progesterone contraception Flashcards

1
Q

progesterone only pill - 2 treatment options

A

microlut (levonorgestrel) 30microg OD

micronor (norethisterone) 350microg OD

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2
Q

progesterone only pill - which pill should you avoid if oestrogen is absolutely contraindicated, and why

A

micronor (norethisterone), its partly metabolised into ethinyloestradiol

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3
Q

progesterone only pill
- how many tabs can you miss
- how many hours wrong can you be
before its ineffective

A

3 hours, 3 day rule
- every tablet within 3 hours of the last dose the day before
- 3 days (ie missed 2 tablets)
then you need extra contraception

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4
Q

long acting reversible contraception - what proportion get amenorrhoea

A

around 1/5

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5
Q

intrauterine devices - when is highest risk of PID to develop, and when does it return to baseline

A

first 20 days after insertion is highest risk

goes to baseline after that

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6
Q

intrauterine device - managing PID in first 20 days

A

do not remove IUD
antibiotics
* ceftriaxone 500mg + 2mL 1% lignocaine IM
* metronidazole 400mg PO BD for 14 days
* doxycycline 100mg BD for 14 days \/ Azithromycin 1g PO stat, repeated at 1 week

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7
Q

important IUD insertion complications

A

perforation
ectopic pregnancy
pelvic inflammatory disease
expulsion of IUD

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8
Q

short term management of irregular bleeding on hormonal LARC

(first line x3), second-line x1, depot-specific

A
  • add a combined oral contraceptive pill, continuous use
  • ponstan 500mg PO TDS for 5 days
  • tranexamic acid 500mg BD for 5 days
    second-line
    norethisterone 5mg PO TDS for 3 weeks
    depot - give it earlier, like at 10/52
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9
Q

implanon - contraindications

A
having a cardiovascular event on implanon (IHD, CVD,, TIA)
breast cancer
liver diseases
* decompensated cirrhosis
* hepatocellular adenoma
* liver tumors
on liver enzyme inducing medication
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10
Q

implanon

- some circumstances where this is safe, but other hormonal contraceptives are not (5)

A
migraine with aura
VTE
breastfeeding
postpartum
post abortion
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11
Q

common side effects of implanon, and proportions affected

A

dysmenorrhoea - 85% improve with time
irregular bleeding
- 1 in 5 get no bleeding, 1 in 5 get heavy or frequent bleeding
- 3 in 5 get sporadic bleeds

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12
Q

heavy bleeding with implanon - what proportion improve, over how long

A

50% will improve after 3 months

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13
Q

implanon insertion - when is it immediately effective

A

day 1-5 of period

5 days after UPA emergency contraception

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14
Q

implanon insertion - how long does it take before effective (when inserted outside of menstruation)

A

7 days

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15
Q

implanon complication - how to manage

  • a bent implant
  • a broken implant
  • implant that isn’t palpable
A
bent - leave it in, its still effect
broken - all of it needs to be removed, so refer to family planning specialist?
if its not palpable 
- don't try to remove it
- use xray or USS to try and find it
- arrange a pregnancy test
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16
Q

implanon - investigations for patient with irregular bleeding

A

update CST, CT/NG PCR

17
Q

implanon - managing irregular bleeding

  • heavy bleeding
  • intermittent bleeding
A

heavy - COCP for 3/12 continuously, then stop
intermittent
* ponstan 500mg PO BD for 5/7
* tranexamic acid 500mg PO TDS for 5/7