Contraceptives Flashcards
In the menstrual cycle, when to start COC?
Wtihin 7 days of first period, but protection only starts day 5 onwards
How does COC works in contraception?
Prevent ovulation from ovaries
What is the side effect to be expected in the first few months of taking COC?
Bleeding at unexpected times
In general, what are the side effects of COC?
- Cardio (e.g. HTN)
- Clotting (e.g. increased risk of VTE)
- Cancer (breast cancer)
Counselling for missed pill
< 12 hours: take asap, then the rest at usual timing
> 12 hours: take asap even if it means to take 2 at once, then take the rest at usual timing, but use backup for next 7 days
If missed pill during 3rd week: start next pack immediately once the current pack finishes
Place in therapy for progesterone-only-piills?
When estrogen is C/I: lactation, current DVT, migraines
- Recommended for post-partum and breastfeeding (estrogen affects quantity and quality of milk hence progesterone can help here)
Contraindication of progesterone-only-pills
Ongoing breast cancer
When can women restart COC containing estrogen postpartum?
At least 6 months postpartum
(Note meanwhile, POP or implants can be used)
Dosing regimen for postinor-2 (levonogestrel) for emergency contraception
2 tabs STAT, then another 2 after 12 hours
- Take within 72h after unprotected sex
Dosing regimen for Ella (Ulipristal acetate) for emergency contraception
1 tab STAT within 120h (5d) of unprotected sex
(MoA: selective prosterone receptor modulator, prevents implantation of fertilised ovary, or delay ovulation)
In emergency contraception, what to do if patient vomits after taking the pills?
- If within 2h, take another dose
(less prominent with levonorgestrel)
Side effects of emergency contraceptions?
- Irregular bleeding: Menses occur within 1 week before or after expected time
- Breast tenderness, abdominal pain, fatigue, dizzy, etc.
How long to withhold breastfeeding after taking the following:
- Ella (Uripristal acetate)
- Levonorgestrel
- Ella: withhold 1 week
- Levonorgestrel: withhold 3 days
How to resume contraception after taking EC?
- Levonorgestrel: Resume right away, use barrier method for next 7 days
- Ulipristal: Wait until 5 days after UPA. Meanwhile use barrier method until next menstrual cycle or 14 days, whichever first
Dosing regimen for contraceptive patch
Once weekly for 3 weeks, then patch free for 1 week
Weight cutoff before contraceptive patch becomes less useful?
> 90kg –> not recommended
Application sites of contraceptive patch
Lower abdomen, buttock, upper arm, upper thigh
Can depo-provera (methoxyprogesterone injection) be used in patients taking AEDs?
Yes, efficacy not affected by AEDs
Advantages of methoxyprogesterone injection?
- No estrogenic side effects
- Reduces menstrual bleeding after long-term usage
Disadvantages of methoxyprogestone injection?
- Hypoestrogenic state: may ppt menopause sx
- Irregular bleeding for 6-9 months
- Progestogenic side effects: weight gain, acne, nausea
- Requires visit to doctor every 12 weeks for subsequent dosing
When to inject methoxyprogestone injection?
- By day 5 of menses
- Immediately post-abortion
- Immediately postpartum, non-breastfeeding
- 6 week postpartum (exclusively breastfeeding)
When to initiate backup contraception for methoxyprogestone injection, and how long should the backup contraception be for?
- If injected outside of window, or 1 week late for next injection
- Backup for at least 3 days (3-5 days)
Significant adverse effect of methoxyprogestone injection?
Reduction in bone density
(Hence don’t use in young adults)
Concerns of copper IUD?
- Perforation
- Embedement: pain and difficult to remove
- Expulsion: verify position with x-ray/ultrasound
When can you insert copper IUD for contraception?
Anytime, as long as:
- No preg
- No dysmenorrhea
How long can minera (levonorgestral 52 mg) IUD last?
5 years
Implannon mechanism of action
- Suppress FSH and LH hence suppressing ovulution
- Thickening of cervical mucus
- Thinning of endometrum lining
When to insert implanon (etonogestrel)? What is its onset of contraception effects?
Day 1-5 of menstrau cycle, or after 1st trimester abortion
Onset is IMMEDIATE (similar to copper IUD)
Main concerns of implanon?
- Unpredictable, irregular bleeding patterns, which usually leads to early removal
- Insertion and removal issues (since it can be implanted under arm) (similar to IUDs)
