TBL contraception Flashcards
What are the different types of progesterone that can be used in the contraceptive pill?
They are either 2nd generation progesterone which includes:
Levonorgesterol
Norethisterone
Norgestimate
3rd generation progesterones:
Desogesterol
Gestodene
4th generation progesterone:
Drospirenone
What is an appropriate dose of oestrogen to be found in combined contraceptive pills?
Either low dose 20mcg or standard dose 30-35mcg, no higher is given due to risk of thromboembolism
What is an example of a monophasic, biphasic or triphasic combined oral contraceptive?
Monophasic: Microgyon
Biphasic: Azurette
Triphasic: Trivora
Explain the principle of a monophasic combined pill?
It contains the same amount of oestrogen and progesterone in every single pill in the cycle and is prepared in 21 day or 28 day formulations.
Explain the principle of a biphasic combined pill?
They use a lower ratio of oestrogen: progesterone in the first half of the cycle and then a higher ratio in the second to mimic the natural levels during the menstrual cycle.
Explain the principle of a triphasic combined pill?
The combination of hormones changes approximately every week during the pill cycle, providing three phases.
Why would you chose biphasic or triphasic over a monophasic preparation?
Patients medical history
Personal preference
Previous contraceptive experience
Age related considerations
What are some of the advantages of the combined oral contraceptive pill?
Reduces menstrual pain and bleeding
Reduces risk of ovarian, endometrial and colorectal cancer
Predictable bleeding pattern
Maintains mineral bone density of pre-menopausal women under 50
Protects against pelvic inflammatory disease
What are some of the disadvantages of using the combined contraceptive pill?
No protection against STIs
Increased risk of breast cancer
Increased risk of ovarian cancer
Causes fluid retention so can lead to an increase in weight
Acne
Risk of venous thromboembolism
Breast tenderness
Mood swings
Increased risk of stroke
Breakthrough bleeding
What are the other four risk factors for developing deep vein thrombosis that are contra-indicated in use for combined oral contracpetives?
Family history (first degree relative who developed one under 55)
Surgery
Long haul flight
Obesity
When is combined oral contraceptives contra-indicated?
2 or more risk factors of DVT
Active liver disease
Breast feeding
Major surgery
Current or past history of VTE, stroke or ischaemic heart disease
How long in advance should you stop COC before surgery and restart after surgery?
4 weeks in advance due to risk of DVT and continue at first menses at least 2 weeks after full mobilization is regained.
Which surgery should you stop COC?
Any surgery to the legs or surgery that is going to cause immobilisation
If surgery is an emergency, what is the appropriate steps to implement to avoid DVT?
Compression hosiery and prescribe thrombo-prophylaxis (heparin)
What are some of the risk factors of DVT?
FH of VTE/arterial disease in first degree relative <45yrs
▪ Obesity – BMI > 30 (avoid if BMI >35)
▪ Long term immobilisation
▪ >35 yrs (avoid if >50 yrs)
▪ Smoking
▪ DM (avoid if diabetes complications)
▪ HT - >140/90 (avoid if >160/95)
▪ Migraine without aura (avoid if migraine with aura)
What are some of the benefits of the progesterone only pill?
Reliable and reversible
Does not have the oestrogen associated risks
Can use whilst breast feeding
Can be used in patients where the combined pill is contraindicated
Which patients are suitable for the progesterone only pill that can’t take the combined pill?
Heavy smokers (over 15 a day)
Over 35
Hypertension
Diabetes
Migraine
Major surgery
What are some of the disadvantages of the progesterone only pill?
Must be taken at the same time each day (three hours later than the normal dose means you are not protected).
Increases risk of ovarian cysts
Increases risk of breast cancer
Can cause menstrual irregularities
No STI protection
Do you have to alter progesterone only contraception before surgery?
No it does not need to be changed as it does not cause an increased risk of DVT.
What should you do if a women misses one or pill or starts the pack one day late on both the combined pill or the progesterone only pill?
Combined pill: Missing one pill
Take the pill immediately even if it means taking two pills in one day.
Carry on as normal
You are still protected
Combined pill: Starting the pack a day late
Same advice as above, on starting the medication if you take your first pill more than five days after the start of your period you are not protected and need to use additional methods of contraception for 7 days.
Progesterone only: Missing one pill
If you are less than 3 hours late for a traditional POP Noriday, Micronor, Norgeston
If you are less than 12 hours later for a desorgesterol containing pill such as Cerelle or Cerazette
You are protected and just take the pill immediately even if it means taking two in one day and then carry on as normal
More than 3 or 12 hours, same advice as above but you are not protected and need to use extra protection for two days.
What should you do for the combined contraceptive pill if you miss more than 2 pills?
If you are in Week 1 of your pill cycle (pills 1-7)
Probably unprotected.
Take the last missed pill immediately and leaving the missed pills before and carry on as normal.
Will need to use additional contraception for the next 7 days.
Will need emergency contraception if you have unprotected sex in the 7 days after missing.
Still have pill break
Week 2: (pills 8-14 days)
Take the last missed pill immediately and leaving the missed pills before and carry on as normal.
Will need to use additional contraception for the next 7 days.
Do not need emergency contraception
Still have a pill break
Week 3: (pills 15-21 days)
Take the last missed pill immediately and leaving the missed pills before and carry on as normal.
Will need to use additional contraception for the next 7 days.
Do not need emergency contraception
If your pack usually has 21 pills in it, take the rest of the pills in your pack as normal and start a new pack the next day.
If your pack usually has 28 pills in it, take the rest of the active pills (the first 21 pills in the pack) as usual. When you have taken the last of the active pills, start a new pack the next day.
Do not have a pill break
What should you do if you are sick or have diarrhea with the contraceptive pill?
If you are sick or have diarrhea within 3 hours for the combined contraceptive pill or 2 hours for the progesterone only, you need to:
Take another pill
Carry on afterwards as normal taking your next pill at the normal time the following day
Do not need to use extra contraception for the following days or emergency contraception as long as your are not sick again.
If sickness carries on for more than 24 hours, count each sick day as a missed pill.
Which broad spectrum antibiotics interact with combined oral contraceptive?
Penicillin and tetracyclines
No longer need to use additional contraceptive methods whilst taking a course of antibiotics however GI disturbances of associated with the antibiotics may cause sickness/ diarrhea and therefore treat as appropriate.
Why can’t you take anti-epileptics with combined oral contraceptive?
They reduce the levels of progesterone and oestrogen