further increases the risk of stroke and is contra indicated

Question 19

what is an aura

Answer 19

change occurring 5-20 mins before the onset of a headache

visual/altered sensation/smell/taste/hemiparesis

Question 20

unwanted affect - malignancy in CHC

Answer 20

breast cancer risk
if personal history then CHC contra indicated
FH - UKMEC1
BRACA-UKMEC 3

cervical cancer - small risk with long term use, discuss HPV/condom, keep up to date with cervical screening

Question 21

examination before prescribing CHC

Answer 21

record BP and BMI before first prescription

check smear status if relevant

Question 22

protection against what with CHC

Answer 22

20% reduction of ovarian cancer for every 15 years of use to 50% reduction after 15 years of use
20-50% reduction in endometrial cancer
benefit for both may last decade after stopping CHC

Question 23

CHC and acne

Answer 23

all CHC beneficial for acne

Question 24

what are some other non contraceptive benefits of CHC

Answer 24

pre menstrual syndrome
PCOS
functional ovarian cysts
bleeding - withdrawal bleeding

Question 25

SE of CHC

CTP
CVR

Answer 25

unscheduled bleeding - up tp 20% experience, usually settles with time
mood changes - no signs of it leading to depression tho
weight gain - insufficient evidence

CTP - breast pain, nausea, painful periods than COC/CVR

CVR - less bleeding problems, acne, irratibility/mood changes

Question 26

when is CHC started

Answer 26

up to and including day 5 of the cycle without the need for additional contraception

beyond day 5 a woman can start the COC at any other time provided she is not pregnant and uses condoms/anstains for 7 days

Question 27

after EC

Answer 27

levonelle (prog) - abstain/condoms for 7 days

ulipristal acetate(anti prog) - avoid starting contraception for 5 days

Question 28

POP types

mode of action primary and secondary

Answer 28

levonorgestrel. norethisterone, etonergestrel

primary - thickening of mucous, suppression of ovulation
secondary - suppression of ovulation, decrease in endometrial receptivity to blastocyte, reduction in cilia activity in fallopian tube

Question 29

POP risks

Answer 29

little effect on metabolism
can be given in most circumstances
UKMEC 4 - current breast cancer

Question 30

POP interactions

Answer 30

liver enzyme inducers 0 cytochrome P450

effect continues for 28 days after stopping

Question 31

how to take a POP

Answer 31

L, N - daily at the same time, no break, within 24-27 hours of last dose

E - daily at the same time within 24-36 hours of last dose, no break

Question 32

POP missed pills

Answer 32

one missed dose plus UPSI = EC and 2 day of extra protection

Question 33

POP efficacy

Answer 33

perfect use 0.3% failure

typical use 9%