progesterone contraception Flashcards
progesterone only pill - 2 treatment options
microlut (levonorgestrel) 30microg OD
micronor (norethisterone) 350microg OD
progesterone only pill - which pill should you avoid if oestrogen is absolutely contraindicated, and why
micronor (norethisterone), its partly metabolised into ethinyloestradiol
progesterone only pill
- how many tabs can you miss
- how many hours wrong can you be
before its ineffective
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
long acting reversible contraception - what proportion get amenorrhoea
around 1/5
intrauterine devices - when is highest risk of PID to develop, and when does it return to baseline
first 20 days after insertion is highest risk
goes to baseline after that
intrauterine device - managing PID in first 20 days
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
important IUD insertion complications
perforation
ectopic pregnancy
pelvic inflammatory disease
expulsion of IUD
short term management of irregular bleeding on hormonal LARC
(first line x3), second-line x1, depot-specific
- 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
implanon - contraindications
having a cardiovascular event on implanon (IHD, CVD,, TIA) breast cancer liver diseases * decompensated cirrhosis * hepatocellular adenoma * liver tumors on liver enzyme inducing medication
implanon
- some circumstances where this is safe, but other hormonal contraceptives are not (5)
migraine with aura VTE breastfeeding postpartum post abortion
common side effects of implanon, and proportions affected
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
heavy bleeding with implanon - what proportion improve, over how long
50% will improve after 3 months
implanon insertion - when is it immediately effective
day 1-5 of period
5 days after UPA emergency contraception
implanon insertion - how long does it take before effective (when inserted outside of menstruation)
7 days
implanon complication - how to manage
- a bent implant
- a broken implant
- implant that isn’t palpable
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