Gynae contraception Flashcards
What is the MOA of levonorgesterel and ulipristal?
Inhibit ovulation
When do you double the dose of levonorgestrel for emergency contraception?
If BMI >26 or weight >70kg
How long should you wait to commence regular contraception following Ulipristal?
5 days
What emergency contraception should you avoid in asthmatics?
Ulipristal
Commencing the implant:
1. When is additional contraception required?
2. How long is it required for?
- If commenced after day 5 of the menstrual cycle
- 7 days
Commencing the depot injection:
1. When is additional contraception required?
2. How long is it required for?
- If commenced after day 5 of the menstrual cycle
- 7 days
Commencing the IUD/IUS:
1. When is additional contraception required?
- Additional contraception is not required. Both are effective immediately
When can you take Levonorgestrel following UPSI?
72 hrs
When can you take Ulipristal following UPSI?
5 days
When can the IUD be used for emergency contraception?
If inserted within 5 days of UPSI or if 5 days after likely ovulation date
What type of contraception is the contraceptive patch?
Combined
When should the COCP be avoided in relation to weight and smoking?
BMI > 35
Smokes >15/day
Which between the Fraser guidelines and Gillick guidelines are specific to contraception?
FRASER GUIDELINES!
What 2 forms of contraception can be commenced anytime from birth?
- POP
- Implant
When can the COCP be starting post birth in women who are breastfeeding?
> 6 weeks post birth
When can the IUD/IUS be inserted post birth?
Within 48 hrs of birth or >4 wks post birth
What cancers does the COCP increase/decreased the risk of?
Increases risk of…
- Breast
- Cervical
Decreases risk of…
- Endometrial
- Ovarian
- Colon
Commencing the COCP:
1. When is additional contraception required?
2. How long is it required for?
- If commenced after day 5 of the menstrual cycle
- 7 days
Commencing the POP:
1. When is additional contraception required?
2. How long is it required for?
- If commenced after day 5 of the menstrual cycle
- 48 hrs
What are the rules when switching from a traditional POP to a COCP?
Use additional contraception for 7 days
When should you stop the COCP prior to a major operation?
Stop 4 weeks before a major operation.
When is emergency contraception needed regarding missed COCP?
If missed >1 pill from days 1-7 of packet
When is additional contraception needed regarding missed COCP? How long for?
- If more than one pill has been missed
- Use condoms until 7 days of regular pill taking has been established
What should you do if missed > 1 COCP from days 15-26 of packet?
Skip pill free interval and start new pack
What 2 types of POP should you remember?
- Traditional POP
- Desogestrel-only pill (Cerazette)
What delay would mean a POP was missed?
> 3 hrs
What delay would mean a desogestrel-only pill was missed?
> 12 hrs
What delay would mean a COCP was missed?
> 24 hrs
How can you summarise the potential bleeding patterns women starting progesterone only contraception can experience?
- 1/3 will have lighter/no bleeding
- 1/3 will have normal bleeding
- 1/3 will have heavier/unsceduled bleeding
This more troublesome bleeding usually settles after 3 months
When is emergency contraception needed regarding missed POP?
If unprotected sex occurred within 48hrs of restarting regular pills
When is additional contraception needed regarding missed POP? How long for?
- In the event of a missed pill
- Use condoms until 48 hrs of regular pill taking has been established
