Missed pills, POC, Non Hormonal Flashcards
KEY definitions
Missed pill:
- Definitions vary depending in med
Missed pill is one that is 24 hrs or more late for COC.
- 12hrs or more for zoely, Qlaira, Desogestrel
- >3 hrs for Levonorgestrel or norethisterone.
Critical time:
Time where contraception is lost ie when pill is missed at the START/END of cycle. (lengthens pill free interval)
ie miss 1 pill = 7 + 1 = 8 days pill free
CHC missed pills (PICs)
1 missed pill
Missing 1 pill DONT need Emergency contraception (EHC) BUT:
If 1 pill is missed and no Sex
- Take active pill ASAP even if means 2 at once.
- Mnemonic 1 pill smile
2 missed pill
If miss ≥2 esp. 1st 7 days = not protected - Take ACTIVE pill ASAP. Abstain from sex/ use extra protection.
- or 7 days/9-zoely & Qlaira
- EHC recommended for this case.
IF missed in last 7 days 14/21 start new pack ASAP. DONT NEED EHC
- Mnemonic: 2 pill Cry
POC
3 forms:
Oral
Parenteral
Intra uterine devices IUD
Oral POC
- Examples: Levonorgestrel 30mcg, desogestrel 75mg, Norethisterone 350mcg - NO PILL FREE INTERVAL to be taken DAILY.
These are used as suitable ALT to CHC when oestrogen contraindicated
(VT or Hx of VT, Heavy smokers, HTN >160/95, Valvular disease, Diabetes with complications and migraine with aura).
Progestogens alter cervical mucus to prevent sperm plantation and can inhibit ovulation in some women.
- They can cause menstrual irregularities (heavy/light periods)
- Deso the only prep that inhibits ovulation
NOTE - EHC levo = 1.5mg
POC - LEVONOGESTREL - missed pills ETC
If missed take ASAP and take next pill on time.
- Pill >3hrs overdue PT is not protected. continue normal pill taking but use extra protection for 2 days.
USE EHC: ≥1 POC missed or taken >3hrs late & Sex occurred before 2 further tabs been correctly taken
Summarise missing pill >3 hrs not covered and need 2 on time pills to be covered again (takes 2 days)
Vomiting/Diarrhoea
If vomit within 2 hrs of POC take another pill.
- If replacement pill not taken within 3 hrs of normal pill time or if severe diarrhoea or persistent vomiting use extra protection for 2 days after recovery.
POC - DESOGESTREL - Missed pill etc
75mcg daily - Take same time daily.
Start on day 1 of cycles then continue. Extra protection for 2 days if started after day 5 of cycle.
- Missed dose >12 hrs = Missed pill.
Vomiting/Diarrhoea - Take another pill within 2 hrs if vomiting occurs.
If replacement not take within 12 hrs use extra protection for 2 days
USE EHC if 1 or more pills are missed or taken >12 hrs late and Sex occurred before 2 further tabs been correctly taken
Parenteral POC (ALL long acting)
Injections/Implants
- Medroxyprogesterone (Depo provera) injection - 2 years
* Can cause troublesome bleeding & menstrual issues, can reduce bone mineral density = osteoporosis.
* For adolescents use only when everything else not able
- Norethisterone (Noristerat) - Injection = 8 weeks contraception
- Etonogestrel (Nexplanon) Implant - contraception for up to 3 years
MHRA - Nexplanon can move around from insertion site causing neurovascular injury or block artery - Remove implants that cant be felt at insertion site ASAP.
IUD - POC
Examples: Mirena, jaydess, levosert
- They release levonorgestrel in to the uterine cavity
- Chosen for women with excessively heavy periods
Return to fertility is rapid after removal.
Advantages of levo IUD vs Copper IUD
* Reduces blood loss
* Improved dysmenorrhea
* reduced pelvic diseases
In primary menorrhagia menstrual bleeding is reduces sig. within 3-6months of inserting Progestogen IUD
Surgery
ALL POC are suitable as ALT for CHC before surgery.
- As they dont increase risk of VT (only oestrogen causes this)
Non hormonal Contraceptives
Spermicidal (films, gels, foams)
- AVOID alone unless fertility sig. diminished
- Use with barrier methods
- Don’t use with condoms or PTs high risk of STIs
Oil based lubes damage condoms so avoid
Copper IUD
Suitable for ALL ages but CAUTION in <25 yrs due to > risk of PID.
- AVOID IN PID
- Most effective. Smaller devices = Less AEs.
