O&G: Contraception Flashcards
Emergency contraception
what are the 3 options
- Levonorgestrel
- Ulipristal
- copper coil
Emergency contraception
when can levonorgestrel be taken
within 72 hours of UPSI
Emergency contraception
when can Ulipristal be taken
within 120 hours of UPSI
Emergency contraception
when can the copper coil be inserted
within 5d of UPSI
or within 5d of the estimated ovulation
Emergency contraception
can levonorgestrel and ulipristal be used more than once in a menstrual cycle
yes
Emergency contraception
when is ovulation in a 26 day cycle
14d before the end of the cycle so day 12
Emergency contraception
what may insertion of copper coil lead to
pelvic inflammatory disease
Emergency contraception
when can copper coil be removed
until at least the next period or can be left in as long term contraception
Emergency contraception
what is in levonorgestrel
progestogen (it delays or prevents ovulation)
Emergency contraception
what can be started immediately after levonorgestrel
COCP or progestogen only pill
Emergency contraception
dose of levonorgestrel if woman >70kg or BMI>26
double the dose!
usually 1.5mg so give 3mg
Emergency contraception
woman vomits within 3h of taking levonorgestrel, what should you do
dose should be repeated
Emergency contraception
can breastfeeding continue after taking levonorgestrel
NICE CKS advise that breastfeeding is avoided for 8 hours
Emergency contraception
what is Ulipristal (EllaOne)
a selective progesterone receptor modulator (SERM) that works by delaying ovulation.
Emergency contraception
how long should you wait before started the COCP or progestogen only pill after taking ulipristal
5d
Emergency contraception
woman vomits within 3h of taking Ulipristal, what should you do
repeat dose
Emergency contraception
can breastfeeding continue with ullipristal
avoid for 1w
Emergency contraception
which condition is Ullipristal CI’d in
pts with severe asthma
COCP
what does it contain
oestrogen and progesterone
COCP
3 ways it prevents pregnancy
- preventing ovulation (primary mechanism of action)
- progesterone thickens cervical mucus
- progesterone inhibits proliferation of endometrium, reducing chance of successful implantation
COCP
how does it prevent ovulation
Oestrogen and progesterone have a negative feedback effect on the hypothalamus and anterior pituitary, suppressing the release of GnRH, LH and FSH
COCP
what are the 2 types
- monophasic pills
- multiphasic pills
COCP
what are monophasic pills
contain the same amount of hormone in each pill
COCP
what are multiphasic pills
contain varying amounts of hormone to match the normal cyclical hormonal changes more closely
COCP
what is oestrogen aka
ethinylestradiol
COCP
1st line (lower risk of VTE)
pill with levonorgestrel or norethisterone first line (e.g. Microgynon or Leostrin).
COCP
1st line for premenstrual syndrome
Yasmin and other COCPs containing drospirenone
Drospirenone has anti-mineralocorticoid and anti-androgen activity, and may help with symptoms of bloating, water retention and mood changes
COCP
what pill to consider for acne and hirsutism
Dianette and other COCPs containing cyproterone acetate (i.e. co-cyprindiol)
Cyproterone acetate has anti-androgen effects
COCP
SEs
- Unscheduled bleeding is common in the first 3m
- Breast pain and tenderness
- Mood changes and depression
- Headaches
- Hypertension
COCP
Risks
- VTE
- small increased risk of breast and cervical cancer
- small increased risk of MI and stroke
COCP
reduces risk of?
endometrial, ovarian and colon cancer
benign ovarian cysts
COCP
what are the specific RFs that should make you avoid it (UKMEC 4)
- Uncontrolled HTN (particularly ≥160 / ≥100)
- Migraine with aura (risk of stroke)
- History of VTE
- Aged >35 and smoking more than 15 cigarettes/day
- Major surgery with prolonged immobility
- Vascular disease or stroke
- IHD, cardiomyopathy or AF
- Liver cirrhosis and liver tumours
- SLE and antiphospholipid syndrome
COCP
BMI above 35 is UKMEC 3. Should you take the pill
probably not as risks generally outweigh the benefits
COCP
if you start on the 1st day of your menstrual period, what contraception is required
No additional contraception is required if the pill is started up to day 5 of the menstrual cycle.
COCP
if you start after day 5 of the menstrual cycle , what contraception is required
extra contraception (i.e. condoms) for the first 7 days of consistent pill use
COCP
when switching between COCPs, when do you start the new one
immediately start the new pill pack without the pill-free period.
COCP
advice when switching from POP
can switch at any time but 7 days of extra contraception (i.e. condoms) is required.
COCP
why does switching from desogestrel require no additional contraception compared to a traditional POP
because desogestrel inhibits ovulation
COCP
definition of missing one pill
when the pill is >24h late
COCP
advice to give if one pill was missed (<72h since last pill was taken)
- Take the missed pill as soon as possible (even if this means taking two pills on the same day)
- No extra protection is required provided other pills before and after are taken correctly
COCP
advice to give if >1 pill missed (>72h since the last pill was taken)
- Take the most recent missed pill as soon as possible (even if this means taking two pills on the same day)
- Additional contraception (i.e. condoms) is needed until they have taken the pill regularly for 7 days straight
- consider emergency contraception depending what day of the packet
COCP
if >1 pill missed (>72h since the last pill was taken) and on day 1-7 of the packet, do they need emergency contraception
yes if they have had UPSI
COCP
if >1 pill missed (>72h since the last pill was taken) and on day 8-14 of the packet, do they need emergency contraception
no
COCP
if >1 pill missed (>72h since the last pill was taken) and on day 15-21 of the packet, do they need emergency contraception
no, they should go back-to-back with their next pack of pills and skip the pill-free period.
COCP
which medication may reduce the effectiveness of the pill
rifampicin
COCP
is a day of vomiting or diarrhoea classes as a missed pill
yes
COCP
how long should you stop the pill before a major operation (lasting >30 minutes) or any operation or procedure that requires the lower limb to be immobilised
4 weeks
postpartum and wants to start contraception immediately, what can be used?
POP
what is the only suitable option for a postpartum woman actively breast-feeding
POP
when can an IUS or IUD be inserted after giving birth
within 48 hours of birth, or four weeks postpartum
why can’t COCP be given to women <6 weeks postpartum who are breast-feeding
- increased risk of VTE in the post-pregnancy state
- contamination of breast milk
- After 6 weeks, it becomes a UK MEC2
when can the lactation amenorrhea method for contracteption be used
- <6m postpartum
- solely breastfeeding
- has no periods
Absolute Contraindications to Contraception (UKMEC 4)
- Known or suspected pregnancy
- smoker >35y who smokes >15 cigarettes
- obesity
- breast feeding <6 weeks post partum
- Fx of thrombosis before 45y
- breast cancer or cancer within last few years
- BRCA genes
Disadvantages of a contraceptive outweigh the advantages (UKMEC 3)
- Breast feeding >6weeks post partum
- Previous arterial or venous clots
- continued use after heart disease or stroke
- migraines with aura
- active disease of liver or gallbladder
Advantages of a contraceptive outweigh the disadvantages (UKMEC 2)
- Initiation after current or past history of MI or stroke
- multiple risk factors for arterial cardiovascular disease
what is the the only acceptable form of contraception in women with active breast cancer or PMH of it
Copper intra-uterine device (IUD).
when should you double emergency contraception dose
In women with a BMI >26 or a weight >70kg, the dose of Levonelle must be doubled
the dose of ellaOne should not be changed according to weight
when can the Copper intrauterine device (IUD) be used for emergency contraception
5d post UPSI or 5d post earliest possible ovulation - whichever is later.
how to calculate earliest possible ovulation
e.g. if 28 day cycle
(28-14) + 5 = day 17
