sexual health 1 Flashcards

Question

How long can COC be used for?

Answer 1

Up to the age of 50 years After that, switch to A non-hormonal method such as Cu-IUD Progestogen-only contraception

Answer 2

As a prescriber you can prescribe up to 12-month's supply for women who are initiating or continuing COC However, arrange a follow up 3 months after initiation, and annually thereafter Follow ups should include: BP & BMI checks Asking about headaches, particularly migraine Any new risk factors Addressing issues or adverse effects Check if taking correctly and consistently Check knowledge of what to do if a pill is missed, including during vomiting or diarrhoea, or if requires surgery Reminder of possible drug interactions Offer verbal and/or written advice about LARCs To return at any time if has any issues or concerns

Answer 3

Only one patch should be worn at a time The patch can be applied to clean, dry, lotion-free, healthy, hairless skin Suitable sites include the upper outer arm, upper torso (excluding breast), buttock, or lower abdomen Avoid red, broken, or inflamed skin Use a different site when changing patch to avoid irritation Can be used in shower, bath, sauna, hot tub, swimming pool and during exercise (But Advise to) Check the patch daily to ensure it is still attached Apply patch on the same day each week for 3 weeks, followed by a patch free interval for week 4, then start a new cycle, unless using a tailored regimen May or may not experience a withdrawal bleed in week 4 Bleeding may start on any day in the patch-free week, is usually lighter & less painful than a normal period, and may continue after the patch free week The new cycle should be started as scheduled even if still bleeding Used patches should be placed in the disposal sachets provided and binned

Answer 4

A partially detached CTP is treated the same as one that is completely detached Advice for detached CTP depends on the length of time the patch has been detached for How long the woman has used the same patch for The timing within the cycle that the patch has become detached Advice for a patch not changed in time will depend on If it has been 8 completed days or more since the last patch was removed and the timing within the cycle

Answer 5

Vomiting and diarrhoea do not affect the bioavailability of the CTP So no additional contraception is required Pregnancy If a woman becomes pregnant whilst using CTP Advise to stop using immediately There is no evidence of harm to the baby or mother if pregnancy occurs while using CTP

Answer 6

Same as those associated with COC Except: Some evidence of higher risk of VTE in patch users compared to COC Additionally More breast discomfort, dysmeorrhoea, nausea & vomiting than COC users

Answer 7

Advantages Applied once weekly so more convenient than taking pill daily Patches do not become less effective if the user vomits or has diarrhoea Is as effective as COCs at preventing pregnancy Disadvantages It can be seen It can become detached compromising efficacy It may be less effective in women who weigh more than 90kg Skin irritation, and additional adverse effects compared to COC There may be a delay in return to normal fertility after stopping In some women the delay can be up to a few months

Answer 8

Drug interactions same as COCs For all drug interactions you will need to advise on how to manage the interaction, which may be different to COCs Surgery & immobilisation advice and how long CTP can be used for is same as COCs Follow up arrangements as with COCs But check knowledge of the CTP, with regards to what to do if patch isn't changed, if tx cycle is started late, if patch becomes detached

Answer 9

NuvaRing® is currently the only licensed CVR in the UK Releases 120mcg of etonogestrel & 15mcg of ethinylestradiol/24 hrs, over a 3-week period Can prescribe up to 12 months' supply for women who are initiating or continuing CHC Only 3 months can be dispensed at one time A ring is inserted into the vagina and left in for 21 days It is removed for a 7-day ring-free period to allow a withdrawal bleed A new ring is inserted the day after the 7th day of the ring-free period

Answer 10

Insert one ring high into the vagina for 3 weeks of continuous use per cycle A new ring should be inserted after a 7-day ring-free break A new cycle should be started after the ring-free break unless tailored regimen is being used To insert the ring the woman should find a comfortable position (standing on one leg, squatting or lying down) Compress ring and insert into the vagina until it feels comfortable Check the presence of the ring regularly Ring should be kept in during tampon use, sexual intercourse (may be removed for 3 hours during sexual intercourse if uncomfortable) Ring can be removed by hooking the index finger under the ring or grasping it between the index finger and middle finger Ring should be placed in the disposal sachets provided and put in the bin

Answer 11

Advice for detached CTP depends on the length of time the ring has not been in place or broken The timing within the cycle that the ring has not been in place or broken Advice for when a ring has not been changed for 3 weeks depends on if the ring has been left in place for more than 21 days, but 28 days or less more than 4 weeks or 5 weeks or less More than 5 weeks No withdrawal bleed in the ring-free interval

Answer 12

Some women will not experience a withdrawal bleed in the ring-free period If the ring has been used as recommended, pregnancy is unlikely If it has not been used as recommended prior to first missed withdrawal bleed, or if there are two or missed withdrawal bleeds, pregnancy should be excluded before continuing use of CVR

Answer 13

Vomiting and diarrhoea do not affect the bioavailability of the CVR So, no additional contraception is required Pregnancy If a woman becomes pregnant whilst using CVR Advise to remove the ring There is no evidence of harm to the baby or mother if pregnancy occurs while using CVR

Answer 14

Same as those associated with COC Except: Some evidence of higher risk of VTE in ring users compared to COC May experience more vaginal irritation & discharge However, there is less nausea, acne, irritability and depression than with COCs

Answer 15

Advantages More convenient to use as left in place for 3-weeks as opposed to daily pill, or weekly change of patch Ring does not become less effective if the user vomits or has diarrhoea Is as effective as COCs and the CTP at preventing pregnancy Disadvantages Most undesirable adverse effects are headache, vaginal infections, & vaginal discharge Discomfort during intercourse, and the sensation of a foreign body Can become broken during use, or expelled, compromising efficacy Can inadvertently be inserted into the urethra and may end up in the bladder (if this happens) There may be a delay in return to normal fertility after stopping use Can be a delay of up to a few months

Answer 16

Release progesterone which inhibits ovulation stimulates the production of thick, sticky mucus making it difficult for sperm to travel and thins the lining of the uterus preventing the egg from attaching (to the uteri wall)

Answer 17

Progestogen-only pill (POP) Norethisterone 350mcg Levonorgestrel 30mcg Desogestrel 75mcg Drospirenone 4mg Progestogen-only implant Etonogestrel 68mg Progestogen-only injections Depot medroxyprogesterone acetate (DMPA) 150mg – most commonly used Depot medroxyprogesterone acetate (DMPA) 104mg Norethisterone enantate (NET-EN) 200mg – rarely used

Answer 18

POPs Increase volume & viscosity of cervical mucous, preventing sperm penetration Suppress ovulation by suppressing mid-cycle peaks of luteinisng hormone and follicle stimulating hormone Reduces number and size of endometrial glands & inhibition of progesterone receptor synthesis in the endometrium, preventing implantation Reduces activity of cilia in the fallopian tube, thus slowing passage of an ovum Progestogen-only implant & Progestogen-only injection Inhibit ovulation Causes changes in the cervical mucous to inhibit sperm

Answer 19

Very effective when used consistently & correctly (0.3% will conceive within 1st year of use due to method failure) Can be used during breastfeeding Useful when COC not suitable No evidence of delay in the return of fertility once POP stopped Desogestrel may help alleviate dysmenorrhoea & mid-cycle ovulatory pain No evidence of pregnancy in POP users with higher BMI

Answer 20

POP must be taken daily with no pill-free interval (could be both really) Adverse effects include unscheduled bleeding & breast tenderness Contraceptive efficacy is likely reduced when taking liver enzyme-inducing drugs Does not protect against STIs

Answer 21

Very effective when used consistently & correctly (0.05% will conceive within 1st year of use due to method failure) Users do not have to think about contraception for 3 years Can be used during breastfeeding Useful when COC not suitable Normal fertility returns as soon as implant is removed May help alleviate dysmenorrhoea, although a few reports of the opposite Some evidence of improvement in pain associated with endometriosis Contraceptive effectiveness not affected by weight or BMI

Answer 22

Adverse effects include unscheduled bleeding & complications of insertion and removal Contraceptive efficacy is likely reduced when taking liver enzyme-inducing drugs Does not protect against STIs

Answer 23

Very effective when used consistently & correctly (0.2% will conceive within 1st year of use due to method failure) Users do not have to think about contraception for as long as injection lasts (12 weeks for DMPA & 8 weeks for NET-EN) Can be used during breastfeeding No known interactions with liver enzyme-inducing drugs May reduce heavy painful periods & help with menstrual symptoms Useful when COC not suitable Can be used by women with a BMI of over 35kg/m2 (but may cause further weight gain) May help alleviate dysmenorrhoea, although a few reports of the opposite May reduce pain associated with endometriosis Option for women with sickle cell disease & may reduce severity of sickle cell crisis pain

Answer 24

Effect not rapidly reversible Could be a delay of up to 1 year in the return of normal fertility after stopping Menstruation can take several months to return to normal Adverse effects include unscheduled bleeding, weight gain, & loss of bone mineral density Does not protect against STIs

Answer 25

Menstrual irregularities Ectopic pregnancy Breast tenderness Ovarian cysts Libido changes Depression & mood changes Panic attacks (with desogestrel) Headache & migraines Weight change Small increased risk of breast cancer – risk reduces with time after stopping Limited evidence of risk of cardiovascular disease (CVD)

Answer 26

Liver enzyme-inducing drugs Griseofulvin Lamotrogine Ulipristal acetate as emergency hormonal contraceptive

Answer 27

If a woman aged over 50 years with amenorrhoea wishes to stop contraception before the age of 55 years Once a woman reaches 55 years of age, contraception can be stopped even if she is still experiencing menstrual bleeding.

Answer 28

Arrange follow up 10-12 weeks after 1st Rx, then annually thereafter Follow ups should include: BP & BMI checks Any new risk factors Addressing issues or adverse effects Check if taking correctly and consistently Check knowledge of what to do if a pill is missed Reminder of possible drug interactions Offer verbal and/or written advice about LARCs

Answer 29

Desogestrel was licensed as a pharmacy (P) medicine in July 2021 Lovima 75mcg film-coated tablet Hana 75mcg film-coated tablet Improved contraptive access as a Rx not required The issues around access have been improved with the introduction of the pharmacy contractive service

Answer 30

Must only be inserted by healthcare professionals who have been appropriately trained and accredited

Answer 31

Risks & adverse effects Similar to POP, but check for differences Drug interactions Liver enzyme-inducing drugs Griseofulvin Ulipristal acetate EC

Answer 32

For any concerns such as Not being able to feel the implant Removal of implant Pregnancy

Answer 33

Can be left in for 3 years Should seek review if it cannot be felt Can be removed at any time No delay in return to fertility Does not protect against STIs No routine follow up is required once inserted How long it can be used for depends on specific age & need

Answer 34

When to start the injection depends on if: Having menstrual cycles Is amenorrhoeic Postpartum – breastfeeding or not breastfeeding Post 1st or 2nd trimester abortion After oral EC Repeat injection is due

Answer 35

Risks & adverse effects Similar to POP, but check for differences Drug interactions Ulipristal acetate EC Efficacy of progestogen-only injection is not reduced by liver enzyme-inducing drugs

Answer 36

IUCs are long-acting reversible contraceptives (LARCs) Licensed duration of use ranges from 3-10 years There are two types licensed in the UK Cu-IUD & LNG-IUS Should only be inserted by trained & accredited healthcare professionals Main mode of action of Cu-IUD Inhibition of fertilisation through the effect of copper on the ovum & sperm Main mode of action of LNG-IUS Progestogenic effect on endometrium and cervical mucus, preventing passage sperm & inhibiting implantation of the ovum Effectiveness of IUCs is very high They are not affected by enzyme-inducing drugs or BMI

Answer 37

Pain on insertion Expulsion of device Unscheduled bleeding Uterine perforation Infection, including pelvic inflammatory disease Ectopic pregnancy For LNG-IUS, adverse effects of progesterone such as acne & ovarian cysts

Answer 38

Advanatges Inserted at any time during menstrual cycle (exclude pregnancy) Effective Long-term Normal fertility returns as soon as device removed Periods can be lighter, shorter, and less painful May be suitable when COC contraindicated 52mg LNG-IUS can be used to manage menorrhagia With Cu-IUD: no hormonal effects, so suitable when hormonal contraceptives contraindicated, & no drug interactions Disadvantages Internal pelvic examination required Do not protect against STIs Additional methods of contraception required for 7 days with LNG-IUS

Answer 39

Male & female condoms Prevent pregnancy by providing a barrier method Reduces risk of STIs Male condoms worn on the penis & female condoms inside the vagina, during sex Diaphragms & caps Fit into the vagina to cover the cervix Cevical caps are smaller than diaphragms Both must be used in with spermicide

Answer 40

Both Easy to obtain & use Only need to be used during sexual activity Provides protection against STIs No drug interactions Non-hormonal form of contraception Female condoms Can be used with oil-based lubricants Can be used if either partner allergic to latex Can be inserted up to 8 hrs before intercourse, providing spontaneity Less likely to tear than latex male condom No known adverse effects (adverse effects are rare with male condom)

Answer 41

Both Forward planning required Less effective at preventing pregnancy than hormonal and IUC Careful disposal of used condoms Male Break or slip off during intercourse Loss of sensitivity during intercourse Allergy to latex can occur Female Requires careful insertion Can slip, get pushed into vagina, be dislodged, penis can be inserted between vaginal wall & condom Noisy during intercourse

Answer 42

Can be inserted up to 3 hours before intercourse – maintaining spontaneity The woman can control use of the contraception No drug interactions Adverse effects are rare Non-hormonal

Answer 43

Less efffecive at preventing pregnancy than hormonal & IUCs Require planning & careful use Must be left in for at least 6 hours after sexual intercourse Cannot be used used until 6 weeks post-partum or following 2nd trimester termination Fit needs to be rechecked after weight gain/loss of 3kg or more, & after giving birth Allergy to the material or the spermicide Diaphragm may increase incidence of urinary tract infections (UTIs) - often due to poor fit & size May not reduce risk of STIs Should not be worn by women at high risk of STIs, as spermicides can increase risk of infection Some women find them messy to use

Answer 44

Check relevant safety marking and expiry date A new condom should be used for each episode of sexual intercourse Check if applied correctly No more than one condom should be worn at the same time Male & female condoms should not be worn at the same time Care should be taken when removing from packaging & handling to maintain integrity Spermicides & oil-based lubricants should not be used with male condoms Topical antifungals may damage the latex of male condoms Should seek advice in the event of failure of the condom – may require EC/STIs testing

Answer 45

Initially fitted by a trained healthcare professional Another method of conraception should be used until the fit has been reassessed as well as the woman's ability in using it Check for holes or deterioration – will require immediate replacement Discolouration with use is normal Oil-based products shoud not be used as can damage the latex Should seek advice in the event of failure device – may require EC/STIs testing

Answer 46

Sterilisation is considered a permanent method of contraception, so is very effective at preventing pregnancy The operation to sterilise a man is called a vasectomy The operation to sterilise a woman is called tubal occlusion An assessment should be carried out Verbal & written information should be provided Advice offered on other methods of contraception & their efficacy Does not prevent against STIs

Answer 47

The term describes methods of preventing or planning pregnancy based on observation of different fertility indicators during a woman's menstrual cycle There are two types of methods Fertility awareness methods (FAM) Lactational amenrrohoea methods (LAM) There is also the withdrawal method (coitus interruptus) The penis is taken out of the vagina & ejaculated outside of the vagina Assessment should be carried out Verbal & written information provided Advice on other methods of contraception Efficacy is much lower than other methods of contraception Does not protect against STIs Can be convenient, but also difficult to manage

Answer 48

Involves indentifying when a woman is least/most fertile by monitoring and recording fertilty indicators such as: Basal body (waking) temperature – slight rise that persists for 3 days indicates that the fertile time has ended Cervical secretions – an increase in the volume of clear cervical secretions indicates that ovulation is approaching Changes in cervix – fertile window starts at the first sign of the cervix changing from being low & firm (closed) to high & soft (open) Length of menstrual cycle – involves calculating length of menstrual cycle & using this to estimate the time of ovulation & fertile days of the cycle

Answer 49

Involves breastfeeding after childbirth to prevent pregnancy Breastfeeding delays the return of ovulation by disrupting gonadotrophin release The following conditions must be met before LAM can be used: Complete amenorrhoea Fully or nearly fully breastfeeding (baby is getting 85% or more of its feeds as breast milk) Less than 6 months post-partum

Answer 50

Condoms should be promoted as they provide protection against STIs However, they are less effective than LARCs at preventing pregnancy Combination of the two is the ideal solution The longest acting LARC is the copper-IUD Can be left in place for up to 10 years (depending on device used)