Gynae - Contraception Flashcards
define contraception
the prevention of pregnancy
what is the effct of breast feeding on pregnancy?
if one is FULLY breastfeeding, it CAN be effective meethod of contraception apparently up to 6 months?
but one can get pregnant after 3 weeks… just saying
a postpartum woman has unprotected intercourse day 16 postpartum. she does not want any more children. what is your advice?
she will not require emergency contraception because is within 3 weeks.
should discuss long term contraception
woman was taking cocp before birth of her newborn. she liked it and is now keen to restart it 4 weeks postpartum. what is your advice? why?
The combined pill COCP affects breast milk volume and is avoided before 6 weeks postpartum
and is relatively contraindicated between
6 weeks and 6 months postpartum.
she CAN use it after 6 weeks if she wants but ideally not.
Because;
- still in hypercoagulable state ?
- estrogens can reduce milk production
she can have progesterone only methods instead
when can different contraception forms be used after pregnancy?
Progestogen-only methods :
- immediately postpartum and thereafter
IUD:
- can be inserted 4 weeks postpartum
COCP - contraindicated
Combined formualtions - Patches, ring
sterilisation
A woman comes in. she has a PMH of Ulcerative bowel disease. She would like contraception to avoid pregnancy. what do you advise?
With IBD - NO ORAL FORMS!
patches, progesterone-only injectables and
implants, intrauterine and vaginal methods ONLY!
BUT also depo is NOT the best due to increased risk of osteoporosis! with IBD - already increased risk due to malabsoprtion
under 18s must NOT have which contraception option? why?
Depo-Provera should
not be the first-line option in patients under 18 years
of age.
a 46 year old woman comes in. she is currently taking contraception. she would like to discuss stopping the contraception because she believes she has entered menopause. Her last period was 12 months ago. what do you advise?
Women under the age of 50 years are advised to continue contraception for at least 2 years after the last
period.
so in her case she needs to continuee for another 12 months
a 52 year old woman comes in. she is currently taking contraception. she would like to discuss stopping the contraception because she believes she has entered menopause. Her last period was 12 months ago. what do you advise?
a woman over 50 should continue contraception for 1
year after the last period;
so in this case she can stop the contraception if she has been taking it all the 12 months since her last period.
how do COCPs work?
Combined oral contraceptives (COCs) act mainly by
exerting a negative feedback effect on gonadotrophin
release and thereby inhibiting ovulation.
They also thin the endometrium and thicken cervical mucus.
hwo is eefficacy of contraceptive rated?
Pearl index
tells how many women per 100 using the method get pregnant in 1 year.
what are the rules if there is vomiting/diiarrheoa during taking the COCP?
The woman should
continue taking the pills but follow the missed pill
instructions (see below) for each day of the illness. ( barrier contraception?)
If
she vomits within 2 hours of taking the pill, she should
take another or follow the rules for missed pills
what are the rules if there taking antibiotics during taking the COCP?
wiith broad-spectrum antibiotics, she should continue
the pills but use condoms during and
for 7 days after the antibiotic course
what happens if some1 misses pills in the COCP pack?
Up to 2 if fine - normal stregnth eg microgynon
low dose preps - only 1 missed is fine
The forgotten pill should be taken as soon as possible and then the packet continued as normal.
If more pills have
been missed, the packet should be continued as normal
but condoms should be used for 7 days.
woman has missed 4 pills. she has 5 pills left in the pack. what advice to give her?
Continue pack as normal
Use condoms for 7 days
If there are fewer than 7 pills remaining in the packet, the next
packet should be started straight after the last, avoiding
a pill-free break
woman has beeen takinig COCP for 4 months. she has ben having vaginal bleeding and spotting every month in between periods. what adviice?
breakthrough bleed should stop in 3 months
change to higher dose oestrogen cocp
or stronger proesterone cocp
what is the must know informatoin regarding COCPs and their use?
Failure: Pearl Index (PI) 0.1 (perfect use); 5.0 (typical
use)
Mode of action: Inhibits ovulation
How to use: Start on day 1 of cycle, 3 weeks, then 1 week
break
Benefits: Good contraception, cycle control, well
accepted. Reduces risk of developing fibroids,
and ovarian, endometrial, bowel cancer
Rare major problems:
Deep vein thromboses, ischaemic heart disease!!
Others: cerebrovascular accident, hypertension,
breast and cervical carcinoma
Common side effects: Breast tenderness, bleeding, headaches, nausea, breakthrough bleeding - progestogenic side effects
Drawbacks: Major side effects and contraindications. User dependent so failure rate increased
which women cannot use COCPs?
Who can use:
Any
Absolute contraindications: Hx venous thrombosis Hx CVA, IHD, High BP - controlled or NOT! Migraine w aura Active breast or endometrial CANCER Inherited thrombophilia Pregnancy Smokers >35 years and >15/day BMI > 40 DM with vascular complications Liver disease
Relative contraindications: Smokers Chronic inflammatory disease Renal impairment DM Age >40 BMI 35-40 Breastfeeding up to 6m postpartum
How are transdermal patches used?
A new patch is applied weekly for 3 consecutive weeks,
this is followed by a patch-free week
how is the nuva ring used?
what is the mode of action?
The ring is easily
inserted into the vagina by the patient and worn for
3 weeks. It is then removed to allow for a 7-day ringfree
break and a withdrawal bleed.
It is
recommended that the ring not be removed during
intercourse but, if necessary, may be removed for a
maximum of 3 hours.
mode of action: inhibits ovulation
what are the side effects and benefits of nuva ring?
Benefit : better tolerated than the COC
due to lower systemic oestrogenic side effects
Negative : same
metabolic and coagulation effects as other combined
hormonal methods
what is the must know information regarding POPs and their use?
Failure: PI 0.5 (perfect use); 5.0 (typical use)
(Cerazette/ Cerelle similar to combined pill)
How to use: Continuous, every day at same time - only 3 hour window (Cerazette/ Cerelle 12 h window)
Side effects: Vaginal spotting, weight gain, mastalgia
and premenstrual-like symptoms are most common.
Functional ovarian cysts!
Benefits: Few contraindications, lactation. no increased risk of thrombosis
Drawbacks: Compliance and failure rate. User dependent. COCP better
how do POPs work?
Mode of action: makes cervical mucus hostile
to sperm and sometimes inhibition of ovulation
who can use POPs?
Who can use: Any. Need to be strict and good with timing
Usually used for older women and lactatinig mothers!
what are the progestogenic side effects?
vaginal
spotting (breakthrough bleeding), weight gain, mastalgia
and premenstrual-like symptoms are most common
woman is taking a POP. She has missed her pill by 5 hours. what do you adviise?
If a pill is missed
by more than 3 hours then another should be taken as
soon as possible and condoms used for 2 days.
