Sexual Health Medications Flashcards
MoA of POP?
• Progestogen-only pills (POPs) have several independent modes of action that contribute to their contraceptive effect: They increase the volume and viscosity of cervical mucus, thereby preventing sperm penetration into the upper reproductive tract.
MoA of COCP/CHC?
Combined hormonal contraceptives (COCP/CHC) (pill, patch, and vaginal ring) act primarily to inhibit ovulation.
Contains oestrogen and progesterone. Act on hypothalamo-pituitary axis to reduce production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH).
With no surge in LH and FSH to stimulate the ovaries, ovulation does not occur.
Oestrogen component of the CHC causes the endometrium to proliferate and grow.
Progestogen component of the CHC prevents hyperplasia (excessive growth) of the endometrium by opposing the proliferative effects of ostrogen
MoA of Copper Coil?
Copper coil: Copper ions released from an IUD enhance the inflammatory response and reach concentrations in the luminal fluids of the genital tract that are toxic for spermatozoa.
Moa of Levonorgestrel IUD?
Mirena coil: The main mode of action of levonorgestrel intrauterine devices (LNG-IUDs) is their progestogenic effects on the endometrium and cervical mucus: the effects on cervical mucus prevent the passage of sperm into the upper reproductive tract, whilst the effect on the endometrium may inhibit implantation of the fertilized ovum.
<15m
Side Effects of Nexplanon ?
Irregular menstrual bleeding
Nexplanon implant, which contains the progestin etonogestrel, mainly functions by inhibiting ovulation. However, it also alters the endometrium and cervical mucus, which can lead to changes in menstrual bleeding patterns.
MOA Mirena Coil
progestogenic effects on the endometrium and cervical mucus:
on cervical mucus - it prevent the passage of sperm into the upper reproductive tract
on the endometrium - it inhibits the implantation of the fertilized ovum.
<15m
Should the COCP pill be given to a wheelchair user as first line contraceptives and justify your answers?
Wheelchair users should not be prescribed the COCP as first-line contraceptive, as they are ‘UKMEC 3’- risks outweigh benefits
UKMEC 1: a condition for which there is no restriction for the use of the contraceptive method
UKMEC 2: advantages generally outweigh the disadvantages
UKMEC 3: disadvantages generally outweigh the advantages
UKMEC 4: represents an unacceptable health risk
Examples of UKMEC 3 conditions include
more than 35 years old and smoking less than 15 cigarettes/day
BMI > 35 kg/m^2*
family history of thromboembolic disease in first degree relatives < 45 years
controlled hypertension
immobility e.g. wheel chair use
carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
current gallbladder disease
Examples of UKMEC 4 conditions include
more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)
What happens if 2 pills are missed in week 1?
COCP: If 2 pills are missed in week 1, consider emergency contraception if she had unprotected sex during the pill-free interval or week 1
Rules for missed pills in COCP?
Missed COCP (protects for 7 consecutive days unless 2 or more missed)
- If 1 missed (any time in cycle): take it and continue as normal
- If 2 or more missed: take it and use condoms for 7 days
- If 2 or more missed in week 1 and she has had sex this week or previous pill-free interval: + emergency contraception
- If 2 or more missed in week 3: start next pack as soon as she finishes current pack
Rules for missed pills in POP?
Missed POP
- Traditional (micronor, noriday, nogeston, femulen): if > 3 hours late then action required
- Cerazette (desogestrel): if > 12 hours late then action required
- Action: Take the missed pill as soon as possible (take just one if >1 missed) and the next at the usual time. Use condoms for 48 hours
COCP- Increases the risk of and decreases the risk of?
Combined oral contraceptive pill
increased risk of breast and cervical cancer
protective against ovarian and endometrial cancer
Way to remember what COCP is protective of and increases the risk of?
COCP increases the risk of cancers we screen for (breast and cervical) and is protective for those we don’t (ovarian and endometrial).
It is protective ‘inside the womb’ (ovarian/endometrial) and increases the risk of everything ‘outside the womb’ (breast and cervical) -
migraines with aura - a condition that can increase using the COCP
What should you do ? And Why?
The woman is having migraines with aura - a condition that can increase using the COCP. Women who have migraine with aura should stop the pill immediately - this is because the oestrogen component of the COCP can increase the risk of the women having an ischaemic stroke. A progesterone-only contraceptive pill is therefore the only alternative contraceptive medication that can be prescribed, as the others have oestrogen.
young women travelling- what contraceptives
Implantable contraceptives are the most effective form of contraception and are hence very suitable for young women, particularly if they are planning to go travelling, have chaotic lifestyles etc
Advice to give regarding mirena coil and the effects on the period?
initially irregular bleeding later followed by light menses or amenorrhoea
