Non LARC contraception Flashcards
What determines choice of contraception?
Effectiveness
Control ** (most common determinant)
Long/Short term
Non-contraceptive benefits
Procedure
Which methods fall under the combined hormonal conception (CHC) bracket?
Pill
Patch
Vaginal ring
How efficient is CHC?
Failure rate:
Perfect use = 0.3%
Typical use = 9%
How to take combined oral contraception
Start in first 5 days of cycle
OR
At any time in cycle when reasonably sure not pregnant + condom for 7 days
Take daily for 21 days followed by a 7 day break
Withdrawal period - occurs upon withdrawal of contraception
Factors affecting effectiveness of CHC
Impaired absorption
– GI conditions (COC)
Increased metabolism
– Liver enzyme induction,
Drug interaction
Forgetting :(
Risks of COC
Venous thromboemolism
- varies according to EE dose and progesterone type, as well as risk factors
Arterial thrombosis
Adverse effects on some cancers
What is the VTE risk in pregnancy per 10,000 women?
21-30/10,000
What is the postnatal VTE risk per 10,000 women?
130-140
Circulatory SE of COC
Systemic hypertension - COC use shows a small increase in blood pressure in some individuals. Must therefore check initially, at 3 mths then annually
Arterial disease
- May be small increased risk of MI in COC users, particularly smokers
- ?increased risk of ischaemic stroke in COC users
- Hypertensive COC users (systolic ≥160 mmHg, diastolic ≤ 95 mmHg) are at higher risk of MI and stroke than hypertensive non-COC users`
Migraine with Aura - increases the risk of ischaemic stroke - CHC USE IS CONTRAINDICATED
Contraindications to COC
- Migraine with aura
2. Age > 35 years
Unwanted effects - Cancer
Breast Cancer
Cervical cancer
- Small increased risk with long term use (>5 yrs)
- Reduces to baseline 10 years after stopping
- Discuss HPV/condom use
- Check up to date with cervical screening
Examinations before commencing
BP and BMI before first prescription
Check smear status if relevant
Are there multiple risk factors? - UKMEC
Benefits of CHC
- Protection against ovarian and endometrial cancer
- Acne treatment (Dianette, but increased risk of clotting)
- Less bleeding
- Reduced risk of cysts
- Reduced PMS
- PCOS - keeps endometrium thin, gives a withdrawal bleed
Side effects of CHC
Nausea
Bleeding
Breast tenderness
Spots
How to take/start progestogen only pill
Take it every single day without a break
Day 1 – 5 of period
OR
Anytime if reasonably certain not pregnant plus condoms 7 (2 for POP) days
Risk of subdermal implants and progestogen only pill
Little effect on metabolism
Can be given in most circumstances
‘safer than pregnancy’ – UKMEC 3
UKMEC4 = current breast cancer
Irregular bleeding
Which contraceptive method has a high chance of amenorrhea and is highly effective?
Depo Provera
Sayana Press
Consequence of Depo Provera / Sayanna Press?
Suppress FSH
Lowers estradiol
Therefore causes:
Osteopaenia
Post menopausal state
CI of Depo
Family history of bone problems
When is the use of diaphragm indicated?
Contraindicated for hormonal treatments
Irregular sexual activity
Important numbers to remember when using diaphragm
Needs to remain in the vagina for 6 hours post sex
If you put spermicide and don’t have sex within 3 hours you need to reapply the spermicide. Also reapply spermicide if you have sex again
Content to cover during vasectomy counselling
Risks and benefits
Vs female sterilisation/other methods
Regret – reversal?
Pearl index = 0.1 (1 in 2000 0.05% after clearance has been given)
What techniques can be used during vasectomy?
Local or general anaesthetic
No scalpel technique
Complications of a vasectomy
Failure - early (non compliance)
Pain & bleeding
Anaesthetic
Infection
Post vasectomy seminal analysis - late – motile or >100 000 non- motile sperm at 7 mths
