short acting reversible contraception Flashcards
name the types of SARC (3)
Combined hormonal Contraception (CHC)
Progesterone only pill (POP)
Emergency hormonal Contraception (EHC) in context of “quick start” and bridging contraception
name barrier methods of contraception?
Male condom
Female condom
Diaphragm/cap with spermicide
give non-contraceptive indications for use of CHC as
heavy menstrual bleeding Painful periods Acne Irregular periods Premenstrual symptoms Endometriosis Menstrual migraine (NO AURA)
CHC
- contains what?
- name the 3 different types
- mode of action?
- risks?
- metabolic effects of? (3)
- when to start?
-oestrogen (ethinyl estradiol (EE)), progesterone
-combined oral contraceptive pill (20-35ug EE
Combined transdermal patch (33ug EE)
combined vaginal ring (15ug EE)
-inhibiting ovulation via action on hypothalamic- pituitary-ovarian axis to reduce LH and FSH
+alters cervical mucus & endometrium
-venous thrombosis
arterial thrombosis
Adverse effect on some cancers
-alteration in clotting factor levels induced by EE may be thrombogenic e.g. reduces levels of antithrombin III and protein S
if arterial wall disease significant then EE might promote superimposed arterial thrombosis
inc fibrinolytic activity but reversed in heavy smokers
-COC’s can be started up to day 5, after this need condoms for 7 days if reasonable certain
COC
- describe a standard regime
- missed pills: procedure?
take daily for 21 days then stop for 7 days during which a withdrawal bleed occurs due to shedding of the endometrium
first 7 pills inhibit ovulation and then the txt 14 maintain anovulation
follicular activity may resume after 9 pills omitted
-if one:
over 24 hrs and less than 48 hrs then take pill as soon as remembered
remaining pills are taken at normal time
EC is not required
2+:
more than 48 hrs without pills
take the most recent missed pill
take remaining pills at the correct time
use condoms until 7 pills taken consecutively
days 1-7- consider EC
Days 8-14- no extra instructions
Days 15-21- omit pill free interval
CTP (patch)
- describe a stand regime
- disruptions to efficacy?
-one patch applied and worn for 1 week to suppress ovulation. then patch replied weekly for 2 wks and the 4th wk path free for withdrawal bleed
new patch after 7 patch free days
-patch can stay off up to 48 hrs
can be worn for 9 days
can be extended to 9 days
CVR (vaginal ring)
- standard regime?
- disruptions to efficacy?
ring placed into vagina and left fro 21 days
after ring free interval of 7 days for withdrawal bleed a new ring should be inserted
-can be left out of vagina for 48 hrs
ring can be worn for up to 4 wks
ring free interval can be extended by 48 hours
off license regimes for CHC?
-tri-cycling: 3 pack taken back to back then 7 days off
shortened hormone free interval- 3wks on and 4 days off
extended use- method used continuously till breakthrough bleed after which point stop for 4-7 days
factors that affect the effectiveness of CHC?
impaired absorption (GI) increased metabolism (liver enzyme induction/interactions) Forgetting
Unwanted circulatory effects of CHC?
- risk factors?
- what version carries the highest risk?
-venous disease leading to venous thromboembolism
systemic hypertension (check after 3 months)
arterial disease (small inc risk stroke & MI)
Migraine with aura (inc risk stroke)
-risk factors for VTE
Obesity, smoking, age, known thrombophilia
VTE in 1st deg relative
up to 6 wks post natal
+trekking/long haul flights/reduced mobility/antiphospholidid syndrome
-EE
Unwanted cancer effects of CHC?
-cancers affected?
-breast cancer (don't use in prev hx or fam hx or BRACA) cervical cancer (small inc risk with long term use
non-contraceptive benefits of CHC?
-CHC licensed for acne?
protects against ovarian & endometrial carcinoma
can have a beneficial effect on acne
reduces heavy bleeding
can aid PMS & PCOS (acne)
-EE/Cyproterone acetate
Side effects of CHC?
-CTP & CVR vs COC
unscheduled bleeding
mood changes
weight gain
-CTP had more breast pain/nausea/painful periods
CVR had less bleeding probs/acne/irritability/mood changes
what is:
- Quick start contraception?
- Bridging contraception?
- anytime starting
- After emergency contraception
Bridging contraception:
-how long after each form of EC should you start CHC?
-levonelle- 7 days with condoms
Ulipristal Acetate- avoid starting for 5 days
