Sexual Health Flashcards
Combined contraceptives mechanism
Contain oestrogen + progesterone
- Inhibit LH + FSH release + ovulation
- Thicken cervical mucus - prevent sperm passage, thin endometrium
UKMEC - UK medical eligibility criteria
1 - no restriction
2 - benefits > risks
3 - risks > benefits
4 - unacceptable health risk
Combined contraceptives CIs
- Migraine with aura
- Current breast cancer (small increased risk of breast cancer whilst taking - reduces to normal after 10yrs of stopping)
- VTE RFs (AF, SLE, >35 smoking >15 cigarettes / day, hx of stroke/VTE …)
- CV RFs (BP >160/100, IHD)
- Severe liver disease
- Immobility, BMI >35, VTE FHx, BRCA1/2
- Pts who have had gastric sleeve / bypass cannot have oral contraception ever again - due to lack of efficacy
positives and negatives for combined COCP
+VEs
- Lighter, regular periods
- May reduce ovarian, endometrial, bowel ca risk
-VEs
- Increased VTE risk
- Slight breast / cervical ca risk
- headaches, nausea, breast tenderness, mood swings
- Forgetting pill reduces efficacy
examples of COCP + need to know facts r.e. efficacy
- Microgynon, Rigevidon
- 21/7 or maybe 63/7 cycle
- If started within 5d of cycle, no need for additional contraception. If at any other point, use 7d condoms
- UPSI during pill-free period fine as long as next pack started on time
- Efficacy reduced - vomit within 2hrs taking, liver-enzyme inducing drugs, rifampicin, some AEDs
contraceptive patch - need to know facts r.e. use
- One patch for 7 days, then change - typically 21/7 - withdrawal bleed in last week
- If patch change delayed wk 1/2 - if <48hrs delay, change immediately, no further action, >48hrs change + 7d barrier contraception, emergency contraception if UPSI during this >48hr period
- Removal delay at end of wk 3 - remove asap then replace patch on usual day
- Delay applying at start of wk 1 - 7d barrier contraception
POP - examples
- Take every day, no breaks
- Desogestrel - inhibits ovulation, thickens cervical mucus, thins endometrium, take within same 12hrs each day
- Norethisterone / levonorgestrel - thicken cervical mucus, thin endometrium, take within same 3hrs
from when does POP protection start?
- Immediate protection if started in day 1-5 of cycle, otherwise, use condoms for 2d
- Gives immediate protection if continued straight on from COCP
positive and negatives of POP
+VEs
- Can use where oestrogen CI’d
- Take w/o breaks
-VEs
- less protection if pill missed
- Irregular bleeding, amenorrhoea
- Affected by enzyme inducer drug
what is depo-provera and how does it work?
IM progestogen every 3mo
- Inhibits ovulation, thickens mucus, thins endometrium
S/E of depo
- Irregular bleeding, amenorrhoea
- Affects bone mineral density
- Fertility takes months to return after stopping
implant - how does it work and from when are you protected?
- Subdermal, slow release progestogen (eg Nexplanon), lasts 3yrs
- If not inserted between day 1-5 of cycle, need 7d condoms
- irregular bleeding (co-prescribe cOCP to prevent)
- Acne - worsens
how does the IUS / hormonal coil work? how long do you need to use condoms for?
- Release progestogen - thicken mucus, thin endometrium - 3-5yrs
- Use condoms for 7d after insertion
IUS s/e
- Reduce heavy menstruation
- systemic S/E few
- Amenorrhoea, irregular bleeds
- Acne, headaches, breast tenderness, painful
- Uterine perforation risk
- higher risk of ectopic pregnancy
copper coil - mechanism ?
- creates inhospitable environment for sperm - 5-10yrs
- no hormones
- efficacy unaffected by meds
copper coil risks and S/E?
- heavy, long, painful menstruation
- perf risk
- ectopic pregnancy
female sterilisation procedure?
Under GA / during c-section
Clips to occlude fallopian tube / salpingectomy / fallopian implants under hysteroscopy
Can still get pregnant, ectopic likely
Difficult to reverse
male sterilisation procedure?
Vasectomy - under LA, remove section of vas deferens
Less invasive than female
Difficult to reverse
Levonelle / levonorgestrel - emergency contraception - how does it work?
- Progestogen - delays ovulation until after sperm has died
- Take <3d of UPSI
- If vomit <3hrs, rpt dose
- Can start hormonal contraception immediately
- Can take more than once in cycle
- Least effective emergency contraception, affected by enzyme meds
- No benefit if taken after LH surge / ovulation
Ellaone / ulipristal acetate - EC - how does it work?
- Delays / stops ovulation
- Take <5d UPSI
- Wait 5d before starting hormonal contraception
- Delay breastfeeding 1wk after
- Some efficacy after ovulation
- More effective than levonorgestrel
- Use more than once in one cycle
- Affected by meds
- CI - severe asthma, liver problems, PPI / antacids
using copper coil as emergency contraception?
- Insert <5d UPSI / <5d ovulation
- Most effective EC
- Not affected by meds / weight
- CI’d >5d post ovulation
rules if missed COCP
If 1 missed pill at any time
- Take last pill, today’s as normal, continue, no additional contraception
If 2+ missed pills
- Take last pill, todays, continue
- 7d condoms
- if in wk 1 + UPSI - consider EC
- if in wk 2 - no EC need
- if in wk 3 - finish pills in current pack, start next pack immediately, omit pill-free interval
rules if missed POP?
- <3hrs late, continue as normal
- > 3hrs late, action needed
- 12hr timeframe for desogestrel
Action:
- take missed pill asap, as well as next pill in day, continue
- 48hrs condoms
contraception >40?
cOCP may help maintain bone mineral density perimenopause / reduce menopause sx
HRT - use POP alongside, as long as HRT has progestogen component
stopping contraception: non hormonal
<50yo stop after 2yrs amenorrhoea
>50yo stop after 1yr amenorrhoea
stopping contraception: COCP
<50yo - continue to 50yo
>50yo - switch to non-hormonal / progestogen only
stopping contraception: depo
<50yo - continue to 50yo
>50yo - switch to non-hormonal / progestogen only
stopping contraception: implant, POP, IUS
<50yo - can continue >50yo
>50yo - continue, if amenorrhoeic check FSH and stop after 1yr if FSH raised or stop at 55yo - if bleeding consider Ix for abnormal bleeding
post partum contraception?
- need after day 21 after birth
POP
- start at any time breastfeeding or not
- condoms for 2d at start
COCP
- If breastfeeding, UKMEC4 contraindicated <6wks postpartum, UKMEC2 6wks-6mo
- Do not use <21d postpartum - VTE
- May reduce breast milk production
- 7d condoms
IUS/D
- Insert <48hrs or >4wks after childbirth
lactational amenorrhoea?
- Works <6mo post-partum if exclusively breastfeeding
BV
Overgrowth of anaerobic organisms in vagina and raised vaginal pH
Loss of friendly lactobacilli (produce lactic acid, keep vagina pH <4.5)
BV RFs
Multiple sexual partners
Excessive vaginal cleaning
Recent abx
Smoking
Copper coil
BV Px
Vaginal discharge - fishy, offensive, grey/white
Not usually sore, itchy
Asymptomatic in 50%