Contraceptives Flashcards
hormones, interactions, non-hormonal, emergency
Hormonal contraception ~ Fraser guidelines
~ for under 16s; can give contraception without parenteral consent if
1. Understands doctors advice
2. Cannot be persuaded to inform parents
3. Likely to continue having sex
4. Unless she receives contraception her mental and physical health will suffer
5. in her best interest to provide tx
name 2 types of contraception
- Combined
- Progesterone only
Combined oral pill
Oestrogen content
~ ethyinylestradiol
~ estradiol
Progesterone content
~ Norgestimate
~ Desogestrel
~ Drosperinone
~ norethisterone
~ levonorgestrel
~ Gestodene
Porgesterone only pill
ORAL
~ Desogestrel
~ Norethisterone
~ Levonorgestrel
Parenteral
~ Medroxyprogesterone
~ Etonorgestrel
Intrauterine device
~ levonorgestrel
which oral combined is good for women with acne, headaches, depression, breast symptoms, breakthrough bleeding with other progestogens
~ Norgestimate
~ Desogestrel
~ Drosperinone
COC MOA
~ inhibits ovulation
~ contains oestrogen and progestogens
COC administration
Take 1 daily for 3 weeks + 1 week pill-free interval for withdrawal bleeding
~ start anytime in menstrual cycle; if started on day 6 or later = use protection for 7 days
~ NOT for women >50y
COC types of preparations
- Monophasic
~ fixed amount of oestrogen + progesterone - Phasic
~ varied amount of oestrogen + progesterone
~ For women who do not have withdrawal bleeding
~ OR have breakthrough bleeding with monophasic - Everyday
~ pil–free replaced with inactive pills - Low-strength oestrogen
~ risk factor for circulatory disease (20mg Ethinylestradiol)
Oestrogen and risks
~ Increased risk of VTE
certain risk factors further increase risk of VTE =
~~ Type of progesterone; desogestrel, gestodene, drosperinone
– Obesity BMI>30
– Smoking
– Primary relative under 45 with VTE
— Superficial thrombophlebitis
– Long term immobilization
– >35y
~ Increased risk of arterial thromboembolism
certain risk factors further increase risk of VTE =
– DM, HTN, Migraine without aura
AVOID IF 2 OR MORE RISK FACTORS PRESENT
Surgery and COC
stop 4 weeks before
!! for major surgery & all surgery to legs, or that cause prolongs immobilisation of lower limb
— POP = alternative
— Restart usual contraception on 1st period at least 2 weeks after mobilisation
– Thromboprophylaxis in emergency surgery or if COC not stopped
Travel and COC
if journey longer than 3h
~ reduce risk by wearing compression stocking & leg exercises
Possible reasons to stop COC, or Oestrogen-containing HRT
VTE
– sudden chest pain, SOB, cough, sputum (PE?) or unexplained swelling in calf of 1 leg (DVT)
Stroke
~ prolonged headache, loss of vision/hearing, dysphasia (Slurred speech), epileptic seizure, numbness, weakness
Liver dysfunction
~ jaundice, hep, liver enlargement, severe stomach pain
BP
~ >160/95
Prolonged immobility after surgery
Contraindication detected
~ smoking >40 a day
~ Hx of VTE
~ Migraine
~ DM with complications
~ Heart disease HTN, Angina, ACS, MI
~ >50y
~ BMI>30
~ TIA
POP MOA
prevents pregnancy by thickening mucus in cervix to stop sperm reaching egg
~ alternative when oestrogen COC is contra-indicated
POP administration
1 tablet daily on continuous basis starting on day 1 of cycle and taken same time each day
~ if started after day5 of cycle, take extra precaution for 2days
Cancer SEs of hormonal contraception
COC: risk of cervical & breast
POP: risk of breast
Benefits of COC
~ reduces ovarian & endometrial cancers
~ reduces dysmenorrhea, menorrhagia, premenstrual tension, PID risk, fibroids risk less
Missed pill COC
Missed pill >24h
1 missed = take ASAP & next one as normal even if it means taking together
2 or more missed = Take 1 ASAP + condom for 7 days, omit pill-free intervals, EHC (if missed in first 7 days & unprotected sex occurs)
Missed pill POP
Missed >3h (OR if desogestrel >12h)
= Take ASAP + use condom for 2 days, EHC (unprotected sex occurs before 2 pills taken correctly)
vomiting / diarrhoea with COC
Vomiting <2h of taking = take ASAP
>24h (severe) = protection until 7 days after recovery & ill resumed
if occurs in last 7 days = omit pill-free interval
vomiting / diarrhoea with POP
Vomiting <2h of taking = take ASAP
Severe / pill not taken within 3h of normal time (12h if desogestrel) = protection until 2 days after recovery and pill is resumed
Missed patch “missed” = detachment / delayed application
Transdermal patches (EVRA)
1 cycle: weekly patch for 3 weeks, then 1 week patch-free
detached >24h or delayed application at beginning of cycle
= apply new ASAP + start “new day 1 cycle” + condom for 7 days
delayed application in middle of cycle; beginning of week 2 (day 8) or week 3 (day 15)
<48h = apply new patch + continue as normal
>46 = start “new day 1 cycle” + condom for 7 days
Hormonal contraception and drug interactions
Enzyme inducers (and griseofulvin) = reduced contraceptive effectiveness
~ Carbamazepine, Phenytoin, Phenobarbital, St John wort, Rifampicin, rifabutin
Regular contraception
~ copper IUD, progesterone-only injections
EHC management
1st line = copper IUD
~ most effective form
~ 120h (5 days) after unprotected intercourse or 5 days after earliest calculated ovulation
2nd line = hormonal
~ oral EHC = levonorgestrel or Ulipristal
~ if BMI >26kg or 70kg weight: Ulipristal or double dose of levonorgestrel
Levonorgestrel MOA
prevents ovulation and fertilization
Levonorgestrel administration
dose : 1500mg <72h of unprotected sex
… if vomiting <3h of taking = another dose given
CAUTION
- Crohn
- Past ectopic pregnancy
- Ciclosporins (toxic)
Ulipristal MOA
progestogen receptor modulator inhibits or delays ovulation
Ulipristal administration
use: 30mg <120h of unprotected sex
>96-120h unprotected sex
… if vomiting <3h of taking = another dose given
Ulipristal caution & contra-indications
CAUTION
~ severe asthma treated by oral steroids
~ severe liver impairment
CONTRA-INDICATIONS
~ repeated use within same menstural cycle
Ulipristal counselling
- it reduced effectiveness of regular contraceptives
~ use additional barriers
COC = use for 14 days and POP = use for 9 days - Wait 5 days beofre starting regular hormonal contraception
IUD
less suitable for <25y due to increased risk of PID
IUD types
- Copper
- Levonorgestrel
