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GP > Sexual Health - COCP and POP > Flashcards

Sexual Health - COCP and POP Flashcards

1
Q

What is the UKMEC?

A

Guidelines to categorise risk of starting different contraception
UKMEC1- No risk
UKMEC2- Benefits outweigh risks
UKMEC3- Risks generally outweigh benefits
UKMEC4- Unacceptable risk

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2
Q

What are some examples of barrier methods of contraception?

A

Condoms
Diaphragms and cervical caps
Dental dams

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3
Q

What is the effectiveness of condom use?

A

98% with perfect use
82% with typical

Oil-based lubricants can damage latex condoms increasing risk of tearing

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4
Q

What are diaphragm and cervical caps?

A

Fit over cervix to prevent sperm entering

Left in place for 6 hours after sex

Use with spermicide gel

95% effective

No STI protection

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5
Q

What are dental dams?

A

Used in oral sex to provide a barrier between the mouth and vulva, vagina or anus

Prevents STIs through oral sex

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6
Q

What STIs can be transmitted in oral sex?

A

Chlamydia
Gonorrhoea
Herpes simplex 1 and 2
HPV
E.coli
Pubic lice
Syphilis
HIV

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7
Q

What is the COCP?

A

Combination of oestrogen and progesterone

Can be used up until 50 years old

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8
Q

What is the mechanism of action of the COCP?

A
  • Prevents ovulation
  • Progesterone thickens cervical mucus
  • Progesterone inhibits proliferation of the endometrium

Oestrogen and progesterone have negative feedback, suppressed release of LH and FSH

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9
Q

What are the two types of COCP?

A

Monophasic pills - same amount of hormone per pill
Multiphasic pills- varying amounts of hormone to match cyclical hormonal changes

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10
Q

What is the first line COCP use?

A

Pills with levonorgestrel or norethisterone

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11
Q

What pill can be used for acne and hirsutism?

A

Co-cyprindiol pill

Stopped after 3 months due to higher VTE risk

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12
Q

What are the risks of using the COCP?

A

Breast pain and tenderness
Unscheduled bleeding
VTE risk
Increased risk of breast and cervical cancer
Increased risk of MI and stroke
Hypertension
Headaches

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13
Q

How long does it take the risk of breast and cervical cancer to return to normal after COCP use?

A

10 years

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14
Q

What are the benefits of the COCP?

A

Effective contrception
Fertility returns after stopping
Improvement of premenstrual symptoms (menorrhagia and dysmenorrhoea)
Reduced risk of endometrial, ovarian and colon cancer
Reduced risk of benign ovarian cysts

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15
Q

What are the contraindications to COCP use?

A

Unctrolled hypertension
Migraine with aura
History of VTE
Over 35 and smoking
Liver cirrhosis
SLE and anti-phospholipid syndrome

BMI over 35 is UKMEC3 rather than 4 like the rest above

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16
Q

How should the COCP be started?

A

Start on first day of cycle, offers protection straight away

No additional contraception needed if pill started up to day 5 of menstrual cycle

17
Q

What should be done if the COCP is started after day 5 of the menstrual cycle?

A

Requires extra contraception for the first 7 days of consistent pill use

18
Q

How long should additional contraception be used when switching from the POP to the COCP?

A

7 days

Can switch at any time

Desogestrel
Can switch immediately as it inhibits ovulation

19
Q

What are missed pill rules?

A

Missing one pill is when the pill is more than 24 hours late (48 hours since last pill was taken)

Missing one pill
- Take missed pill ASAP, even if it means taking two on same day
- No extra protection is required, provided previous pills taken correctly and after this

Missing more than one pill (over 72 hours)
- Take most recent missed pill
- Additional contraception until taken pill for 7 days straight
- If day 1-7- need emergency contraception
- Day 8-14, no emergency needed (if 1-7 taken correctly)
- Day 15-21, no emergency needed, go back-to-back with next pack of pills and skip pill-free period

20
Q

What can stop the efficacy of the COCP?

A

Vomiting
Diarrhoea
Rifampicin

Day of vomiting is classed as a missed pill day

21
Q

How long before a major operation should the COCP be stopped?

A

4 weeks before

22
Q

What is the only absolute contraindication to the POP?

A

Active breast cancer

23
Q

What are the two types of POP?

A

Traditional progestogen-only pill
- Missed if taken more than 3 hours late

Deogestrel-only pill
- Missed if taken more than 12 hours late

24
Q

How does the traditional progestogen only pill work?

A
  • Thickens cervical mucus
  • Makes endometrium less receptive to implants
  • Reduces ciliary action in fallopian tubes
25
Q

How does the desogestrel pill work?

A
  • Inhibits ovulation
  • Thickens cervical mucus
  • Makes endometrium less receptive to implants
  • Reduces ciliary action in fallopian tubes
26
Q

How can the POP be started?

A

Starting on day 1-5 means the woman is immediately protected

Must take additional contraception for 48 hours to give cervical mucus time to thicken

Women should do pregnancy test 3 weeks after last uprotected intercourse
(may need emergency cotnraception before starting)

27
Q

How do you switch between POPs?

A

Can swtich immediately, no need for extra contraception

28
Q

How can you swtich from a COCP to a POP?

A

No additional contraception if
- Taken COCP for 7 days consistently and in week 2 or 3 of pack
- On days 1-2 of hormone free period

Days 3-7 of hormone free period and days 1-7 of COCP
- If they havenot had intercourse on day 3 of hormone free just take additional contraception for 48 hours
- If they have had intercourse, should take COCP until 7 days consecutively and can switch over without any requirements

29
Q

How long can sperm live in the uterus?

A

5 days

30
Q

How is bleeding affected in the POP?

A

Unscheduled bleeding in first 3 months

20% amenorrhoea
40% regular bleeding
40% irregular, prolonged or troublesome bleeding

31
Q

What are the side effects and risks of the POP?

A

Side effects
Breast tenderness
Headaches
Acne

Risks
Ovarian cysts
Ectopic pregnancy risk
Minimal increased risk of breast cancer, returns to normal after 10 years

32
Q

What are the missed pill rules for the POP?

A

Traditional POP
More than 3 hours late (more than 27 hours after last pill)

Deogestrel
More than 12 hours late (more than 36 hours after last pill)

Take a pill asap, use extra contraception for next 48 hours

Need emergency contraception if had sex within 48 hours

GP (37 decks)

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