Extra Contraceptive Stuff Flashcards
How often should the COCP be taken?
21 days out of a 28 day cycle with a week off. Sugar pills may be taken during this period to aid compliance
What is in the combined contraceptive pill?
Ethinyl estradiol and a progestogen, usually levonorgestrel, a second generation progestogen
How does the COCP work?
Prevention of ovulation be negative feedback to pituitary, reducing release of LH and FSH
Endometrial effects if progesterone prevent implantation
Cervical mucus changes exclude sperm
What are common side effects of COCP?
Nausea Mastalgia Headache Irregular bleeding Most settle down within three to six months
What risks are increased with COCP?
Venous thromboembolism
Ischaemic stroke
Cancer of the breast
Cancer of the cervix
Some reductions in uterine and ovarian cancer
Always mention risk of VTE when counselling!
What are the contraindications of COCP?
Smoking more than 35 a day if older than 35 BMI over than 35 Migraine with aura History of VTE Breast cancer Liver disease Vascular disease including CVA Congenital heart disease
What drugs do COCP interact with?
Enzyme inducers Phenytoin, carbamazepine Rifampicin St. John's wart Ritonavir (HIV therapy)
What are the missed pill rules for COCP?
A pill is missed when it is >24 hours late
If two or more missed pills, use condoms or abstain for a week
If missed in first week, consider emergency contraception
Mistakes in the last week? Run packs together!
How is the combine contraceptive patch (evra) used?
Three patches for seven days
Three weeks out of four
Failure rate is 1.24
Alternate site of application
Each patch has hormone for nine days
Cover is lost if patch has fallen off and not replaced with a new one in 24 hours
How is the combined vaginal ring used?
Failure rate 1.2
Inserted by patient, left in Vagina for three weeks, then one week off
New ring inserted every cycle
If ring is out for three hours or more, efficacy is lost
If falls out, wash and replace
What is the mode of action of progestogens?
Prevents ovulation
Thickens cervical mucus
Reduces endometrial receptivity
What are common side effects of progestogens?
Bleeding irregularities Headaches Mood changes Weight gain Acne
How is the progestogen only pill taken?
Taken continuously throughout the cycle, no week off
Desorgestrel is most common type
What are the contraindications of POP?
Breast cancer in last five years
Current enzyme inducers
Continuing use following a CVA
Severe cirrhosis, hepatoma
What are the missed pill rules for POP?
With desorgestrel, pill is missed if not taken for 12 hours
With other progestogens, it is three hours
Take additional precautions for 48 hours and consider emergency contraception
