Female Hormonal Contraception Flashcards
Why use contraception?
(3)
- not designed for numerous babies ( 2nd= 3rd = safest but increased risk after that)
- reduces mortality
- reduced unwanted pregnancies
-reduced risk of cancer ect. if nulliparity
the perfect contraceptive criteria (8)
- 100% Reliable
- 100% Safe
- Non User Dependent
- Unrelated to Coitus
- Visible to the Woman
- No ongoing Medical Input
- Completely reversible within 24 hours
- No Discomfort
UK Medical Eligibility for Contraception
2016 - ABCD (4)
1/A: A condition for which there is no restriction for the use of the method - ALWAYS usable
2/B: A condition where the advantages of using the method generally outweigh the theoretical or proven risks - BROADLY usable
3/C: 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 - COUNSEL/CAUTION
4/D: A condition which represents an unacceptable health risk if the method is used - DO not use
Types of contraception (10)
Methods which require ongoing action by the individual:
* Oral Contraception
* Vaginal contraception
* Barrier Methods
* Fertility awareness
* Coitus interruptus
* Oral Emergency
contraception
Methods which prevent conception by default:
* IUD
* Progesterone
implant/IUS/injection
* Male Sterilisation
* Female sterilisatio
Combined Oral Contraception - what is used? (2)
- Oestrogen EthinylOestradiol - 20,30,35,50 micrograms
(synthetic oestrogen) - Progestogens
- Older (2nd generation) – Norethisterone (Norethindrone) &
Levonorgestrel
-Newer(3rd generation) – Desogestrel, Gestodene &
Norgestimate (Noregestromin) - Latest (derived from Spironolactone) - Drospirenone - blocks mineralocorticoid action (BP + fluids)
What is the diff b/w all types of COCs and why do ppl go through so many before finding a permanent one?
The progesterone component of the pill differs - but nonetheless if every woman had the same pill it would still produce varying results due to individual differences but alse the progesterone causing these effects = ppl go through 3/4.
Where do Oestrogens act? (2)
giving more than prod. in menstrual cycle
- On anterior pituitary & hypothalamus (-ve feedback) = anov
- On the Endometrium
Why is it combined and not just oestrogen?
will cause prolif. on endo = keep bleeding = hyperplasia (= cancer)
so proges. given to combat that
Where do Progestogens act? (4)
giving more than prod. in menstrual cycle
* On anterior pituitary & hypothalamus (-ve feedback) = anov
* On the Endometrium
* On the fallopian tubes
* On cervical mucus
Proges. role in COC (4)
HPG -tve feedback
O:P ration = instead of cyclical change b/w prolif + sec, = high levels of both all the time = endo switched off = P>O action = thin, atrophic phase endo(not prolif/sec = no preg.)
muscle relaxant = uterine tubes cant get sperm + egg together very well
+ thicken cervical mucus = no penetration
Combined Oral Contraception-
basic principles (6)
- Supra-physiological levels
- “Pseudo-pregnancy”
- Suppression of the HPO axis
In reality: pharmacokinetics highly variable
* Individual serum levels vary
* Suppression may not be absolute
* Follicular activity possible in some
* Breakthrough bleeding in some
-Combined Oral Contraception-
Benefits (10)
- Reliable
- Safe
- Unrelated to coitus
- Woman in control
- Rapidly reversible
- Halve ca ovary
- Halve ca endometrium
- Helps endometriosis,
premenstrual syndrome,
dysmenorrhoea, menorrhagia - Can stop periods if taken continuously
-Combined Oral Contraception-
Risks (6)
- Cardiovascular - Arterial – Progestogen , HBP, smoking (>35)
- Venous – Oestrogen-VTE-clotting disorders
(DVT, PE, Migraine) - Neoplastic - Breast - no, Cervix – no , Liver
- Gastrointestinal – COH/insulin metabolism, Weight gain?
- Hepatic – hormone metabolisms, congenital non-haemolytic jaundices, gall stones
- Dermatological – Chloasma, acne, erythema multiforme
- Psychological – Mood swings, depression, Libido
Oestrogen and Progesterone
Contraindications (10)
Breast cancer;
undiagnosed genital bleeding; pregnancy; <3
weeks post partum; breast feeding;
hypertension; PH
thrombosis; migraine with aura (numb - risk of stroke);
active liver disease; thrombophilia; systemic lupus erythematosus; thrombotic thrombocytopenic purpura;
smoking >15 and age >35
Relative contraindications: BMI>35;migraine without aura; hypertension; diabetes; hyperprolactinoma;
Drugs which induce liver metabolism and
reduce hormone levels (12)
Always check any new drug if on COCP/renewal !!!!!!
- Griseofulvin
- Barbiturates
- Lamogitrine
- Topiramate
- Carbamazepine
- Oxcarbazepine
- Phenytoin
- Primidone
- Rifampicin
- Modafinil
- Certain antiretrovirals
these drugs induce ccp450 (which breakdown drugs in liver) - P/O will make p450 really active/high/mad = breakdown o+p = PREG.
-Combined Oral Contraception-
Pill Rules (7)
- Start 1st packet 1st day of a menstrual period
- Take 21 pills and stop for 7 day break (PFI)
- Restart each new packet on 8th day (same)
- Do not start new packets late
- If late or missed pills in 1st 7 days, condoms
- If missed pills in last 7 days no PFI(break) - 10days needed to ov. so breaks here = preg can occur
Annual BMI and BP
