Genitourinary contraception Flashcards
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
which progesterone only pills have been approved by MHRA for OTC use?
Desogestrel 75mg - Hana,Lovima
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
When can progesterone only pill be started?
up to day 5 of cycle without additional precautions
after this - ned 48hrs of additional contraception
Which contraceptive would be used if a patient experiences headaches?
Containing Gestodene dosperinone norgestimate desogestrel
How long supply can you give contraceptives prescriptions
12months
What is the age cut off for combined contraception
50 (not in >50)
What cancers do combined contraceptives reduce the risk of?
Ovarian
Endometrial
colorectal
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
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
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)
How long can etonogestrel implant be used for?
3 years
How long can the intrauterine system releasing levonorgestel be used for?
3-10 years
What cancers do combined contraceptives increase the risk of?
Breast and cervical
progesterone is just breast
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)
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
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
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
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?
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 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
