Gynae - Contraception Flashcards
Advantages of the COCP
Reversible
Periods lighter, more regular, less painful
Reduced ovarian, endometrial, colorectal cancer
Reduce ovarian cysts, benign breast disease, acne
Disadvantages of the COCP
May forget
No protection against STI
Increased VTE risk
Increased breast and cervical cancer risk
Increased stroke/IHD risk (esp in smokers)
Temp side effects (headache, nausea, breast tenderness)
UKMEC 4 COCP
- > 35yo and smoking 15+ daily
- Migraine w/ aura
- Thromboembolic disease history
- Stroke/IHD history
- Breast feeding <6 weeks post partum
- Uncontrolled HTN
- Current breast cancer
- Major surgery iwth prolonged immobilisation
- Antiphospholipid antibodies (e.g SLE)
Does COCP need additional contraception when starting?
If started within first 5 days of cycle, no.
Otherwise, 7 days of additional contraception
What is the COCP regime
Typically
- 21 days on, 7 days off.
- Alternatively, 3 21 day packs followed by a 4 or 7 day break.
- Intercourse in pill free period safe if next pack started on time
What 3 things reduce efficacy of the COCP
- Vomiting within 2 hours of taking
- Medications that induce diarrhoea or vomiting
- Liver enzyme inducing drugs
What if someone misses a COCP pill
If 1 missed, take the last pill, even if it means taking 2 in one day, then continue daily; no additional contraception.
What if someone misses 2 COCP pills
Take last, even if it means taking 2 in one day. Use condoms or abstain until pill has been taken for 7 consecutive days.
If pills missed in:
- Week 1 (day 1-7) - emergency contraception if sex in pill free interval or week 1
- Week 2 (8-14) - Already taken 7 days, no need for emergency or barrier
- Week 3 (15-21) - Finish current pack and start new pack next day (omitting pill free interval)
What contraception can be used beyond 50 years old
Implant
POP
IUS
If amenorrhoeic, check FSH and stop if FSH>=30, or stop at 55.
How should a COCP be changed at 50yo
Switch to non hormonal (IUD, condoms, family planning) and stop after 1 year of amenorrhoea
How should Depo-Provera (injection) be stopped
Swithch to non hormonal method and stop after 2 years amenorrhoea, or switch to POP and stop after 1 year if FSH >=30, or stop at 55.
MoA of COCP, POP, Injection and implantable contraceptives, IUD and IUS.
What is unique about desogesterel
COCP: Inhibits ovulation
POP: Thickens cervical mucus
Injectable/implant: Inhibit ovulation (primary) and thicken cervical mucus.
IUD (copper): Decreases sperm motility and survival
IUS (progesterone releasing): Prevents endometrial proliferation and thickens cervical mucus
Desogesterel is a POP that also inhibits ovulation
What contraceptives cause irregular bleeding
- POP
- Implant
- IUS
How long do implant and injection last
Injection: 12 weeks
Implant: 3 years
What are some emergency contraceptiosn
Levonorgestrel and ulipristal: inhibit ovulation
IUD: Toxic to sperm and ovum and inhibits implantation
What contraception is less effective in patients over 90kg. What BMIs are UKMEC 2 and 3 for COCP
COCP
- 30-34 UKMEC2
- 35+ UKMEC3
Patch is less effective
What are Fraser guidelines
Young person must:
- Understand professional’s advice
- Cannot be persuaded to inform parents
- Likely to begin, or continue having sex with or without contraception
- Their physical, mental or both health are likely to suffer without
- Young person’s best interests, with or without parental consent
How should STI testing occur in kids and what is the contraception of choice
2 and 12 weeks after UPS
Progesterone implant is best, as progesterone injection is UKMEC 2
What is the most effective emergency contraceptive
When should Levonorgestrel and Ulipristal be taken
Copper IUD most effective - within 5 days of UPS
Levon - within 72 hours (1.5mg). (if they vomit within 3 hours, repeat dose)
Ulip - within 120 hours. May reduce effectiveness of hormonal contraception - pill, patch or ring must be started 5 days after.
Orals can be used more than once in the same cycle
What are UKMECS for contraceptive in epilepsy
For lamotrigine:
UKMEC 3: the COCP
UKMEC 1: POP, implant, Depo-Provera, IUD, IUS
For women taking phenytoin,carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine:
UKMEC 3: the COCP and POP
UKMEC 2: implant
UKMEC 1: Depo-Provera, IUD, IUS
What is the implant
Nexplanon (subdermal implant) - most effective form of contraception - lasts 3 years.
Doesnt contain oestrogen - can be used if VTE history
Additional contraceptive needed unless inserted day 1-5.
Adverse effects and MECs of Nexplanon
Irregular/heavy bleeding is main.
Progestogen effects: Headache, nausea, breast pain
4: Breast cancer
3: IHD/Stroke if continuiation
2: suspicious vaginal bleeding, past breast cancer, liver cirrhosis/hcc
Missed POP pill rules
If less than 3 hours late
no action required, continue as normal
If desogestrel less than 12 hours late, no action
If more than 3 hours late (i.e. more than 27 hours since the last pill was taken), or more than 12 hours (more than 36 hours since last pill):
- take the missed pill as soon as possible.
- If more than one pill has been missed just take one pill. Take the next pill at the usual time, which may mean taking two pills in one day
continue with rest of pack
extra precautions (e.g. condoms) should be used until pill taking has been re-established for 48 hours
