Progesterone only contraceptives Flashcards

1
Q

How do progestogen only contraceptives work? E.g.

A

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

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2
Q

What advice on starting POP?

A

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

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3
Q

What advice on taking POP?

A

Taken at same time everyday without pill free break

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4
Q

What advice on missed pills POP?

A

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

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5
Q

What are side effects of the POP

A
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
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6
Q

What should you advise about illness/drugs and POP

A

D/V - continue taking POP but assume pills have been missed
Abx - no effect on POP
Liver enzyme inducers may reduce effectiveness

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7
Q

What are advantages of POP?

A

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

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8
Q

What are disadvantages of POP?

A

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

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9
Q

What are contraindications to POP?

A
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
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10
Q

What is the main injectable contraceptive? When is it given?

A

Depo Provera - medroxyprogesterone acetate

IM every 12 weeks
Can be given up to 14 weeks after last dose with no extra precautions

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11
Q

What are advantages of injectable progestogen?

A

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

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12
Q

What are disadvantages of Depot progestogen

A

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

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13
Q

What are CI to Depot progestogen?

A
Current breast cancer
History of severe arterial disease
Pregnancy
DM with any vascular disease
Fertility required in near future
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14
Q

How does implant work?

A

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

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15
Q

How should implant be started?

A

Insert on day 1-5 of cycle (immediately effective)

Any other time - use condoms for 7d

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16
Q

What are adverse effects of implant?

A

Irregular/heavy bleeding

Progestogen effects - headache, nausea, breast pain, acne, weight gain

17
Q

What are advantages of implant?

A
No impact on bone desnity
Can be used in VTE/migraine
Can be used in women CI to COCP
Don't have to think about contraception for 3y
Can be used when breastfeeding
Normal fertility returns as soon as implant removed
Effective in women fo all body mass
May reduce endometrial cancer risk
18
Q

What are disadvantages of implant?

A

Irregular bleeding
Fitting and removing may cause pain, bruising, irritation
Small increased risk of breast cancer
Can bend or break
Professional needed to insert and remove
Additional contraceptive methods needed for 7d if not inserted on day 1-5

19
Q

What are CI to implant?

A
Current breast cancer
Pregnancy
Unexplained vaginal bleeding
Liver cirrhosis or tumours
History of breast cancer
Stroke or TIA while using implant
20
Q

When should Depo Provera be stopped?

A

At 50 years
Depo-Provera is associated with a risk of osteoporosis and so continuing it in a post-menopausal woman would increase her risk of a fragility fracture

  • Switch to non-hormonal years and stop after 2 years of amennorhoea or switch to progesterone only method - Implant, POP, IUS
21
Q

What are side effects of Depo Provera?

A

Proven Weight Gain
Delay of up to 1 year to resume fertility
Increased risk of osteoporosis
Irregular bleeding

22
Q

Where should implant be inserted?

A

Subdermal

Non-dominant arm

23
Q

How long until contraceptives are effective if not first day period?

A

IUD - instant
POP - 2 days
COC, Injection, implant, IUS - 7 days

24
Q

MOA of contraceptive implant/injection?

A

Inhibition of ovulation

Also thickens cervical mucus

25
Q

MOA of desogestrel?

A

Inhibits ovulation

Also thickens cervical mcuus