Non-Long Acting Reversible Contraception Flashcards
What are some factors that influence contraceptive choice?
Effectiveness, control, long or short term, non-contraceptive benefits, procedure itself
What is the typical failure rate of combined hormonal contraception?
9% = perfect rate is 0.3%
How should combined hormonal contraception be taken?
Start in first 5 days of period OR at any time in cycle when sure not pregnant plus condoms for 7 days, take daily for 21 days followed by 7 day break
What are the factors influencing the effectiveness of combined hormonal contraception?
Impaired absorption = GI conditions
Increased metabolism = liver enzyme induction, drug interaction
Forgetting to take it
What are the risks associated with combined hormonal contraception?
Arterial thrombosis, venous thrombosis, adverse effect on some cancers
What does the risk of VTE with combined hormonal contraceptive use depend on?
Varies according to EE dose and progestogen type = risk is low but will affect those with other VTE risk factors
What are the unwanted circulatory effects of combined hormonal contraceptives?
Systemic hypertension = check BP initially then at 3 months and annually thereafter
Arterial disease = small increase in MI (especially smokers) and ischaemic stroke especially in hypertensives
What is a contraindication of combined hormonal contraception?
Migraine with aura
When does an aura occur?
5-20mins before onset of headache = may be visual with typical scotoma, also altered sensation/smell/taste, may be hemiparesis
What does migraine with aura increase the risk of?
Stroke
What age group should the use of combined hormonal contraceptives be given extra thought to?
Consider other risk factors before prescribing if age >35
What cancers do combined hormonal contraceptives increase the risk of?
Breast cancer and small risk in cervical cancer associated with use >5 years
What cancers are combined hormonal contraceptives protective against?
Ovarian cancer = 20% reduction for every 5 years use
Endometrial cancer = 20-50% reduction
What are the benefits of using combined hormonal contraception?
Reduce acne, less bleeding, fewer functional and ovarian cysts, helps premenstrual syndrome and PCOS
What are the methods of delivering progestogen only pill?
POP, subdermal implant, DMPA
How is the progestogen only pill taken?
Take on day 1-5 of period OR anytime if sure not pregnant plus condoms for 7 days (2 for POP)
What are some features of progestogen only pills?
Contraindicated in current breast cancer
Depo Provera lowers oestradiol and suppresses FSH
How effective are diaphragms?
71-88%
What are some features of vasectomy?
Counselling = risks and benefits, reversal Methods = local or general anaesthesia, no scalpel technique
What are some potential complications of a vasectomy?
pain, infection, bleeding/haematoma, failure
What does the post-vasectomy seminal analysis?
Late-motile or >100000 non-motile sperm at 7 months
What is the most effective method of emergency contraception?
IUD = 99% effective
When must an emergency IUD be fitted in order to be effective?
Within 5 days of earliest possible date of ovulation OR within 5 days after single sexual encounter
What is the most popular emergency contraceptive method?
Oral = EllaOne and Lipostelle
What is the action of EllaOne?
Progesterone receptor modulator = stops LH surge so delays ovulation
When must EllaOne be taken to be effective as emergency contraception?
Can be used up to 5 days after unprotective sex = up to 90% effective if taken within 24hrs but efficacy decreases over time
What is the disadvantage of using EllaOne?
Can’t use progesterone immediately prior to or after using EllaOne = my delay starting contraception
How does Lipostelle work as emergency contraception?
Delivers large dose of progesterone = aims to inhibit ovulation
When is Lipostelle effective as emergency contraception?
Can be used up to 72hrs after sex = up to 90% effective if used within 24hrs but decreases over time
What are the disadvantages of Lipostelle?
Not as effective as EllaOne and need to take double dose if weight is >70kg
What are the disadvantages of the oral methods of emergency contraception?
Don’t work very well in second half of cycle
Both affected by enzyme-inducing medication and vomiting
