NON-LARC Flashcards
What affects choice of contraception?
control
What are combined hormonal contraceptions?
Mix of estrogen and progesterone
- pill
- patch
- vaginal ring
Failure rate of CHC?
- 0.3% if perfectly used
- 9% with typical use
How to take COC?
- start in first 5 day of the cycle
- or any time when SURELY not pregnant plus condom for 7 days
- take daily for 21 days+ 7 day break
What is meant by break-through bleed?
- slight spotting that occurs with use of COC (NOT period)
- if bleeding goes on for more than 4 days; stop COC for 4 more days and then continue
What affects the effectiveness of COC?
- impaired ABSORPTION (GI conditions)
- increased metabolism (liver enzyme induction or drug interaction)
- forgetting
How may risk of VTE vary with COC drugs?
- varies according to EE dose and progestogen types
- —-3rd gen of Progestogens has a HIGHER risk of VTE
WHat is the VTE risk in pregnant women?
21-30 per 10 000
Post-natal VTE risk ?
130-140 in 10 000
When is migraine dangerous with the pill?
- when you have an AURA (5-20 mins prior to headache)
- –USUALLY IN THE FORM of a SCOTOMA
- OR hemiparesis/smell/taste/altered sensation
What is the danger of having the pill if you have migraines with aura?
- ischemic stroke
- so CHC is C/I in people with migraine with aura
Another risk of using the pill?
- age > 35 YEARS
What is an unwanted effect of pill?
- increased risk of breast cancer (1.24 risk)
- cervical cancer ( use of >5 years)
- —-do regular smear and condom use
What examination is done prior to first CHC prescription?
- record BP and BMI before 1st prescrip.
- smear status
- multiple risk factors?
Best acne protection by______.
Why?
Dianette (Cyproterone Acetate = anti-androgen, progestagen)
WHat are the non-contraceptive benefits of CHC?
- PCOS (fewer functional ovarian cysts)
- menorrhagia
- —-though regular withdrawal bleeding
- reduced PMS
- acne rx
- protec. against ovarian cancer (50% reduct. after 15 years of use) and endometrial cancer
Best avoid COC in _______
bleeding disorders.
What is as effective as COC?
- Cerelle
(progesterone only pill )
—–ensure you take it every single day
What is a s/e of the progesterone-only pill?
- irregular bleeding
What is DEPOT PROVERA?
- depot injection every 3 months…LOWERS estradiol, supresses FSH
- causes AMENNORHOEA (esp. nice if people want this)
What is Sayana Press?
- self-administration
- LOWERS estradiol, supresses FSH
Advantage and disadvantage of hormonal Depots?
- not affected by enzyme inducing drugs
- (-VE): osteopenia
The most effective contraception ?
- Sub-dermal implants
When is a diaphragm indicated?
- mid-30s
- no regular partner
- on cancer treatment
What should be remembered for diaphragm?
- leave it for 6 HRS after sex
- more spermicide needed after 3 hrs if you have more sex
What techniques are involved in a vasectomy?
- local/general anaesthetic
- NO scalpel needed
What are complications of the vasectomy?
- pain
- infection
- bleeding
- anaesthetic
How is female sterlization done?
- clips over the fallopian tubes; bands; essure
- done LAPROSCOPICALLY
What does natural planning involve?
- app where you insert personal information about various things to obtain fertile window
Risks of CHC?
- Venous Thrombosis
- Arterial thrombosis
- Adverse effects on some cancers !
Is there a particular s.e with the use of COC on blood pressure?
- systemic hypertension!
- —COC use shows a SMALL increase in BP in some (so check initially at 3 months, then annually)
- –>140/90
What are some arterial pathologies that may arise from CHC use?
- small INCREASED risk of MI in COC users (esp. smokers)
- increased risk of ISCHEMIC stroke in COC users
- —-Hypertensive COC users are at a higher risk of MI and stroke then hypertensive non-COC users
How “protective” is CHC against ovarian cancers?
- 5 years of use: 20% reduction in ovarian cancer
- 15 years of use: 50% reduction
How protective is CHC against endometrial cancer?
- 20-50% reduction
What are side effects of COC?
- nausea
- spots
- bleeding
- breast tenderness
How to start PO- methods (pill, patch or DMPA)?
- day 1-5 of period
OR - anytime if certain youre not preggers + 7 days of condoms (2 for POP)