Contraception non-LARC Flashcards
what reasons other than contraception might someone use CHC
heavy periods painful periods acne irregular periods premenstrual symptoms endometriosis menstrual migraine (no aura)
what do CHC contain
estrogen and prog
types of CHC
combined oral contraceptive pill 20-35 ug EE
combined transdermal patch 33ug EE
combined vaginal ring 15 ug EE
CHC mode of action
inhibiting ovulation via hypo-pit axis to reduce LH and FHS
endometrium and mucous affected
CHC failure rate
0.3% perfect
9% typical
how is COC taken
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
CTP application
1 patch per week for 3 weeks
1 week off for withdrawal bleeding
suppress ovulation
CVR regime
placed and left for 21 days
7 days off to induce withdrawel bleed
new ring
what factors affect CHC
impaired absorption - GI conditions for COC
impaired metabolism - liver enzyme induction, drug interaction
forgetting
missed pills protocol
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
more than 48 hours without pills
days 1-7 consider EC
days 8-14 no extra instructions
days 15-21: omit pill free interval
patches
removal
how long can it be worn
how long can it be off
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
TVR
how long can it be left out
how long can ti be worn
how long can the ring free interval be
48 hours
4 weeks
9 days
risks of CHC
venus thrombosis
arterial thrombosis
adverse effect on some cancers
metabolic affect of CHC
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
unwanted circulatory effects in CHC and risk factors for it
another unwanted affect and the monitoring for it
another one
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
what can work as a contraceptive but is not licensed as one and what is it licensed for
cyproterine acetate
acne and hirsutism treatment
migraine and link to CHC
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
what is an aura
change occurring 5-20 mins before the onset of a headache
visual/altered sensation/smell/taste/hemiparesis
unwanted affect - malignancy in CHC
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
examination before prescribing CHC
record BP and BMI before first prescription
check smear status if relevant
protection against what with CHC
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
CHC and acne
all CHC beneficial for acne
what are some other non contraceptive benefits of CHC
pre menstrual syndrome
PCOS
functional ovarian cysts
bleeding - withdrawal bleeding
SE of CHC
CTP
CVR
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
when is CHC started
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
after EC
levonelle (prog) - abstain/condoms for 7 days
ulipristal acetate(anti prog) - avoid starting contraception for 5 days
POP types
mode of action primary and secondary
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
POP risks
little effect on metabolism
can be given in most circumstances
UKMEC 4 - current breast cancer
POP interactions
liver enzyme inducers 0 cytochrome P450
effect continues for 28 days after stopping
how to take a POP
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
POP missed pills
one missed dose plus UPSI = EC and 2 day of extra protection
POP efficacy
perfect use 0.3% failure
typical use 9%
