Short-acting Contraception

Question 1

What is the UKMEC and what do the scores 1-4 denote?

Answer 1

-Risk score for if a particular patient were to take a particular medication
1 = no restriction
2 = advantages outweigh risks
3 = risks outweigh advantages (use with caution, requires specialist input)
4 = unacceptable health risk

Question 2

What are some examples of the COCP?

Answer 2

-Microgynon
-Yasmin
-Rigevidon

Question 3

How effective is the COCP?

Answer 3

-99% - perfect use
-91% - typical use

Question 4

How does the COCP work?

Answer 4

-Contains both oestrodiol and progestogen
-Inhibits GnRH / FSH / LH
-Prevents ovulation, thickens cervical mucus and thins endometrium

Question 5

What advantages are there to taking the COCP?

Answer 5

-Reduction in:
–Bleeding, period pain, PMS, functional ovarian cysts, acne, benign breast disease
-Protects against:
–Ovarian, uterine, colon cancers and pelvic infection
-Can treat:
–PCOS, PMS, endometriosis
-Regular cycle
-Fertility returns to normal after stopping
-Can be used while breastfeeding

Question 6

What disadvantages are there in taking the COCP?

Answer 6

-Missed pills (pregnancy risk)
-Breakthrough bleeding and spotting (especially first few months)
-Vomiting

Question 7

How should the COCP be started?

Answer 7

Can start at any time
-If start on days 1-5 of cycle = effective immediately
-If start at any other time = use additional barrier method
-Use barrier methods if vomiting / diarrhoea

Question 8

In which patients is the COCP contraindicated?

Answer 8

-Those with BMI >35, smokers aged >35, diabetics
-Migraine with aura
-Vascular disease
-PMHx of VTE
-High bp
-Breast cancer
-Liver disease
-P450 inducers (reduced efficacy)

Question 9

What risks does taking the COCP bring?

Answer 9

-Blood clots (stop 4 weeks before major surgery)
-Breast + cervical cancer
-VTE / IHD
-Temporary SEs:
–Headaches
–Nausea
–Mood changes
–Breast tenderness
–Breakthrough bleeding

Question 10

What are the missed pill rules for the COCP?

Answer 10

-Missed pill = taken >24h late
-Take as soon as you remember
-1 missed pill = continue as normal (unless already missed a pill earlier in pack)
-2 missed pills = barrier methods / abstain
–If in week 1 = EC if UPSI
–If in week 2 = only EC if previous missed pills
–If in week 3 = omit pill-free week

Question 11

What are some examples of CYP450 inducers?

Answer 11

-Anticonvulsants (phenytoin, carbamazepine)
-Steroids (dex, pred)
-Antibiotics (rifampicin
-Others (alcohol, nicotine, St John’s wort)

Question 12

What does the vaginal ring do?

Answer 12

-‘NuvaRing’
-Small, flexible plastic ring
-Releases oestrogen and progesterone

Question 13

How does the vaginal ring work?

Answer 13

-Used like the pill ie 3 weeks then remove and have 1 week without
-Prevents ovulation, thickens cervical mucus and thins endometrium

Question 14

What are the advantages of using the vaginal ring?

Answer 14

-Don’t have to think about it every day
-Not affected by D+V (avoids 1st pass metabolism)
-Can make bleeds regular, lighter and less painful
-Low incidence of breakthrough bleeds
-Can protect agains uterine, ovarian and colon cancers
-Fertility returns to normal after stopping

Question 15

What are some disadvantages to the vaginal ring?

Answer 15

-Made less effective by some meds
-Women must be comfortable inserting and removing themselves

Question 16

How is the vaginal ring started?

Answer 16

-If started on day 1 of cycle = effective instantly
-If started on any other day = 7 days to work, use barrier methods