oral contraceptives Flashcards
Oestrogen examples (combined
estradiol
ethinylestradiol
mestranol
Progesteogen content (combined)
norgestimate
desogestrel
levonorgestrel
drosperinone (spironolactone derivative)
gestodene
norethisterone
dienogest
nomegestrel
what is zoely
nomesgetreol +estradiol
what is qlaira
estradiol with dianeogest
what 3 progestogens preferred when acne breakthrough bleeds depression
desogesterol
drosperinone
norgestimate
cCombined transdermal patch
EVRA (ethinylestradiol/ norgestamin)
combined ring
nuva ring - etonogestrel and ethinylestradiol
progestogen only pills
desogestrel - cerelle, cerazette
norethisterone (micronor or noriday )
levonorgestrel ( norgeston)
parenteral injection
medroxyprogesterone acetate - depo provera injection
- norethisterone injection
- etonogestrel implant
IUD
copper
or levonogestrel releasing.
freser guidelines (5) what is it and what are rules
decision whether to give a child under 16, contraception without consent
1) does she understand advice given
2) cannot be convinced to tell parents
3) likely to continue having sex anyway
4) more of a mental detriment not to give her the pill
5) best interest
if she doesn’t meet criteria a parent/ carer can be told
two types of oral contraception
COC and POP
dosing for coc
one to be taken daily for 3 weeks and 1 week is pill free to allow a withdrawal bleed
when can you start COC?
any time in menstrual cycle but if day 6 or later, need contraceptive protection i.e. condom for 7 days
what age group cannot have COC
50+
4 types of COC
1) monophasic fixed amount of progestogen and oestrogen (21 day prep)
2) multiphasic/ PHASIC (varying amount of progestogen and oestrogen) - 21 day prep
3)every day (ED) prep can be multi or monophonic but (28 day prep) has a strip of placebo tabs
4) low strength oestrogen prep i.e 20mg ethinylestradiol
why have phasic preparation
for women who do not have withdrawal bleed
or have breakthrough bleed with monophonic
what do oestrogens inc risk of
VTE or arterial thrombosis
risk factors of oestrogen and VTE
- AGE>35
- long term immobilisation
- thrombophlebitis
-type of progestogen ; drosperinone, gestodene, desogesterl - primary relative under 45 with VTE
- obesity >30
- smoke
(avoid if 2 or more risk factors)
oestrogen arterial thrombus risk
diabetes mellitus, htn, migraine without aura
how long to stop COC before surgery
4 weeks (for major surgery and surgery to lower legs and limbs = prolonged immobilisation
coc and surgery
alternative contraceptive?
when to restart usual contraception?
what to do in emergency surgery?
alt contraceptive= POP
restart on first menses two weeks after full mobilisation
in emergency where coc not stop give thromboprophylaxis
coc and travel more than 3 hrs
have compression hosiery and do exercise
REASONS TO STOP COC AND OESTROGEN CONTAINING HRT
VTE, stroke, jaundice, blood pressure, prolonged dvt after surgery (dvt risk
VTE (coc and OHRT) symptoms
- sudden severe chest pain, dyspnoea, cough blood in sputum- pulmonary embolism?
- unexplained swelling in calf or leg (dvt)
Stroke symtoms (OHRT and COC)
serious CNS effect- severe prolong h/a, sudden partial / comp loss of vision (sensory disturb) , slurred speech, faint attack, collapse, first unexplained epileptic seizure, weak ,motor disturb, marked numbness one side body
liver dysfunction (coc/ OHRT)
vomiting, persistent abdominal pain, jaundice, dark urine (hepatitis liver enlarge)
BP (coc/Ort)
Systolic >160 and diastolic >90 mmHg
what are the oestrogen only risks that c/I tx
1) age over 50
2) smoke 40 + cig
3) bmi >35
4) migraine aura, migraine>72hr or tx with ergot derivatives
5) diabete mellitus with comp
6) valvular Heart disease (stroke risk) / pulmonary HD ( with risk of embolism
7)TIA w/out H/A
8) Severe or multiple risk factor (2+ or more)
9) bp >160> 90
POP moa
work by thickening mucus in cervix so egg cant be fertilised
alternative when COC or OESTRogen c/I
dose for POP
one pill at same time each day on a continuous basis (28 days)
- if started after day 5 of menstrual cycle need 2 days added contraception with condom
Hormonal contraceptive s/e combined and POP
Combined: risk of cervical and breast cancer
progestrogen: risk of breast
oestrogen increases risk of cervical
