FEMALE HEALTH DRUGS

Question 1

Combined Oral Contraceptive Pill (COCP)

Ethinylestradiol with Levonorgestrel

Answer 1

I: Menstrual symptoms, contraception
MOA: prevents ovulation
SE: Acne, headaches, nausea, weight gain
increase risk of breast cancer, >5 years increase risk of cervical cancer , risk of VTE **
CI: Smoker >35yrs, Obese, Diabetes, HTN, Severe migraines with aura, Hx/Fhx VTE, Breast cancer
C: Hepatic impairment
PC: - each tablet to be taken around the same time each day - if delayed, contraceptive protection may be lost
- If woman is not pregnant, first course can start any day of cycle
- precaution after day 6/7 of cycle - will not be protected until 7 days of taking pill - protection
- withdrawal bleed for 7 days (like a period)

If you miss one pill <12hrs, take as soon as you remember - no contraception needed (may need to take 2 in one day but it is fine)
If you miss a pill >12hrs, take an additional ASAP but not the missed pills. use protection for 7 days from the date of missed pill

If you have <7 pills left in the packet before withdrawal bleed, begin next pack without 7 day break
If you have >7 piils left in pack before withdrawal bleed, finish pack and allow bleed to occur before starting next pack

Question 2

Progesterone Only Pill (POP)

Desogestrel

Answer 2

I: Contraception ( preferred in smokers when cocp is contraindicated)
MOA: prevents ovulation - Thickens cervical mucus and thins the endothelium
SE: Breast abnormalities, depressed, headache, nausea, decreased libido, can cause irregular bleeding
CI: Breast cancer
C: Diabetes, Hx of breast cancer, hx of VTE, IHD, hepatic impairment
KI: Carbamazepine, Rifampicin, Topiramate

Question 3

Emergency Contraception
Levonorgestrel (Levonelle)
Ulipristal Acetate (EllaOne)
Emergency Copper IUD

Answer 3

I: Unprotected sex, split condom , missed a pill etc.
MOA: EllaOne and Levonelle both work by stopping the release of the egg
SE: Headache, Abdo pain, Nausea, Vomiting, dizziness
CI: Both: Breast cancer, < 21 days following giving birth, <5 days following miscarriage/ abortion
KI: Ellaone: Clarithromycin, carbamazepine
Levonelle: Carbazepine, Rifampicin
C: EllaOne: severe asthma
Levonelle: BMI >26kg/ >70kg
PC: - Emergency contraception needs to be taken within 3 days with Levonelle or within 5 days with EllaOne
- EC pill can make next period earlier later or more painful
- If you vomit within 2 hrs of taking Levonelle or 3 hrs of taking EllaOne, Go to GP as you may need an IUD fitted
- SAFETYNET: severe abdo pain, radiates to shoulder, abdo tenderness (adnexal mass)
- EC are not intended for regular contraception - if pt wants they can discuss IUD

IUD: - small T shaped plastic copper device that is inserted in the womb
- can be fitted up to 5 days after unprotected sex or up to 5 days after ovulation
MOA: Inhibitory effect on both fertilisation and implantation (stops egg in the womb from being fertilised)
SE: Pain, risk of infection, damage to the womb, risk of IUD coming out, heavier/longer/painful periods the longer you use it
PC: very effective (99%)

Question 4

Hormone Replacement Therapy

Oestrogen and Progesterone

Answer 4

I: Hormonal contraception , HRT to delay early menopause/ treat menopausal symptoms
SE: irregular bleeding, mood changes, increase risk of CVD + stroke, increased risk of breast + cervical cancer
CI: Breast cancer, increased risk of VTE, CVD (>35, smoker, migraine with aura)
C: Fhx of VTE
KI: P450 inducers (rifampicin, carbamazepine) reduced efficacy
PC: Should only be offered after discussion of risks and benefits of various contraceptive methods available.
- Pill results in withdrawal bleed each month [ irregulat bleeding may occur initially]
- How to deal with missed pills
M: follow up in 3 months to check BP and discuss issues then yearly for BP and BMI