Sexual Health Flashcards
Levonogestrel for Emergency Contraception
- Synthetic progesterone
- 1.5mg single dose as soon as possible after sexual intercourse
- Licensed up to 72 hours after SI
- If vomiting within 2 hours, rpt dose can be given
Ulipristal (EllaOne)
- Selective progesterone receptor modulator
- 30mg single dose
- Effective up to 5 days after SI
- If vomiting within 3 hours, rpt dose can be given
Avoid in enzyme inducing drugs!
Recommended advice if 2 or more pills have been missed (> 48 hours late)
1. Pills 1-7 (first week)
2. Pills 8-14 (second week)
3. Pills 15-21 (third week)
The most recent missed pill should be taken as soon as possible.
The remaining pills should be continued at the usual time.
Use condoms or avoid sex until 7 consecutive pills have been taken.
Week 1 - EC should be considered if UPSI occurred in the pill free interval or in the first week of pill taking.
Week 2 - No indication for EC if the pills in the preceding 7 days have been taken correctly.
Week 3 - omit the pill free interval by running back to back.
Contraceptive patch removed or detached for < 48 hours?
No additional precautions required.
If contraceptive patch has been removed or become detached for > 48 hours, additional precautions should be used for 7 days and EC considered.
Advice following Ulipristal acetate (Ella One) for emergency contraception ?
Can be used up to 5 days after UPSI.
As it blocks progesterone, there is a risk of reducing the efficacy of contraceptives that contain progesterone and therefore COCP users should use additional precautions for 14 days after use of Ulipristal acetate.
Mechanism of action of POP?
Thickening of cervical mucous
Ovulation inhibited in up to 97% of cycles with new generation POP’s containing desogestrel.
Examples of traditional and new generation POPs ?
What progestogen do the contain ?
Traditional POPs
- Levonorgestrel (30 micrograms)
- Norethisterone (350mcg)
- Norgestron, Micronor, Noriday
New Gen POPs
- Desogestrel (75 mcg)
- Cerazette, Cerelle, Nacrez
Failure rate of vasectomy vs tubal sterilisation?
Vasectomy - 1/2000
Tubal sterilisation - 1/200
Bleeding pattern on POP:
1. Amenorrhoea
2. Regular bleeding
3. Irregular bleeding
- 20% amenorrhoea
- 40% regular bleeding
- 40% irregular bleeding
UKMEC 3 - relative contraindication to POP?
- Current or previous IHD
- Stroke
- Prev breast Ca with no evidence of recurrence for 5 years
- Severe decompensated liver cirrhosis
- Benign or malignant tumours
- SLE with severe thrombocytopaenia and +ve antiphospholipid antibodies
UKMEC 4 - relative contraindication to POP
Current breast cancer
Additional precautions if starting POP > D5 of menstrual cycle?
Additional precautions or abstinence for 48 hours only.
Missed pill advice for POP?
- Traditional pills containing levonorgestrel or norethisterone are considered ‘late’ if taken > 3 hours late
- New gen POP’s containing desogestrel are considered missed if taken > 12 hours late
The missed pill should be taken as soon as it is remembered.
The next pill should be taken at the usual time which may mean taking 2 pills in one day.
Additional precautions should be used for 48 hours.
Em contraception may be required if UPSI has occurred in the 48 hour period after the missed pill.
Advice of DEPO contraceptive injection commenced after D5 of the menstrual cycle?
POI can be started after D5 of the menstrual cycle but barrier contraception should be used for the first 7 days after the injection.
A repeat depo can be given up to how long after missed repeat dose without need for additional precautions ?
2 weeks - risk of ovulation is low.
Mechanism of action of copper IUD?
Inhibits fertilisation - toxic to sperm + ovum
Levonorgestrel (Levonelle) for Em Contraception.
1. Dose
2. Effect
3. Pregnancy rate following use
4. Contra indications
- 1.5mg single dose orally
- Delays ovulation for 5-7days
- Pregnancy rate 2.2% following use
- Liver enzyme inducing drugs may reduce its efficacy and this effect persists for 28 days after.
How long should women be advised to continue contraception for after sterilisation?
7 days
Abortion Act:
1. Clause A
2. Clause B
3. Clause C
4. Clause D
5. Clause E
- Clause A - the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated
- Clause B - the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
- C - the pregnancy has not exceeded 24/40 and the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman
- Clause D - the pregnant has not exceeded 24/40 and continuing the pregnancy would involve risk of injury to the physical or mental health of any existing children of the family of the pregnant woman
- Clause E - there is substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped
Risk of needing surgical intervention after MTOP?
5%
Risk of pregnancy after vaginal rape ?
5%
When to stop contraception in women > 40
1. Women > 50 not on hormonal contraception
2. Women < 50
3. Women > 50 using POP
4. Women > 55
- Stop contraception after 1 year of amenorrhoea
- Continue contraception for 2 years after amenorrhoea
- Contraception can be stopped after 1 year and 2x FSH levels > 30, 6 weeks apart
- Stop contraception
If using COCP - stop for 2 weeks to check FSH levels.
Once a woman is established on HRT, how often should she be reviewed?
Annually
What % of subfertility is male factor?
30%
Mirena IUD releases levonorgestrel at what rate/day?
20mcg/day
Risk of continuing pregnancy in Medical vs Surgical abortion?
Medical: 1-2:100
Surgical: 1/1000 (higher < 7/40)
Antibiotic regime for surgical abortion prophylaxis?
Oral Doxy 100mg BD for 3-7 days starting in within 2 hours of the procedure.
Mife/Miso regime for MTOP (< 12/40)
Mife 200mg orally
Miso 800mcg (PO/PV/buccal/SL) 24/48 hours later
Miso 400mcg 4 hours after if pregnancy not passed (will likely need if > 9/40)
