Wk 11: Contraception in practice: Progestogen only contraception Flashcards
What is the mechanism of action of traditional POPs?
- Primary: alter cervical mucus - more viscous + impenetrable to sperm
- Suppression of ovulation in some: 60%
What is the mechanism of action of desogestrel-only pill?
- Primary = inhibit ovulation 97%
- Alters cervical mucus
When is desogestrel given as a first line?
- Patient <35 years
- Compliance issues w/ traditional POPs
POP initiation: Day 1 upto + including day 5 of menstruation
- No addition contraceptive
- Ideally start on day 1
POP initiation: Day 6 of menstrual cycle onwards
Condom/abstinence required for 2 days
POP initiation: Postpartum
Upto + including day 21 postpartum - no additional
POP initiation: Termination/miscarriage?
Start immediately/upto 5 days after
What is the missed pill guidance for less than 3 hrs late?
- Take late/missed pill ASAP
- Continue taking remaining pill at usual time
- No additional contraceptive
What is the missed pill guidance for more than 3 hrs late?
- Take most recent missed pill ASAP
- Continue taking remaining pill at usual time
- Use additional contraceptive or abstain until 2 consecutive days
What is the contraindication of POPs?
UKMEC category 4
- Breast cancer
What are the actions to take when on short term (<2 months) treatment for enzyme inducing drugs?
- Advise to stop POP + change to alt
- Continue POP + avoid intercourse/barrier for 28 days after stopping
What are the actions to take when on long term (>2 months) treatment for enzyme inducing drugs?
Barrier/progestogen only injectable
If vomiting occurs w/in 2 hrs of taking a pill what should be done?
Take another pill asap - taken > 3 hrs late follow missed pill
If vomiting/severe diarrhoea occurs for > 24 hrs what should you advise the patient?
- Follow missed pill, counting each day of vom/diarrhoea as missed pill
- Avoid intercourse or use barrier during illness + 2 days after
Which 2 brands of POP is available as an OTC?
- Hana
- Lovima
What do the manufacturers of lovima + hana advise?
- 1st supply = upto 3 months
- Repeat = upto 12
- Under 18 = max 3 months
What is the advice given for when switching from COC to POP?
- Complete COC pack omitting HFI
- Start POP next day from last COC
- No additional contraception
What is the advice given for when switching from POP (traditional) to COC?
- Start COC next day after POP anytime in cycle
- Avoid intercourse/barrier for 1st 7 days (9 days for qlaira)
What is the advice given for when switching from POP (desogestrel) to COC?
- Start COC next day after desogestrel POP anytime in cycle
- No additional contraception
What are some key points of the progestogen-only injectable contraception?
- Admin 12 wks
- Weight gain
- Red bone mineral density
- Review: 2 years
- Delay of upto 1 year return of fertility after discontinuation
What are the key points of the progestogen-only implant?
- Lasts 3 years
- Irregular bleeding common
- Effectiveness red in heavier women (esp 3rd year): earlier replacement
What is the progestogen-only intrauterine systems?
Levonogestrel intrauterine system (LNG-IUS):
- Release LNG directly to uterine cavity
- Prevent endometrial proliferation, thickens cervical mucus + suppresses ovulation
Which 4 LNG-IUS are available and should they be prescribed by brand?
Yes
- Jaydess (effective: 3yrs)
- Levosert (5 years)
- Mirena (5yrs)
- Kyleena (5yrs)
What are the key points of the progestogen-only intrauterine systems?
- Irregular bleeding + spotting in 1st 6 months
- Amenorrhoeic after 1 year
What is the copper intrauterine device?
Non-hormonal intrauterine device containing copper:
- Inhibits fertilization: copper’s toxic effect on sperm + ova
- Inhibits implantation: local endometrial inflammatory reaction
What are the key points of the copper intrauterine device?
- Heavier bleeding + dysmenorrhoea
- Duration: 5-10 yrs
