Contraceptives Flashcards
How quickly is an IUD effective?
Instantly
How soon is the POP effective?
2 days
Which 4 contraception methods are effective after 7 days?
- COCP
- IUS
- Nexaplanon (implant)
- Depot injection
How does the progesterone only pill work?
Thickening of the cervical mucus acts as a barrier to sperm entry
What is the mechanism of action of the COCP, injection and implant?
Anovulation (inhibition of ovulation)
Side effects of the POP
Breast tenderness
Weight gain
Acne
Mood swings
Menstrual irregularities
What is the mechanism of action of the copper coil, or IUD?
The copper acts as a spermicide to prevent entry of sperm
At what time in the cycle does the POP provide immediate contraception?
If started prior to day 5 of the menstrual cycle
What are the missed pill rules for POP?
- If 3 hours or less late, continue as normal
- If over 3 hours late, take the missed pill as soon as possible, continue with the rest of the pack, extra precautions (e.g. condoms) should be used until pill taking has been re-established for 48 hours
If one COCP pill is missed, e.g. less than 72 hours since last pill was taken…
Take the missed pill as soon as possible (even if this means taking two pills on the same day)
No extra protection is required provided other pills before and after are taken correctly
If more than one COC pill is missed (more than 72 hours since last pill was taken), what does the patient do?
Take the most recent missed pill as soon as possible (even if this means taking two pills on the same day)
Additional contraception (i.e. condoms) is needed until they have taken the pill regularly for 7 days straight.
If more than one COC pill is missed (more than 72 hours since last pill was taken), what does the patient do if they are are only on day 1-7 of the pack?
They will need emergency contraception if they have had UPSI
if more than one COC pill is missed (more than 72 hours since last pill was taken), what does the patient do if they are are only on day 8-14 of the pack?
If day 8 – 14 of the pack (and day 1 – 7 was fully compliant) then no emergency contraception is required
if more than one COC pill is missed (more than 72 hours since last pill was taken), what does the patient do if they are are on day 15-21 of the pack?
If day 15 – 21 of the pack (and day 1 – 14 was fully compliant) then no emergency contraception is needed.
What does the patient need to know if they are switching from a POP to a COCP?
- they can switch at any time but 7 days of extra contraception (i.e. condoms) is required.
- Ensure the woman is not already pregnant before switching (i.e. they have been using contraception reliably and consistently).
How long after taking ulipristal acetate should a patient’s normal contraceptive be taken?
After taking ulipristal acetate women should wait 5 days before starting regular hormonal contraception
When the patient switches for Desogestrel or cerazette, to the COCP, what do they need to know?
When switching from desogestrel, they can switch immediately, and no additional contraception is required. This differs from a traditional POP because desogestrel inhibits ovulation.
What are the 2 types of “morning after pill”?
levonorgestrel (cezarette) and Ulipristal acetate
When should Levonorgestrel be taken to be effective?
Within 72 h of UPSI
When can a patient start their normal hormonal contraception after taking levornogestrel?
immediately
When can an intrauterine system be implanted after childbirth?
Within 48 hours OR after 4 weeks
How long does the IUD generally last for?
the majority of IUDs with copper on the stem only are effective for 5 years, BUT some of the IUDs that have copper on the stem and the arms of the T may be effective for up to 10 years
How long is the IUS effective for?
Mirena coil, levonorgestrel 20 is effective for 5 years
What are classed as UKMEC 3 conditions for COCP? (7)
- more than 35 years old and smoking less than 15 cigarettes/day
- BMI > 35 kg/m^2*
- family history of thromboembolic disease in first degree relatives < 45 years
- controlled hypertension
- immobility e.g. wheel chair use
- carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
- current gallbladder disease
What does UKMEC 3 mean?
Giving the medication to this person is not approved as disadvantages generally outweigh the advantages
What are the UKMEC 4 conditions? (9)
- more than 35 years old and smoking more than 15 cigarettes/day
- migraine with aura (tingling sensation before headache and loss of vision)
- history of thromboembolic disease or thrombogenic mutation
- history of stroke or ischaemic heart disease
- breast feeding < 6 weeks post-partum
- uncontrolled hypertension
- current breast cancer
- major surgery with prolonged immobilisation
- positive anti-phospholipid antibodies (e.g. in SLE)
What is the main injectable contraceptive in the UK? What is it?
Depo Provera is the main injectable contraceptive used in the UK. It contains medroxyprogesterone acetate 150mg
How often is the Depo Provera given?
Every 12 weeks but can be given every 14 weeks with extra precautions e.g. barrier protection
What is the name of the only licensed contraceptive patch in the UK?
The Evra patch
What is the contraceptive patch regime?
Wear one patch a week for three weeks and do not wear a patch on week four
What is the criteria for Lactational amenorrhoea to work as a contraceptive?
Lactational amenorrhoea is a reliable method of contraception as long as mum is amenorrhoeic, baby under 6 months, and they are breastfeeding exclusively
Give 4 examples of traditional POPs
Micronor
Noriday
Nogeston
Femulen
What is the drug name of Cerazette
Desogestrel
What is the window for traditional POPs working?
3 hours - if pill is 3 hours late, emergency cont needed
Cerazette window
12 hours - if less than 12 hours late, no action needed
