Women's Health: Contraception and infertility Flashcards
What are the benefits of the COC pill?
Lightens and regulates periods
Protective for endometrial and ovarian cancer
What are the side effects of the COC pill?
Spotting
Clotting
Breast and cervical cancer risk
How does breast cancer affect prescription of COC pill?
BRCA: relatively contraindicated
Hx: Completely contraindicated
What neuro condition is COC pill not recommended in?
migraine with aura (MEC 3)
What is the advantage of the POP pill?
Can take if oestrogenergic methods are not available
What are the downsides of POP?
Irregular bleeding
Acne, headache
Who cannot have the progesterone only pill?
Current breast cancer
What is the advantage of injectable contraception (medroxyprogesterone acetate, Depo Provera)
Given every 3 months rather than daily
What contraceptive is most associated with weight gain?
Injectable
How long does restoration to normal fertlity take when stopping the injectablet?
12 months
What are the advantages of the SD implant (etonestergel, nexplanon)
Lasts 3 years
Does not contain oestrogen
What are the disadvantages of the implant?
Heavy or irregular bleeding
Who can’t have the injectable?
Current of past breast cancer
Who cant have the SD implant?
Current or past breast cancer
Gynae: unexplained vaginal bleeding
Systemic: IHD, liver cirrhosis/cancer
How do the IUS and coil compare in terms of advantage, disadvantage and contraindications?
IUS // IUD
Both long lasting
Both can expulse within 3 months, small infection risk or perforation too
lighter/irregular periods // heavy periods
How quickly will you get contraceptive cover with…
Copper coil
POP/desogestrel (cerazette)
COC pill
SD implant
Injectable
IUS
Copper: Immediate any time
POP: immediate <5 days < + 2 days barrier
COC pill, implant, injectable: Immediate < 5 days < + 7 days barrier
IUS: After 7 days
If taking the COC pill, what timeframe do you need for switching to…
POP
Desogestrel
POP: 7 days barrier
Desogestrel: Immediate
How long does it take to gain cover if switching from POP to COCP?
Immediate if during packet completion (day 21)
What do with COC pill if you missed
1 pill missed
>=2 pills missed
1 pill
Take missed regardless of point
>=2 pills
Take missed pill, barrier/abstain for 7 days
Week 1: + emergency contraception if UPSI in wk4/1
Week 2: No emergency needed if 7 days continous pills
Week 3: + continue taking pills through the pill free interval
For the POP and desogestrel…
What are the cut off times for each pill
What do if under the time
What do if over the time
3 hours for POP, 12 for deso
Under
Continue as normal for both
Over time
Take missed immediately, take next at usual time
Continue with rest of pack
Use condoms for 48 hours while pill taking re-established
When is post-partum contraception required and what timescale can you start…
POP
IUS/IUD
None needed until day 21
POP: Immediate but need 48hrs barrier if >21 days
IUS/IUD: <48hrs or 4 weeks after birth
Other forms: After day 21 with 7 days barrier
Under what conditions is the lactational amenorrheic method effective
Fully breast feeding
Amenorrheic
< 6 months post-partum
What contraceptive is most associated with breastfeeding benefits?
Injectable
When can breast feeding recommence if taking the COC pill?
After 6 weeks
Regarding emergency contraception, how do the following compare in terms of time frame, dosage and follow up?
Levonogestrel
Ulipristal acetate (EllaOne)
Intrauterine device
Levonogestrel // UA // IUD
<72hrs // <120 hrs // <5 days of UPSI/ovulation date
1.5mg (3mg if BMI >26, over 70kg) // 30mg // NA
Take hormonal straight after // Start COCP 5 days after if compliant + outside week 1 // Give prophylactic antibiotics
Which emergency contraceptive is cautioned in asthmatics and disallows breastfeeding for a week?
Ulipristal acetate
When can you stop the following contraceptives before and after 50?
IUD
COCP
Depo-provera (injectable)
Implant/POP/IUS
Before 50
Stop non-hormal after 2 years amenorrhea
Continue rest
50 and over
Stop non-hormonal after 1 year amenorrhea
Swtich COCP to POP/non-hormonal
Switch depo to non-hormonal then stop after 2 years amenorrhea
Continue others until amenorrhea with either 55yrs or FSH >30
What is the beneficial side effect of POP in over 40s?
Can preserve bone density and perimenopausal symptoms
For trans/non-binary folk what should be done regarding…
Barrier methods
Cervical screening
HPV vaccinations
prEP
Condoms and dams should be used
Offered to those with a uterus
vaccinate all sexually active indviduals
prEP for those at risk
What should you advise for trans patients wanting contraception regarding hormonal therapy
Hormonal replacement NOT contraception
Avoid COC pill in testosterone takers
POP/Injection/Implant thought to be fine
For epilepsy patients, what drugs
Cannot provide contraception if using lamotrigene
Increase metabolism of contraceptives
Reduce metabolism of contraceptives
COC pill
P450 inducers: Phenytoin, carbamazepine, phenobarbitone (PCP)
P450 inhibitors: Sodium valproate
For infertility, what lifestyle recommendations should be made
BMI 20-25
smoking, alcohol cessation
Sex every 2-3 days
Folic acid for females
What initial investigations should be performed for infertility in
Females
Males
LH, FSH on days 2-5
Progesterone on day 7 (repeatedly <16 then refer)
+ Prolactin (inhibits ovulation)
+ TFTs (low increases prolactin)
+ AMH (rule out congenital)
Males
Seme analysis, refer if any low
When can UPSI proceed following vasectomy
When 8 week semen analysis shows azoospermia
