Genitourinary contraception Flashcards by Samantha Hughes

When can combined contraception be started in the cycle?

Up to and including day 5 of cycle without additional precautions, anytime after day 5 can be started but with additional precautions

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which progesterone only pills have been approved by MHRA for OTC use?

Desogestrel 75mg - Hana,Lovima

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What is an alternative contraceptive if patient takes enzyme inducing drugs? and for how long to use?

Progesterone only injectable e.g. medroxypogesterone acetate
OR Copper IUD

Until 4 weeks after stopping enzyme inducer

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When can progesterone only pill be started?

up to day 5 of cycle without additional precautions

after this - ned 48hrs of additional contraception

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Which contraceptive would be used if a patient experiences headaches?

Containing 
Gestodene
dosperinone
norgestimate
desogestrel

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How long supply can you give contraceptives prescriptions

12months

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What is the age cut off for combined contraception

50 (not in >50)

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What cancers do combined contraceptives reduce the risk of?

Ovarian
Endometrial
colorectal

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Which contraception should be stopped prior to surgery and when?

Combined due to risk of VTE - discontinue at least 4 weeks before and use alternative e.g. progesterone and re-start 2 weeks after full mobilisation

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When would you avoid oestrogens in contraception?

If risk factors for VTE e.g. obesity, smoking, immobilisation long term, >35, primary relative with VTE,
use of desogestrel, gestodene, drosperinone

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There are concerns regarding bone loss due to progesterone only pills, so what are the restrictions on their use because of this?

<18 (only depot can be used if all other options unsuitable)
>50
Significant risk factors for osteoporosis
R/V every 2 years (no specific time limit)

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How long can etonogestrel implant be used for?

3 years

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How long can the intrauterine system releasing levonorgestel be used for?

3-10 years

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What cancers do combined contraceptives increase the risk of?

Breast and cervical

progesterone is just breast

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What is considered a missed pill for combined oral contraception? when is the critical time?

> 24hs
Critical when pill missed at start or end of cycle

(Zoely/qlaria is >12hrs)

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If one contraceptive pill is missed then what should be done?

Take one pill ASAP and next one at normal time even if that means taking two.
No need for extra precuations

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If 2 or more combined contraceptive pills are missed what is done?

Take one pill ASAP and use a condom for 7 days (9 days if zoely/qlaria)

If missed in the last 7 days: Omit pill free interval
If missed in first 7 days and unprotected sex: EHC needed

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If a patient is vomiting or has diarrhoea for >24hrs (severe) then how is combined contraception advised?

Would need extra protection until 7 days after recovery and pill is resumed
(9 days of qlaria)

If it happens in last 7 days= omit pill free interval

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If a patient is vomiting within 2 hours of taking then how is combined contraception advised?

Take another ASAP

What is a missed progesterone only pill considered as?

> 3 hours

or desogesterl is 12hrs

What to do if miss a progesterone only pill?

Take ASAP and use condoms for 2 days

If unprotected sex occurs before 2 pills are taken correctly - EHC

If vomiting/diarrhoea is severe what is advised for progesterone only pill?

Additional Protection until 2 days after recovery and pill resumed

What is considered a missed patch?

detached for >24hrs or delayed application at beginning of cycle
or delayed application in middle of cycle (day 8 or 15)

If a patch has a delayed application in middle of cycle (day 8 or 15) 
and its 
<48 hours OR
>48 hours 
what is advised

<48hrs - apply new patch and continue as normal

>48hrs- start a new day 1 cycle and condom for 7 days

What is the most effective form of emergency contraception and when can it be used?

Copper IUD- up to 5 days after unprotected sex

When would copper IUD as EHC be less suitable?

<25years due to risk of PID (But is used)

What EHC is used if BMI >26kg/m2 or >70kg?

Ulipristal acetate Or doubled dose of levonorgestrel (unlicensed)

What are cautions of levonorgestrel

Crohns /malabsorption syndromes past ectopic pregnancies concomittant ciclosporin (toxicity)

What is a contraindication of Ellaone

Repeat use in the same menstrual cycle - cannot do

What are cautions of EllaOne

Sever asthma treated by oral corticosteroids | Severe liver impairment

What is some counselling for Ulipristal acetate?

It reduces effectiveness of the regular contraceptives so use barrier protection for 14 days (combined) or 9 days (progesterone) Wait 5 days until start taking regular contraception again Use barrier protection until next period If get any irregular periods/unusual - take a pregnancy test 3 weeks after Lower abdominal pain - see GP - ectopic pregnancy rule out

How long can you use the mirena coil for?

5 years

What are 3 side effects of intrauterine devices?

Pain on insertion/bleeding Uterine perforation - severe pelvic pain/changes in periods/bleeding Infection risk

What is the MHRA warning regarding IUD contraception?

Risk of uterine perforation - Report any severe pelvic pain after insertion or sudden changes in periods, pain in sex, bleeding >few weeks

What pre treatment screening is done for IUD?

Chlamydia screening due to risk of PID / infection / carriage of existing STIs - in high risk groups e.g. <25, new partner, multiple partners, history of STI BUT if its emergency contraception then abx prophylaxis given as screening wont occur - treat as emergency if sustained pain in the next 20 days

What pre treatment screening is done for IUD?

What situations would you refer requests for EHC OTC?

>5 days since unprotected sex as need IUD fitting Changes to periods Liver dysfunction Taking enzyme inducers

What circumstance would you refuse EHC?

If only missed one pill of their regular combined oral contraceptive - no need

What are the age limits for Levonelle and Ellaone OTC

Levonelle: 16+ Ellaone: all childbearing age incl <16

Can women still breastfeed if taking EllaONe or levonelle?

Levonelle yes | Ellaone No - not recommended for 1 week - express/discard

What is a significant interaction of levonelle?

Ciclosporin

Can a menopausal woman be given EHC?

Yes because they can remain fertile up to 2 years after their last period

How long does the medroxyprogesterone injection last? what is the risk of this?

2 years Osteoporosis risk

What contraceptive injection would be beneficial for short term use whilst awaiting for a male vasectomy to become effective?

Norethisterone injection - lasts 8 weeks

What is the MHRA alert for etonogestrel implant?

Nexplanon - reports of device in the vasculature and lungs - may reach the lung via the pulmonary artery - needs to be palpable otherwise locate and remove

How long does etonorgestrel implant last for

3 years