Fertility Control Flashcards
Ideal Contraception
Highly Effective No SE or Risks Cheap Independent of Intercourse Requires no regular action by user Non contraceptive benefits Acceptable to all cultures and religions Easily distributed and administered
Failure Rate
Expressed as failure per woman-year
Number of pregnancies that would occur if 100 women were to use this method for 1 year
Potential for failure often due to poor use rather than intrinsic failure
Classification
Combined Hormonal
Progestogen-only
Emergency Contraception
Intrauterine
Contraceptive Consultation
PMHx, PSHx Sexual Hx FHx CVS Disease VTE risk factor query Smoking Blood pressure
COCP
Synthetic oestrogen with progestogen
Available as patch and vaginal ring
Contain Ethinyl Estradiol
Progestogens: Second generation-Norethindrone, levonorgestrel
Third: Desogestrel, Gestodene, Norgestimate
For hirsutism and acne: Contains cyproterone-antiandrogenic
Mechanism of Action of COCP
Inhibition of ovulation: Suppresses FSH and LH preventing follicular development
Peripheral effects: Atrophy of endometrium, making it hostile to implantation, alteration of cervical mucous, preventing ascension of sperm into uterus
How is the COCP taken
One pill daily at the same time for 21 days
7 day pill free interval (some contain placebo pills for that interval)
Contraindications for the COCP
Cardiovascular: CVD, HTN, IHD, VHD Hx of VTE, Major surgery-stop COC at least 2 months before elective pelvic surgery Others: Breastfeeding less than 6 weeks post partum Migraine with aura or >35 Current breast cancer Severe longstanding DM Acute viral hepatitis Severe cirrhosis Liver tumours
Side Effects of COCP
Depressed Mood Swings Headaches Loss of libido Nausea Bloating Breakthrough bleeding Increased vaginal bleeding Mastalgia, enlarged breasts Chloasma pigmentation Fluid retention Might improve Acne, PMS Long term protection against ovarian and endometrial cancer
Cardiovascular SE of COCP
Increased risk 3-5 fold
Oestrogens alter clotting and coagulation leading to pro-thrombotic tendency
3rd Gen Progestogens more likely to sustain VTE
Very small absolute risk but increased in presence of absolute CI such as Inherited Thrombophilia, significant FH of VTE
Arterial disease: Much less common, risk of MI and thrombotic stroke in young, healthy women extremely small
Smoking and HTN increases the risk, advise stopping COCP if >35 years with smoking >15/d or if significant HTN
Breast Cancer and COCP
Small increased risk of developing breast cancer -RR1.24
More relevant to women in 40s or if strong FH
Risk returns to baseline after 10 years stopping
Drug Interactions
Enzyme inducing agents such as some AEDs, higher dose may need to be prescribed instead
Broad spec antibiotics may alter intestinal absorption reducing efficacy , additional contraception should be recommended during Abx therapy and 1 week after
Patient Management of COCP
1 Missed Pill
Three-month supply initially given in first instance, and 6-12 monthly reviews after
• If One or Two 30-35ug EE missed at any time, or One 20ug EE missed – Take most recent pill as soon as remembers and continue other pills daily at same time
o Does not require additional contraceptive protection
o Does not require emergency contraception
Patient Management of COCP
more than 1 missed pill
If ≥3 30-35ug EE pills missed, or ≥2 20ug EE missed – Take most recent pill as soon as remembers and continue other pills daily at same time
o Should use condoms, or abstain from sex until having taken pills 7 days in a row
o If missed pills were in week 1 – Emergency contraception if UPSI in PFI or week 1
o If missed pills were in week 3 – Finish pills in current pack and start new pack after, missing the pill-free interval
Contraception Transdermal Patch
– Norelgesteromin 150mg EE 20mg released per 24hrs;
Weekly for 3 weeks followed by patch-free week; Relatively more expensive
