CONTRACEPTIVE COUNSELLING Flashcards
COCP
what are the steps?
- check eligibility (UKMEC)
- what is it?
- how effective is it?
- what are the different types?
- how does it work?
- advantages and disadvantages
- risks
- starting COCP
- missed pills
- follow up
- summarise
COCP
what should you check for eligibility for UKMEC?
any personal or family history of:
- blood clots
- breast cancer
- heart disease
- stroke
- vascular disease
- thrombophilia
any personal history of:
- diabetes
- liver disease
- gallbladder disease
- migraine with aura
- hypertension
- obesity
- smoking
- recently given birth
- currently breastfeeding
COCP
how would you explain what the COCP is?
contraceptive pill that contains 2 hormones
oestrogen and progestogen which is similar you body’s natural hormone progesterone
COCP
how effective is it?
- can be very effective if taken correctly (91% effective)
- 9% of people taking COCP become pregnant within 1 year
COCP
what are the different types?
monophasic = take tablet for 21 days followed by 7 day pill-free period
everyday pill = take one tablet each day, 7 tablets are placebo
COCP
how does it work?
- prevents ovulation
- thickens cervical mucus
- thins lining of womb to prevent implantation
COCP
what are the advantages?
- non-invasive
- effective if taken correctly
- reduce heavy menstrual bleeding
- reduce menstrual pain
- improve acne
- improve premenstrual symptoms
- reduces risk of recurrence of endometriosis
- help with management of PCOS
- reduced risk of endometrial + ovarian cancer
- reduced risk of colorectal cancer
COCP
what are the disadvantages?
- does not protect against STIs
- can interact with other medications
- increased risk of cervical + breast cancer
COCP
what are the side effects?
- headaches
- nausea
- dizziness
- breast tenderness
COCP
what are the risks?
VTE
- increased risk of blood clots
- increased if smoking, high BMI or immobile
- if you have multiple risk factors COCP would normally be avoided
MI + STROKE
- increased risk but still very uncommon
- if you have any risk factors, we would recommend avoiding this drug)
BREAST CANCER
- small increased risk
- risk reduces with time after stopping the pill
CERVICAL CANCER
- small increased risk after taking COCP for longer than 5yrs
- reduces with time after stopping pill
COCP
how should you start the pill?
- anytime in cycle if not pregnant
- if starting on day 1-5 = immediate protection + do not need additional contraception
- if starting after day 5 = require additional contraception for 7 days
COCP
what should you do if you miss one pill?
- take missed pill as soon as you realise
- take next pill at the normal time
COCP
what happens if you miss more than one pill?
week 1 = emergency contraception
week 2 = continue as normal (additional contraception for 7 days)
week 3 = finish current pack + start next pack the next day, omitting pill free interval
COCP
what is the follow-up?
yearly follow-up
discuss any changes in medical history
any problems
check BP + BMI
COCP
how long can you take it for?
until 50 years old
COCP
what is the safety netting advice?
seek urgent medical attention if you experience any of the following:
- calf pain, swelling or redness
- breathlessness or coughing up blood
- weakness or loss of sensation in any of your limbs or face
POP
what should you check for eligibility?
- current or past breast cancer
- liver problems
- pregnancy
POP
how would you explain what it is?
type of contraceptive pill that contains a hormone called progestogen
this is similar to natural hormone in body called progesterone
POP
how effective is it?
91% effective
means that 9% of women would become pregnant within 1 year
POP
what is the main type?
desogestrel
should be taken at the same time each day
has a 12 hour window
POP
how does it work?
2 main ways
- thickens cervical mucus
- prevents ovulation
POP
what are the advantages?
- non-invasive
- effective (if taken correctly)
- can improve heavy/painful periods
- safe during breastfeeding
- easily reversible
- useful when oestrogen is contraindicated
POP
what are the disadvantages?
- effectiveness depends on compliance
- irregular bleeding (can be light or infrequent or could stop completely)
- does not protect against STIs
- possible increased risk of breast cancer
POP
what are the side effects?
headaches
nausea
mood changes
breast tenderness
POP
what are the rules for starting POP?
- can start at any time in menstrual cycle
- if start on day 1-5 = protected straight away + no need for additional contraception
- if started after day 5 = require additional contraception for 2 days
POP
what are the rules for missing a pill?
desogestrel = missed after 12hrs
- take pill as soon as you remember
- additional contraception for 2 days
- will require emergency contraception if UPSI occurred when pill was missed
POP
how long can you take it for?
until 55 or menopause
IMPLANT
what should you screen for when checking eligibility?
- breast cancer
- unexplained vaginal bleeding
- liver problems
IMPLANT
how would you explain what it is?
- small plastic device similar to a matchstick
- sits under skin of upper arm
- is the most effective form of reversible contraception
- lasts 3 years
- requires a small procedure to insert
IMPLANT
how effective is it?
over 99% effective
less than 1% will get pregnant within 1 year
IMPLANT
how does it work?
- releases hormone over time
- prevents ovulation
- thickens cervical mucus
- thins lining of womb
IMPLANT
what are the advantages?
- highly effective
- lasts 3 years
- easily reversible
- safe in breastfeeding
- may be helpful for premenstrual symptoms
IMPLANT
what are the disadvantages?
- unpredictable bleeding
- does not protect against STIs
- requires procedure to insert + remove (risk of bleeding, infection, nerve damage)
- small increased risk of breast cancer
IMPLANT
what are the risks of insertion?
- pain and discomfort (local anaesthetic used)
- bruising and bleeding
- infection
- deep insertion + neurovascular insertion
- scarring
- difficulty removing
IMPLANT
what is the safety netting advice?
seek medical attention if:
- unable to feel implant
- experience ongoing pain after fitting
- experience unexpected or unwanted change to bleeding
- unusual redness, swelling or fever around insertion site
- change in medical history
IMPLANT
how long does it last for?
3 years
COPPER COIL
what should you check for eligibility?
- active PID
- unexplained vaginal bleeding
- endometrial cancer
- pregnancy
- uterine fibroids
- recently given birth
COPPER COIL
how would you explain what it is?
- small plastic + copper T shaped device
- sits inside womb and prevent pregnancy
- requires small procedure to fit and remove it
- lasts for up to 5-10 years
COPPER COIL
how effective is it?
over 99% effective
less than 1% will get pregnant within 1 yr
COPPER COIL
how does it work?
- prevents sperm from surviving or reaching an egg
- changes womb lining to prevent implantation
COPPER COIL
what are the advantages?
- highly effective
- immediately effective
- lasts up to 10 years depending on type
- fit and forget
- does not contain hormones
- no medication interactions
- safe in breastfeeding
COPPER COIL
what are the disadvantages?
- heavier + more painful periods
- does not protect against STI
- requires procedure to insert + remove
- 1/20 risk of expulsion (highest in first 3 months)
- increased risk of ectopic pregnancy
- does not stop ovulation so will not help premenstrual symptoms
COPPER COIL
what are the risks of insertion?
pain (use local anaesthetic + can take paracetamol/ibuprofen before)
bleeding
infection
perforation of anus
COPPER COIL
what is the process of insertion?
- internal exam with fingers to assess womb position
- speculum inserted to see cervix
- local anaesthetic applied
- measuring device inserted to see length of womb
- coil is inserted
- threads are trimmed
COPPER COIL
what is the aftercare?
- will need to check threads
- can do it yourself or can have appointment to check with speculum
COPPER COIL
what is the safety netting advice?
seek medical attention if:
- unable to feel threads
- experience ongoing pain
- experience any unwanted/unexpected bleeding
- experience any unusual vaginal discharge or fever
- change to medical history
INTRAUTERINE DEVICE
what should you check for eligibility?
- breast cancer
- PID
- STI
unexplained vaginal bleeding - endometrial cancer
- liver problems
- recently given birth
- uterine fibroids
INTRAUTERINE DEVICE
how would you explain what IUS is?
- small plastic device that sits in womb
- releases hormone to stop pregnancy
- can last up to 8 years
- requires small procedure to insert + remove
INTRAUTERINE DEVICE
how effective is it?
over 99% effective
INTRAUTERINE DEVICE
how does it work?
three main ways
- thins lining of womb
- thickens cervical mucus
- prevent ovulation
INTRAUTERINE DEVICE
what are the advantages?
- very effective
- fit and forget
- easily reversible
- safe in breastfeeding
- can be used as HRT (if relevant)
INTRAUTERINE DEVICE
what are the disadvantages?
- irregular bleeding (particularly in first 6m)
- does not protect against STIs
- requires procedure to fit + remove
- 1/20 risk of expulsion (highest in first 6 m)
- ectopic pregnancy
INTRAUTERINE DEVICE
what are the side effects?
- acne
- headaches
- breast tenderness
INTRAUTERINE DEVICE
what are the risks of IUS?
pain (local anaesthetic + can taken paracetamol/ibuprofen before)
bleeding
infection
perforation of uterus
INTRAUTERINE DEVICE
what is the aftercare?
- check can feel threads
- can check it yourself or have follow up with speculum
INTRAUTERINE DEVICE
what is the safety netting advice?
seek medical attention if:
- cannot feel threads
- ongoing pain
- unexpected or intolerable bleeding
- vaginal discharge
- change to medical history
DEPOT INJECTION
what are the contraindications?
- pregnant
- thinking of becoming pregnant in next year
- breast cancer
- liver problems
- severe arterial disease
- osteoporosis
- unexplained vaginal bleeding
DEPOT INJECTION
how would you explain what it is?
injection that contains progesterone
DEPOT INJECTION
how does it work?
- stops ovulation
- thickens cervical mucus
- thinning of womb lining
DEPOT INJECTION
how effective is it?
99% effective
DEPOT INJECTION
what are the advantages?
- long acting
- effective
- not associated with ovarian cysts
- less painful periods
- safe during breastfeeding
DEPOT INJECTION
what are the disadvantages?
- change in periods (lighter/irregular or heavier/longer)
- no protection against STIs
- weight gain
- can take up to 1 year to regain fertility
DEPOT INJECTION
what are the side effects?
- headache
- nausea
- acne
- mood changes
- breast tenderness
DEPOT INJECTION
what are the risks?
- osteoporosis (higher risk if family history or steroid use)
- breast cancer
- infection (at injection site)
DEPOT INJECTION
how is it administered?
injection into muscle, usually in buttock or side of thigh
DEPOT INJECTION
how often is it given?
every 12 weeks
DEPOT INJECTION
when can it be started?
any time as long as they are not pregnant
if starting day 1-5 = immediate protection
if starting after day 5 = additional protection required for 7 days
EMERGENCY CONTRACEPTION
what are the different types?
copper coil
levonorgestrel
ulipristal acetate
EMERGENCY CONTRACEPTION
what is levonorgestrel?
tablet containing progestogen
similar to progesterone which is produced by body
EMERGENCY CONTRACEPTION
how does levonorgestrel work?
- inhibits ovulation
EMERGENCY CONTRACEPTION
when can it be taken?
- should be taken within 72hrs
EMERGENCY CONTRACEPTION
what are the advantages of levonorgestrel?
- safe and well tolerated
- safe in breastfeeding
- can start other contraception immediately after
EMERGENCY CONTRACEPTION
what are the disadvantages of levonorgestrel?
- ineffective if taking enzyme inducing meds
- require double dose (3mg) if BMI >26
EMERGENCY CONTRACEPTION
what is ulipristal acetate?
tablet containing progesterone receptor modulator
EMERGENCY CONTRACEPTION
when can ulipristal acetate be taken?
within 120hrs or 5 days of UPSI
EMERGENCY CONTRACEPTION
which is more effective out of levonorgestrel and ulipristal acetate?
ulipristal acetate is more effective
EMERGENCY CONTRACEPTION
what are the advantages of ulipristal acetate?
- more effective than levonorgestrel
- has longer window of effectiveness
EMERGENCY CONTRACEPTION
what are the disadvantages of ulipristal acetate?
- caution in severe asthma
- other contraception should be restarted after 5 days
- if levonorgestrel has already been used, not recommended to use ulipristal acetate in same month
- breastfeeding should be stopped for 1 week (express + discard milk)
