Ong: Contraception Flashcards
What are the 2 different types of Progesterone Only Pill (POP)?
- Traditional POP
- Cerazette (aka desogestrel)
What are the names of Traditional POPs? (4 things)
- Micronor
- Noriday
- Nogeston
- Femulen
What is the time frame for missing a pill in Traditional POPs?
3 hours
(aka if less than 3 hours since time you shuda taken it, jus take it n do nothing else)
What is the time frame for missing a pill in Cerazette (desogestrel)?
12 hours
(aka if less than 3 hours since time you shuda taken it, jus take it n do nothing else)
What should you do if you miss the time frame of either Traditional POP or Cerazette (desogestrel)? (2 things)
- Take missed pill ASAP
- Extra precaution (aka condoms) for 48 hours
When should you take the next pill after you take your Missed Pill ASAP?
At normal time
(even if it means you take 2 pills on same day)
What is the name of the Patch contraception used in the UK?
Evra patch
How long does the Evra Patch cycle last?
4 weeks
When do you wear Evra patch during cycle and when do you not wear it?
- Week 1-3: Patch worn everyday, changed each week
- Week 4: Patch not worn, you get withdrawal bleed
What comes into play for actions when you delay changing the Evra patch? (2 things)
- What week of the cycle you’re on
- If less / more than 48 hours delay
If Evra patch delay is in Week 1 / 2, and delay is less than 48 hours, what is the action?
No action required, just change patch
If Evra patch delay is in Week 1 / 2, and delay is MORE than 48 hours, what is the action? (2 things)
- Change patch
- Barrier contraception for 7 days
If Evra patch delay is in Week 1 / 2, and delay is MORE than 48 hours, what is the action? (2 things)
- Change patch
- Barrier contraception for 7 days
If Evra patch delay is in Week 1 / 2, and delay is MORE than 48 hours, and intercourse has happened, what is the action?
If intercourse is in last 5 days –> Emergency contraception
If Evra patch delay is in Week 3, what is the action?
- No action: just remove patch, and put patch on again when new cycle starts like normal
- No additional contraception needed
If there is a delay in putting on patch in Week 1 (after patch-free Week 4), what is the action?
Barrier contraception for 1 week
What are the rules regarding COCP and surgery? (2 things)
- Stop 4 weeks before surgery
- Restart 2 weeks after surgery
(bc VTE risk)
What is the rule about restarting hormonal contraception after taking Levonorgestrel as Emergency contraception?
Can restart it immediately
What is the rule about restarting hormonal contraception after taking Ulipristal as Emergency contraception?
Restart after 5 days
What is a CI for Intra-uterine device?
PID
What contraception should you use instead of IUD?
Implantable device
What is the most effective form of contraception?
Implantable device
What are the side fx of Implantable device? (2 things)
- Irregular / heavy bleeding
- Progestogen fx: Headache / Nausea / breast pain
How is the Irreg / heavy bleeding of Implantable device overcome?
COCP co-prescription
What is a weird CI for COCP?
Wheelchair users
(bc double DVT risk)
What cancers does COCP cause? (2 things)
- Cervical
- Breast
(COCP = Causes Outside Cancers Predominantly)
What cancers does COCP protect against? (2 things)
- Endometrial
- Ovarian
(protects against “deeper” cancers)
What emergency contraception can be given which has the longest period you can use it?
Ulipristal (EllaOne)
(up to 120 hours post unprotected intercourse)
What is MOA of COCP?
Inhibits ovulation
What is MOA of Implantable contraceptive (etonogestrel)?
Inhibits ovulation
What is MOA of Copper IUD?
Decreases sperm motility and survival
What is MOA of POP (excluding desogestrel)?
Thickens cervical mucus
What is MOA of POP Desogestrel?
Inhibits ovulation
How many years does Nexplanon (aka implanted contraceptive) work for?
3 years
(number of N’s in name = 3)
What contraception should a Breast cancer pt use?
Copper IUD
(all other contraceptives CI)
What do women who go through menopause under age of 50 require?
Contraception for at least 2 years after LMP
What do women who go through menopause over age of 50 require?
Contraception for only 1 year after LMP
What contraception should you use for women who have gone though menopause?
IUS
What is the ABSOLUTE CI for COCP? (2 things)
- Migraine w aura
- Breastfeeding (less than 6 wks post partum)
What should you advise if pt misses 2 COCP pills in week 1, and has had intercourse in pill-free interval / week 1? (3 things)
- Take extra pill today
- Take emergency contraception
- Barrier contraception for 1 week
What should you advise if pt misses 2 COCP pills in week 3, and has had intercourse? (3 things)
- Take 2 pills now
- Finish pack like normal
- Start new pack immediately (missing the pill-free interval)
How long after taking Levonorgestrel (emergency contraception) can you start hormonal contraception (aka COCP)
Immediately
When can you put Contraceptive Implant in after giving birth if not breastfeeding?
Immediately after childbirth
How many days post-partum do women NOT need contraception for?
21 days
Do you need to take any precaution when taking Abx and POP?
No
When should you give Emergency contraception in COCP? (2 things together)
- 2 pills missed week 1
- Unprotected intercourse @ week 1 / pill free interval
What if you miss 2 pills of COCP in week 2 of cycle?
No emergency contraception is needed, as long as previous 7 days of COCP taken correctly
When is Levonorgestrel most effective?
Within 12 hours
What is the most effective emergency contraception?
Copper coil (IUD)
How long can you use Ulipristal acetate as emergency contraception?
Upto 120 hours
What is the MOA of Ulipristal acetate as emergency contraception?
Prevents ovulation
(so if already ovulated no point giving)
When switching from POP to COCP, what precaution do you need to take?
7 days barrier contraception
When you stop COCP 4 weeks before surgery, what contraceptive can you take instead?
POP
What cancers does COCP protect against? (2 things)
- Endometrial cancer
- Ovarian
What cancers does COCP cause? (2 things)
- Breast cancer
- Cervical
How long does POP take to become affective?
48 hours
What is the most common POP?
Cerazette (aka desogestrel)
Why is Cerazette (aka desogestrel) the best POP?
Because has a window of 12 hours
(aka if u forget to take it, you have 12 hours to remember and no further action needed)
Why are all other POPs not as good as Cerazette (aka desogestrel)?
They have a 3 hour window
(aka if you forget and 3 hours has passed from the time you should have taken it, you need barrier contraception for 48 hours)
What is a CI for COCP in terms of VTE?
Positive antiphospholipid antibodies (aka in SLE)
What is an absolute CI for Copper IUD?
PID
(bc you’re putting something foreign in, so inf risk)
Which contraceptive causes weight gain?
Depo-provera (aka injectable one)
What are the side fx of Depo-provera (aka injectable one)? (3 things)
- Weight gain
- Irreg bleeding
- Delayed infertility (up to 12 months)