E1 Contraception Flashcards
what is contraception?
- the prevention of conception by the use of birth control devices or methods
- a way for individuals to prevent a pregnancy that may not be wanted due to social, financial, cultural or any other reason
- can be permanent or temporary
- can be hormonal or non-hormonal
explain the difference between male and female condoms
male: stop a man’s semen coming into contact with his sexual partner
female: worn inside the vagina to prevent semen getting into the womb
what is a contraceptive diaphragm?
- cup made of silicone that is inserted into the vagina to cover the cervix
- better if used with spermicide
- little STI protection
describe the IUD
- small T-shaped device made of plastic and copper
- causes thickening of cervical mucus so harder for sperm to reach egg
- can stop fertilised egg from being implanted
- inserted by a doctor or nurse and can remain in situ for up to 10 years
- do not protect against STIs
what may need to be considered if an anaemic patient wants an IUD?
- diet
- IUD can lead to heavier menstrual bleeds
what is the fertility awareness method for contraception?
- method of contraception where a woman monitors and records different fertility signals during her menstrual cycle
- takes 3-6 months to establish
- doesn’t protect against STIs
describe male sterilisation
- vasectomy
- surgical procedure to cut or seal the tubes that carry a man’s sperm
- no STI protection
describe female sterilisation
- fallopian tubes are blocked / sealed to prevent the eggs reaching the sperm
- no STI protection
mode of action of oestrogen
Oestrogen suppresses Ovulation
mode of action of progestogen
Progestogen Prevents sperm reaching egg and Prevents implantation
as a whole, what does hormonal contraception do to prevent pregnancy?
- thins endometrial lining
- suppresses ovulation
- thickens cervical mucus
what does the combined oral contraceptive pill (COCP) contain?
- both oestrogens and progestogens
- in case one fails, there is a fallback option
what are monophasic 21 day combined contraceptive pills?
- fixed amount of hormones
- 21 active pills then 7 days pill-free
what are monophasic 28 day combined contraceptive pills?
- fixed amount of hormones
- 21 active pills than 7 dummy pills
- improves compliance
what are phasic COCPs?
- variable amounts of hormones according to stage of cycle
- 21 day and 28 day varieties
- helpful for breakthrough bleeding with monophasic pill
- no withdrawal bleed
what 2 adaptations are there for taking the COCP to avoid pill free intervals?
- ‘back to backing’
- tri-cycling
what are the 4 UKMEC risk factors?
category 1
category 2
category 3
category 4
what is meant by the UKMEC category 1 risk factor?
a condition for which there is no restriction for the use of the method
what is meant by the UKMEC category 2 risk factor?
a condition where the advantages of using the method generally outweigh the theoretical or proven risks
what is meant by the UKMEC category 3 risk factor?
a condition where the theoretical or proven risks usually outweigh the advantages of using the method. the provision of a method requires expert clinical judgement and / or referral to a specialist contraceptive provider, since use of the method is not usually recommended unless other more appropriate methods are not available or not acceptable
what is meant by the UKMEC category 4 risk factor?
a condition which represents an unacceptable health risk if the method is used
risks of COCP
- migraines
- DVT (deep vein thrombosis)
- cancer (breast and cervical)
describe the risk of migraines with COCP
- must use COCP with caution
- contraindication if new onset or migraine with aura
- increased (relative) risk of ischaemic stroke
describe the risk of DVT with COCP
- 3-3.5 fold increased (relative risk) VTE risk
- lower than VTE risk in pregnancy
- risk highest on initiation
describe the risk of breast and cervical cancer with COCP
- small increased risk
- risk diminishes after stopping
- no risk 10 years after stopping
COCP benefits
- reduced premenstrual syndrome
- reduced heavy menstrual bleeding
- reduced menstrual pain
- improved acne
- improved PCOS
COCP benefits relating to ovarian, endometrial and colorectal cancer
ovarian
- reduced risk
- duration dependent
endometrial
- reduced risk
- persists after stopping
colorectal
- reduced risk
common side effects of COCP
- acne
- fluid retention (especially at ankles)
- headaches
- breakthrough bleeding
- nausea
- weight gain
- mood change
uncommon side effects of COCP
- alopecia
- hypertension (contraindication! - taken off if someone gets high blood pressure)
rare side effects of COCP
VTE (venous thromboembolism)
how long are the windows for taking the COCP and POP?
POP is normally 3 hours
COCP is normally 12 hours
indication for POP
- if COCP is contraindicated and oral contraceptive is preferred
- to delay period (if not already using hormonal contraception)
how often should the POP be taken?
- one pill every day
- no pill free days or non-active pills
common side effects of POP
- headaches
- menstrual cycle irregularities
- nausea
- weight gain
- mood change
- breast tenderness
uncommon side effects of POP
- alopecia
- ovarian cyst
describe the contraceptive patch
- transdermal delivery of oestrogen and progestogen
- brand: Evra
- applied once weekly for 3 weeks then have a patch free week
describe the vaginal ring
- vaginal delivery of oestrogen and progestogen
- brand: NuvaRing
- inserted monthly by the individual
describe the contraceptive implant
- progestogen
- brand: Nexplanon
- inserted every 3 years
describe the contraceptive injection
- progestogen
- brands: Depo-Provera, Sayana Press, Noristerat
- injected every 13 weeks (8 weeks for Noristerat)
describe some issues that could come up with the contraceptive injection regarding the schedule it must be given in
- every 13 weeks (8 weeks for Noristerat)
- effect can be lost if the injection schedule isn’t maintained
- can be hard to plan when next injection will be given around life plans
describe the IUS
- progestogen
- brands: Jaydess, Mirena
- inserted every 3 years (Jaydess) or 5 years (Mirena) (unlicensed use of Mirena up to 7 years)
how should vomiting be counselled with the contraceptive pill?
- less than 2 hours after taking pill
- reduced absorption
- should be treated as missed pill
how should diarrhoea be counselled with the contraceptive pill?
- if ‘persistent and severe’ treat as missed pill
- this means more than 6 watery stools in 24 hours
what class of drug reduces effect of hormonal contraception? what is the mnemonic to remember the names of the things that interact with hormonal contraception?
- enzyme inducers reduce effect of hormonal contraception
Roberts Car Goes Putt Putt Putt And Smokes
- Rifampicin / Rifabutin
- Carbamazepine / Oxcarbazepine
- Griseofulvin
- Phenytoin
- Primidone
- Phenobarbital
- Alcohol
- Smoking
these medicines as well as smoking and drinking increase the amount of liver enzymes
how can drug interactions with hormonal contraception be managed?
- double-dosing
- non-hormonal contraception
- progesterone only depot on IUS (tricycling)
describe the Hana and Lovima POPs
- newly licensed Summer 2021
- first contraceptive pill available OTC in UK
- desogestrel 75 microgram film-coated tablets
- usual contraceptive counselling advice on missed pills, diarrhoea & vomiting and STIs
can the OTC POPs (Hana and Lovima) be used during breastfeeding?
yes
indication for OTC POPs Hana and Lovima
oral contraception for women of childbearing age
benefits of the OTC POP
- additional route to access contraceptive services
- reduction in workload for GP surgeries and sexual health clinics
- reduce risk of unplanned pregnancies
potential issues of the OTC POP
- patients have to pay for this
- there are safeguarding concerns
pharmacist role in contraception
- they are not suitable for everyone (must ask questions)
- ensure women aware of the options available to them (if they want LARC, IUD or implant, they’ll need referral to GP or family planning clinic)
- check for interacting medications (especially hepatic enzyme inducers)
what questions should be asked before providing someone with Lovima OTC?
if the answer is yes to any of these questions, Lovima should not be supplied and she should be referred to her doctor
- could the woman be pregnant?
- does she / could she have a thrombosis (blood clot)?
- does she have diabetes?
- does she have, or have a history of liver disease or liver cancer?
- does she have a history of, or suspect she has an active sex-steroid sensitive cancer (eg. breast, uterine or ovarian)?
- does she have any unexplained vaginal bleeding?
- is she allergic to peanuts or soya?
- does she have an intolerance to certain sugars such as lactose?
- does she have any other allergies?
what is the relationship between POP (Lovima) and EHC?
Lovima can reduce the effectiveness of some EHC tablets
if levonorgestrel is taken as EHC, when should Lovima (POP) be resumed / continued?
- start or continue taking Lovima immediately
- use additional barrier contraception (condom) for 7 days
if ulipristal is taken as EHC, when should Lovima (POP) be resumed / continued?
- start taking Lovima no sooner than 5 days after taking ulipristal (Lovima can stop ulipristal from working)
- use additional barrier contraception for 5 days after taking ulipristal and then 7 days after starting Lovima (12 days in total)
