Short acting contraception II Flashcards
What is tri-cycling?
Off-licence regime: 3 packs taken back to back then 7 days off
Shortened hormone free interval?
3 weeks of CHC then 4 days off
Extended use
Method used continuously until breakthrough bleeding occurs, then stop for 4-7 days
Why can CHC be thrombogenic?
Reduces levels of antithrombin III and protein S
How often do you need to check BP if prescribing COC?
Check initially at 3 months and then annually
What is cyproterone acetate?
Progestogen derivative (DIANETTE !!) -given if they need acne and hirsutism treatment)
May be small risk of increased MI in ____
COC
Why can’t you give CHC to patients with migraine with aura?
Migraine with aura increases risk of ischaemic stroke
-CHC increases risk further
Breast cancer and CHC?
Personal history – CHC contraindicated
Family history – UKMEC 1
BRACA – UKMEC 3
CHC and ovarian cancer?
20% reduction in ovarian cancer for every 5 years of use to a maximum 50% reduction after 15 years of use
CHC and endometrial cancer?
50% risk reduction in endometrial cancer
Functional ovarian cysts and CHC?
I think CHC helps stop formation of cysts
Side effects of patch?
More breast pain/nausea/painful periods (compared to using pill/ring)
Good things about the ring
Less bleeding problems /acne/irrtiability/mood changes
Guidance for sex after levonelle?
Use protection for 7 days after
Guidance for contraception after ellaOne (ulipristal acetate)?
Don’t start contraception for at least 5 days –> hormonal contraception interferes with the action of ellaOne
Two or more pills missed
Take the most recent missed pill
Take the remaining pills at the correct time
Use condoms or abstain until 7 pills have been taken consecutively
One missed pill
Over 24 hours and less than 48 hours
Take the missed pill as soon as it is remembered
Remaining pills are taken at the normal time
EC is not required
If more than 48 hours without pills, what should you consider if you missed them over:
Days 1-7
Days 8-14
Days 15-21?
Days 1-7: consider emergency contraception
Days 1-8: no extra instructions
Days 15-21: omit pill free interval
How long is the patch active for once you take it off?
Removal of patch: can remain off up to 48 hours before efficacy is reduced
How long can the patch be worn for?
Patch can be worn for up to 9 days (7 days +48 hours) before efficacy reduced
How long is the patch free interval?
Normally one week but can be extended up to 9 days (7 days + 48 hours) before efficacy reduced
How long can the ring be left out of the vagina for?
Ring can be left out of vagina for up to 48 hours before efficacy is reduced
How long can the ring be worn for?
Normally wear for 3 weeks then week free but can be worn for up to 4 weeks without efficacy being reduced
How long is your ring-free period?
Normally one week but ring-free interval can be extended by 48 hours without efficacy being reduced
POP mechanism of action?
Primary action:
-thickening of cervical mucous
(etonogestrel suppresses ovulation)
Secondary action:
-suppresses ovulation in up to 60% of cycles (levonogestrel)
-decreases endometrial receptivity to blastocyst
-reductio in cilia activity in fallopian tube
POP fits UKMEC4 in which circumstance?
Current breast cancer
POP interacts with which liver enzymes?
Cytochrome P450
- suitable alternative include depot, IUD and IUS
- effect on liver enzymes continue for 28 days after stopping
How to take levonorgestrol or norethisterone? (These are the older POP)
- Daily at the same time
- No breaks
- Within 24-27 hours of last does
How to take etonorgestrel?
- Daily at the same time within 24-36 hours of last dose
- No break
What happens if you miss a POP pill and have UPSI?
Need to take emergency contraception and use protection for 2 days
How does the combined oral contraceptive pill work?
Inhibits ovulation
How does the implantable contraceptive (etonogestrel) work?
Inhibits ovulation
How does the IUD work?
Decreases sperm motility and survical
