Progesterone only contraceptives Flashcards
How do progestogen only contraceptives work? E.g.
Thicken cervical mucus - prevent sperm entry
Reduce receptivity of the endometrium to implantation due to thinning
Inhibit ovulation in some
POP - etyndiol, norehisterone, levonorgestrel
Depot progestogen - medroxyprogesterone acetate
Implants - Etonogestrel
What advice on starting POP?
Start on day 1-5 of cycle - effective immeidiately
If any other time, use condoms for first 2 days
If switching from COCP, gives immediate protection if continued from end of a pill packet
What advice on taking POP?
Taken at same time everyday without pill free break
What advice on missed pills POP?
If < 3h late: continue as normal
If > 3h late: take missed pill ASAP, continue with rest of pack, extra precautions should be used until 48 hours of pill taking re-established
If desogestrel (cerazette)
If < 12h late, no action requried
If > 12h late, take pill ASAP - precautions for first 48h
What are side effects of the POP
Menstrual irregularities: - 40% bleed irregularly - 40% bleed regularly - 20% amenorrhoeic Increased risk of ectopic preanncy Functional ovarian cysts Breast tenderness Depression Acne Reduced libido WEigth change
What should you advise about illness/drugs and POP
D/V - continue taking POP but assume pills have been missed
Abx - no effect on POP
Liver enzyme inducers may reduce effectiveness
What are advantages of POP?
More effective than barrier when taken correctly
Sex doesn’t need to be interrupted
Can be used in COCP contraindication
May reduce risk of endometrial cancer
What are disadvantages of POP?
User dependent
Can produce irregular menstration or amenorrhoea
Some adverse affects - headaches, breast tenderness, skin changes
Increased risk of ovarian cyst
Small increased risk of breast cancer
What are contraindications to POP?
Current or past history of breast cancer Liver disease - cirrhosis, hepatitis, tumour Stroke or IDH Migraine with aura Lower efficacy in women over 70kg Trophoblastic disease
What is the main injectable contraceptive? When is it given?
Depo Provera - medroxyprogesterone acetate
IM every 12 weeks
Can be given up to 14 weeks after last dose with no extra precautions
What are advantages of injectable progestogen?
Very effective
Users don’t have to think about it for as long as injecting lasts
No known interactions
Can be used when COCP are not recommended - migraine and breast feeding
Can be used in women with BMI < 35
May reduce risk of endometrial cancer
Can be used up to age 50y if no other risk factors for osteoporosis
May help PMS or menorrhaagia
What are disadvantages of Depot progestogen
Not rapidly reversible - can take up to year to return to normal fertility
Altered bleeding patterns including persistent bleeding
Increase in body weight
May be slightly increased risk of breast cancer
Loss of bone mineral density with long term use
What are CI to Depot progestogen?
Current breast cancer History of severe arterial disease Pregnancy DM with any vascular disease Fertility required in near future
How does implant work?
Nexplanon is radiopaque flexible rod containing etonogestrel
Implanted subdermally into the medial surface of the upper arm
Slowly releases etonogestrel
- prevents ovulation and thickens cervical mucus
Lasts 3 years
How should implant be started?
Insert on day 1-5 of cycle (immediately effective)
Any other time - use condoms for 7d