Genito-Urinary Tract System - Medium Flashcards
Which form of oestrogen is most commonly used in preparations of combined oral contraceptive?
Ethinylestradiol
A combined oral contraceptive containing a fixed amount of oestrogen and progestogen is known as what?
Monophasic
A combined oral contraceptive with varying amounts of both the oestrogen and progestogen is known as what?
Multiphasic
What is normally the first line choice combined oral contraceptive and why?
A monophasic preparation of 30 micrograms or less of ethinylestradiol with either levonorgestrel or norethisterone.
This choice minimises cardiovascular risk
Besides the more traditional 21 day continuous use and 7 day HFI regimen, what regimens are available to patients using combined oral contraceptives?
- Shortened HFI = 21 days continuous use followed by 4 day HFI
- Flexible extended use = 21 days continuous use followed by 4 day HFI when breakthrough bleeding occurs
- Extended use (tricycling) = 9 weeks continuous use followed by a 4 or 7 day HFI
- Continuous use with no HFI
Use of a traditional combined hormonal contraceptive regimen may be associated with what adverse effects?
- Heavy and/or painful withdrawal bleeds
- Headaches
- Mood changes
- Increased risk of misuse and subsequent unplanned pregnancy
Progestogen-only oral contraceptives may contain which hormone APIs?
Levonorgestrel
Norethisterone
Desogestrel
How often is depot medroxyprogesterone administered?
Every 13 weeks
Which hormone is used in the contraceptive implant?
Etonogestrel
Which hormone is used in contraceptive IUS’?
Levonorgestrel
What is the most effective form of emergency contraception and should be offered to all women who have unprotected sexual intercourse?
Copper intrauterine device
Can be inserted 5 days after he first incidence of unprotected sex in the menstrual cycle, or 5 days after the earliest due date of ovulation
Which progestogens are used as oral emergency contraception and within how long from the incidence of unprotected sex can they be used?
Levonorgestrel - within 72 - 94 hours
Ulipristal - within 5 days
What is the first line emergency oral contraceptive for women who have had unprotected sexual intercourse in the last 96 - 120 hours?
Ulipristal acetate
What is the first line emergency contraceptive for women who have missed a dose/s of regular combined hormonal contraceptive within he first week of restarting their contraceptive regimen?
Levonorgestrel
Can ulipristal and levonorgestrel be used as emergency contraceptives more than once in the same cycle?
Yes
Which form of contraception provides effective ongoing contraception immediately after a women has taken emergency contraception?
Copper IUS
How should a women who does not use regular hormonal contraception start hormonal contraception after receiving ulipistral as emergency contraception?
She must wait 5 days to start regular hormonal contraceptives, during which she must either use condoms or abstain from sex until the contraceptive is effective
How should a women who does not use regular hormonal contraception start hormonal contraception after receiving levonorgestrel as emergency contraception?
She must start hormonal contraception immediately and either use condoms or abstain until the contraceptive is effective
How should a women who does use regular hormonal contraception start hormonal contraception after receiving ulipistral as emergency contraception after missing contraception within the first week of restarting it?
She can start regular hormonal contraception immediately, however she must use condoms or abstain from sex for 7 days until the contraceptive become effective
List some drugs that, when used concurrently with hormonal contraceptives reduce their efficacy
Enzyme inducers:
- Rifampicin
- Carbemazepine
- Phenytoin
- Phenobarbital
- Ritonavir
- Topiramate
Which forms of contraceptives are not affected by enzyme inducers?
- Parenteral progesterogens
- Levonorgestrel IUD
These should be continued up to 4 weeks after the cessation of enzyme inducer therapy
During a short term (<2 months) course of enzyme inducing drugs, what hormonal contraceptive treatments can be used?
- Combined oral contraceptives can be used, but only with the consistent use of condoms during and for 4 weeks after treatment
- Long term course of enzyme inducers (>2 months) excluding rifampicin and rifabutin - Use of a monophasic COC at a dose of >50 micrograms of ethinylestradiol using either a tricycling regimen during and for 4 weeks after treatment
What is the main non-drug related factor which may affect the efficacy of hormonal emergency contraceptives?
Levonorgestrel and ulipistral
High BMI - may require a double dose of levonorgestrel
Ulipistral is still first line and can be given at the normal dose
During long term therapy (>2 months) using enzyme inducing drugs (excluding rifampicin and rifabutin) what hormonal contraceptive measures can be used?
Use of a monophasic combined oral contraceptive at a dose of >50 micrograms of ethinylestradiol using a tricycling regimen during and for 4 weeks after treatment
During long term therapy (>2 months) using rifampicin or rifabutin what hormonal contraceptive measures can be used?
An alternative method of contraception (such as an IUD) must be used instead of combined hormonal contraceptives as they are such potent enzyme inducers
Can oral progestogen-only contraceptives be used in combination with enzyme inducing drugs?
No, an alternative contraceptive method must be used
Can IM norethisterone and medroxyprogesterone be used in combination with enzyme inducing drugs suchas rifampicin and phenytoin?
Yes, they are unaffected by enzyme inducing drugs
What is the MHRA warning associated with the use of copper intrauterine devices?
Updated information os risk factors for uterine perforation (
What is the MHRA warning associated with the use of ulipristal acetate 5mg (ESMYA)?
Further restrictions due to the risk of serious liver injury (February 2021)
