Wk 11: Contraception in practice: Progestogen only contraception

Question 1

What is the mechanism of action of traditional POPs?

Answer 1

• Primary: alter cervical mucus - more viscous + impenetrable to sperm
• Suppression of ovulation in some: 60%

Question 2

What is the mechanism of action of desogestrel-only pill?

Answer 2

• Primary = inhibit ovulation 97%

- Alters cervical mucus

Question 3

When is desogestrel given as a first line?

Answer 3

• Patient <35 years

- Compliance issues w/ traditional POPs

Question 4

POP initiation: Day 1 upto + including day 5 of menstruation

Answer 4

• No addition contraceptive

- Ideally start on day 1

Question 5

POP initiation: Day 6 of menstrual cycle onwards

Answer 5

Condom/abstinence required for 2 days

Question 6

POP initiation: Postpartum

Answer 6

Upto + including day 21 postpartum - no additional

Question 7

POP initiation: Termination/miscarriage?

Answer 7

Start immediately/upto 5 days after

Question 8

What is the missed pill guidance for less than 3 hrs late?

Answer 8

• Take late/missed pill ASAP
• Continue taking remaining pill at usual time
• No additional contraceptive

Question 9

What is the missed pill guidance for more than 3 hrs late?

Answer 9

• Take most recent missed pill ASAP
• Continue taking remaining pill at usual time
• Use additional contraceptive or abstain until 2 consecutive days

Question 10

What is the contraindication of POPs?

Answer 10

UKMEC category 4

• Breast cancer

Question 11

What are the actions to take when on short term (<2 months) treatment for enzyme inducing drugs?

Answer 11

• Advise to stop POP + change to alt

- Continue POP + avoid intercourse/barrier for 28 days after stopping

Question 12

What are the actions to take when on long term (>2 months) treatment for enzyme inducing drugs?

Answer 12

Barrier/progestogen only injectable

Question 13

If vomiting occurs w/in 2 hrs of taking a pill what should be done?

Answer 13

Take another pill asap - taken > 3 hrs late follow missed pill

Question 14

If vomiting/severe diarrhoea occurs for > 24 hrs what should you advise the patient?

Answer 14

• Follow missed pill, counting each day of vom/diarrhoea as missed pill
• Avoid intercourse or use barrier during illness + 2 days after

Question 15

Which 2 brands of POP is available as an OTC?

Answer 15

• Hana

- Lovima

Question 16

What do the manufacturers of lovima + hana advise?

Answer 16

• 1st supply = upto 3 months
• Repeat = upto 12
• Under 18 = max 3 months

Question 17

What is the advice given for when switching from COC to POP?

Answer 17

• Complete COC pack omitting HFI
• Start POP next day from last COC
• No additional contraception

Question 18

What is the advice given for when switching from POP (traditional) to COC?

Answer 18

• Start COC next day after POP anytime in cycle

- Avoid intercourse/barrier for 1st 7 days (9 days for qlaira)

Question 19

What is the advice given for when switching from POP (desogestrel) to COC?

Answer 19

• Start COC next day after desogestrel POP anytime in cycle

- No additional contraception

Question 20

What are some key points of the progestogen-only injectable contraception?

Answer 20

• Admin 12 wks
• Weight gain
• Red bone mineral density
• Review: 2 years
• Delay of upto 1 year return of fertility after discontinuation

Question 21

What are the key points of the progestogen-only implant?

Answer 21

• Lasts 3 years
• Irregular bleeding common
• Effectiveness red in heavier women (esp 3rd year): earlier replacement

Question 22

What is the progestogen-only intrauterine systems?

Answer 22

Levonogestrel intrauterine system (LNG-IUS):

• Release LNG directly to uterine cavity
• Prevent endometrial proliferation, thickens cervical mucus + suppresses ovulation

Question 23

Which 4 LNG-IUS are available and should they be prescribed by brand?

Answer 23

Yes

• Jaydess (effective: 3yrs)
• Levosert (5 years)
• Mirena (5yrs)
• Kyleena (5yrs)

Question 24

What are the key points of the progestogen-only intrauterine systems?

Answer 24

• Irregular bleeding + spotting in 1st 6 months

- Amenorrhoeic after 1 year

Question 25

What is the copper intrauterine device?

Answer 25

Non-hormonal intrauterine device containing copper:

• Inhibits fertilization: copper’s toxic effect on sperm + ova
• Inhibits implantation: local endometrial inflammatory reaction

Question 26

What are the key points of the copper intrauterine device?

Answer 26

• Heavier bleeding + dysmenorrhoea

- Duration: 5-10 yrs