Sexual Health Flashcards
What are the three types of combined hormonal contraception?
Ora Transdermal patch and Vaginal Ring
What’s the basic mechanism of combined contraception
HPA: oestrogen and progesterone act on HPA axis to red LH and FSH -n preventing LH surge and ovulation
‘Local’:
Oestrogen cuses endometrium to proliferate and grow
Progestogen prevents hyperplasia of endometrium by opposing oestrogen effect
Why do you have 7 day pill free period in COCP?
causes oestrogen and progestogen concentrations to fall, which causes the oestrogen-primed endometrium to slough, mimicking menstruation. No actual health benefit to doing this though
Standard vs Tailored Regimen for CHC
Standard = 21 pill/patch/ring -> 7 day off Hormone Free Interval (HFI)
Tailored red freq of HFI, reduce/avoid HFI symptoms, red risk escape ovulation and therefore failure; as safe and effective as 21/7. Off licence but endorsed by FSRH
Outline Tailored Regimens for CHC
- Shortened hormone-free interval (HFI): CHC 21 days (21 active pills or 1 ring, or 3 patches) HFI 4
- Extended use (tricycling): CHC 9 weeks (3 x 21 active pills or 3 rings, or 9 patches used consecutively) HFI 4 or 7
- Flexible extended use Continuous use (21 days or more) of active pills, patches or rings until breakthrough bleeding occurs for 3–4 days HFI 4
- Continuous use: Continuous use of active pills, patches or rings
When to start COCP post partum
D21 if no addtitional risk factors for VTE
Breastfeeding then don’t start if less than 6 weeks postpartum
POP Modes of Action
thickening cervical mucus thereby preventing sperm penetration, delaying ovum transport, inhibiting ovulation, and providing an endometrium hostile to implantation.
however, the contraceptive effect provided is short-lived (less than 24 hours), unless maintained by regular pill taking.
also suppress ovulation by suppressing mid-cycle peaks of luteinizing hormone and follicle-stimulating hormone.
Frequency of Prog implant change
3 yearly
Frequency od Depo Provera and Sayana Press & Noristerat injections
Depo Provera® deep IM every 12 weeks.
Sayana Press® s by subcutaneous injection every 13 weeks. Noristerat® by deep IM every 8 weeks but is only used for short-term use (two injections).
Advantages of POP
It is very effective when taken correctly.
Sex need not be interrupted to use.
It can be used when breastfeeding.
It can be used by women for whom the combined oral contraceptive is not suitable.
There is no evidence suggesting a delay in the return of fertility when the POP is stopped.
The desogestrel pill may help to alleviate dysmenorrhoea and mid-cycle ovulatory pain.
Available evidence has not shown an increased risk of pregnancy in POP users with a heavier body weight or a higher body mass index (BMI).
Disadvantages of POP
The POP must be taken daily with no pill-free interval.
Adverse effects may occur, such as unscheduled bleeding and breast tenderness.
Contraceptive efficacy is likely to be reduced in women using liver enzyme-inducing drugs eg st johns wort
It does not protect against sexually transmitted infections (STIs).
Which contraceptive is a good option for women with SCD and caan reduce severity o sickle crisis pain
progesterone only injectables
Time of fertility & menstruation to return after stopping progesterone onl injectable
There could be a delay of up to 1 year in the return of normal fertility.
Menstruation can take several months to return to normal.
How effective are POPs
Typical use - 9% chance of pregnancy
UKMec 3&4 for POP
Breast Ca current or past
IHD (continuation)
Stroke (Continuation)
VTE during use of POP
Decom Cirrhosis
HCC
>55
Plus AKI, severe cksd, hyperkalaemia, K+ sp diuretic
caution with addisons or mild/mod renal impairmenthen
When to start POP (general, post-aboriton, post pregnancy)
General: Tradition & DSG Days 1-5 MC, DRSP, Day 1
Abortion: by Day 5, DRSP Day 1
Pregnancy By day 21
Other time - 2 dsay barrier or 7 day barrier for DRSP
5 days after emergency contraception UPA
Management of POP missed pill
Late = trad >3hrs / DSG >12hrs / DRSP >24hrs after dose due
Action:
Take Missed pill, Take next dose when due, Barrier for 48hr / 7 days for DRSP
DRSP - omit HFI placebo pills if issed any of last 7 active pills
Consider EC:
If UPSI from missed dose until correct pill-taking had resume for 48hrs / 7 days for DRSP (or HFI)
Pregnancy Test - consider 21 days after last UPSI
