Obstetrics and gynaecological Flashcards
Combined Oral Contraceptives
C- combined oral contraceptives- inhibit ovulation and uterine implantation and thicken cervical mucus
I- Contraception, Acne, Heavy menstrual bleeding, dysmenorrhea, Endometriosis, PMS
Estrogens- ethinylestradiol, estradiol, mestranol
Progestrogens- drospirenone, levonorgestrel, nomegestrol, desogestrel, dienogest, dropirenone, gestodene, cyproterone, norithisterone
D- always 1 daily at the same time
M-pregnancy, VTE, breast cancer, migraine (CI in migraine with aura), smoking status (increased VTE risk- avoid in smokers >35), weight (BMI>30 increases VTE risk), malabsorption disorders/acute VD (risk of contraceptive failure), Blood pressure (uncontrolled increases CV risk and the pill can increase BP), age (caution >40yo), LFTs (can cause cholestasis), surgery (needs to be stopped due to VTE risk, mood changes
C-take at the same time each day, see dr asap for any of these- severe and sudden pain in chest severe headache sudden blurred vision or loss of sight unexplained tenderness or pain and swelling in one leg, irregular bleeding or spotting is common in first 2-3 months but stabilises after that, AE to expect but get better after first 3 months- headache breast tenderness NV spotting fluid retention, talk to dr or pharm before starting other meds (can decrease effectiveness), if vomit or severe diarrhoea occurs within 2 hours of taking dose treat as missed pill.
Missed pills- If <24 late- take other pill contraception not affected, if >24h late- 7 day rule and seek emergency contraception if week 1 or skip placebos if week 3
CALs- nil
Progestrogen only contraception
C-progestrogens only contraceptives- thicken cervical mucus and reduce implantation chance. Implant and depot reliably suppress implantation, POP only suppresses ovulation in 50% of people
I- Contraception, menstural disorders, Endometriosis, HRT
Dose
POP- 1 tablet once daily
Implanon (etonogestrel)- replace every 3 years
Mirena (levonorgestrel IUD)- replace every 5 years
Depo (medroxyprogesterone)- IM 12 weekly
M- breast cancer (CI), VTE (risk is lower with progestrogen only), LFTs (avoid in impairment), surgery (can be continued unless other CV risk factors), can be used in BF, compliance), depot can reduce BMD
C- tablet- take at the same time each day: vomiting or severe diarrhoea within 2h of dose or >3h late dose are missed pills- 2 day rule, continuous- bleeding can be none at all, talk to dr or pharm before starting other medications due to reduced effectiveness, importance of barrier to prevent STIs
Long acting- periods may stop entirely, implanon and mirena- check for presence of device routinely- if cannot be felt see dr asap, mirena- risk of infection post insertion, depot- up to 12 months delayed return to fertility (no delay with others)
CALs- nil
