Non-LARC Flashcards
What are some forms of Non-LARC?
Combined hormonal contraception
Progesterone only pill
Depot Medroxyprogesterone acetate
Barrier contraception
Natural family planning
Sterilisation
What are the 3 forms of combined hormonal contraceptive?
Combined oral contraceptive
Combined hormonal patch
Combined hormonal ring
MOA of combined hormonal contraception
- Preventing ovulation(this is the primary mechanism of action)
- Progesterone thickens the cervical mucus
- Progesterone inhibits proliferation of the endometrium, reducing the chance of successful implantation
- Decreases tubal motility
Perfect use failure rate of CHC
0.3%
Typical use failure rate of CHC
8%
Factors that affect effectiveness of CHC
- Impaired absorption (E.g. IBD)
- Increased metabolism (E.g. Liver enzyme induction)
What examinations are required before prescribing CHC
- Record BP and BMI
- Check smear status if relevant
- Check UKMEC
How should CHC be started?
Start on day 1 of menstrual period (Offers immediate protection)
Starting after day 5 of menstrual period, use 7 days of alternative contraception
How to switch between different COCPs
Finish one pack then immediately start the new pill pack without the pill-free period
How to switch from traditional POP to COC
Can switch any time but 7 days of alternative contraception is required
How to switch from desogrestrel POP to COC
Can switch immediately with no alternative contraception required
What are the 2 types of COC pill
Monophasic pills
Multiphasic pills
What is monophasic COC
The whole pack contains the same amount of hormone in each pill
What is multiphasic COC
The pills in the pack contain varying amounts of hormone to match the normal cyclical hormonal changes more closely
What are everyday formulations (E.g. Microgynon 30 ED)
Monophasic pills containing 7 inactive pills to make it easier to remember the pills
What are some common forms of COC
- Microgynoncontains ethinylestradiol andlevonorgestrel
- Loestrincontains ethinylestradiol andnorethisterone
- Cilestcontains ethinylestradiol andnorgestimate
- Yasmincontains ethinylestradiol anddrospirenone
- Marveloncontains ethinylestradiol anddesogestrel
What are the 2 options for starting COC
- Start in the 1st 5 days of period
- Start at any time in the cycle when not pregnancy with additional protection (E.g. condoms) for 7 days
What are some CHC regimens
Either 21 days on, 7 days off
Extended use for 3 months, 7 days off
Use continuously until 4 days of breakthrough bleeding, then 4 days off
Contraindications of COC (UKMEC 4)
- Uncontrolled hypertension (particularly ≥160 / ≥100)
- Migraine with aura (risk of stroke)
- History of VTE
- Aged over 35 and smoking more than 15 cigarettes per day
- Major surgery with prolonged immobility
- Vascular disease or stroke
- Ischaemic heart disease, cardiomyopathy or atrial fibrillation
- Liver cirrhosis and liver tumours
- Systemic lupus erythematosus (SLE) and antiphospholipid syndrome
What BMI is UKMEC 3 for COC
> 35
What are the main 3 risks of CHC
Venous thrombosis
Arterial disease
Cancer risk
How does venous thrombosis with CHC use compare to that in pregnancy
Much lower in CHC use so benefit greatly outweighs risk
Why is CHC contraindicated in migraine with aura?
There is an increased risk of ishcaemic stroke
What cancer does CHC increase the risk of?
Breast cancer (Contraindicated in BRCA mutations)
Also small increase in cervical cancer risk
How does stopping CHC affect breast cancer risk
Risk returns to normal after 10 years cessation
Benefits of CHC
- 20% reduction in ovarian cancer risk for every 5 years of use up to 50% reduction after 15 years of use
- 20-50% reduction in endometrial cancers
- 12% reduction in all-cause mortality
- CHC can be used to 40 years if no risk factors
- Ethinyestradiol/Cyproterone acetate (Dianette) shows a high benefit in acne use
- Rapid return of fertility after stopping
- Improvement inpremenstrual symptoms,menorrhagia(heavy periods) anddysmenorrhoea(painful periods)
- Reduced risk ofendometrial,ovarianandcoloncancer
- Reduced risk of benign ovarian cysts
Side effects of CHC
- Nausea
- Spots
- Bleeding (Unscheduled)
- Breast tenderness
- Low mood
Missed pill guidance for CHC
- Clarify how many have been taken correctly
- It is usually ok to miss 1 pill anywhere in the packet, however, after this, there is the need to use condoms for 7 days
What are some conditions that are classed as a “missed pill” day
Vomiting,diarrhoeaand certainmedications(e.g. rifampicin)
When should CHC be stopped prior to operation
four weeksbefore amajor operation(lasting more than 30 minutes) or any operation or procedure that requires the lower limb to be immobilised. This is to reduce the risk of thrombosis.
MOA of traditional POPs
- Thickening the cervical mucus
- Altering the endometrium and making it less accepting of implantation
- Reducing ciliary action in the fallopian tubes
What are the
