Contraception Flashcards
What are the options for emergency contraception and when must they be taken?
- Levonorgesterol = within 72 hours
- Ulipristal = within 120 hours
- Copper IUD = within 120 hours
Describe the levonorgesterol pill?
- Mechanism = stops ovulation and inhibits implantation
- Dose = 1.5mg stat (double dose if >26 BMI or >70kg)
- 95% effective in <24 hours, 84% effective <72 hours
- Safe and well-tolerated
- Potential slight menstrual cycle disturbance
- If vomiting within 2 hours of dose → repeat the dosage
- Can be used >1 in each menstrual cycle
Describe the copper IUD?
- Mechanism = selective progesterone receptor modulator → inhibits ovulation
- Dose = 30mg statSTAT
- 95% effective in <120 hours (5 days)
- If on hormonal contraception, should restart 5 days after ulipristal
- Use barrier for 5 days
- If vomiting within 3 hours of dose → repeat the dosage
- Unsure if safe if used >1 in each menstrual cycle
- Contraindications = Levenorgesterol or Severe asthma
What are the side effects of emergency contraception pills?
- N&V
- Headache
- Breast tenderness
- Abnormal menstrual bleeding
What is the Pearl Index?
The number of pregnancies occurring per 100 woman-years
What is the mechanism of the COCP?
Prevents ovulation
What different ways can the COCP be taken?
- OD for 3 weeks → 1 week off = withdrawal bleed
- Tricycle = OD for 9 weeks → 1 week off = withdrawal bleed
What are the benefits of the COCP?
- >99% effectiveness - if taken correctly
- Reversible on stopping
- Less pain, more regular, lighter periods - used in dysmenorrhoea
- Reduced risk of ovarian, endometrial and bowel cancer
- Ovarian cancer risk is associated to the greater number of ovulations
What are the side effects of the COCP?
- Headache
- N&V (if vomit <2hr since pill, take another)
- Breast tenderness
- Mood swings
- Decreased libido
- Bloating
What are the disadvantages of the COCP?
- Easy to forget to take
- May cause breakthrough bleeding and spotting at first
- Does not reduce risk of STIs
- Increased risk of VTE , breast cancer, cervical cancer
- Has to be stopped 4w before surgery - can’t be restart until 2w after surgery
What are the contraindications to the COCP?
- <6w postpartum and breastfeeding
- Ischaemic or valvular HD
- Diabetes with complications
- ≥35yo and smoke >15/day
- BP >160/100mmHg
- VTE history
- Breast cancer
- Migraine with aura
- Liver damage
What should a patient do if they miss doses of the COCP?
- 1 pill missed = take last pill and current pill (even if 2 in 1 day) → no further action needed
-
2 pills missed = take last pill and current pill (even if 2 in 1 day) → further action
- Use condoms until pill has been taken correctly for 7 days in a row
- 2 missed in week 1 → consider emergency contraception
- 2 missed in week 2 → no need for emergency contraception
- 2 missed in week 3 → finish current pack, start new pack immediately/no pill-free break
What is the mechanism of the POP?
Thickens cervical mucus
How is the POP taken?
OD at the same time every day → no pill-free week
- If started if first 5 days of the cycle → offers immediate contraceptive protection
- If starting at any other time → use additional measures for the first 2 days
- If switching over from the COCP → provide immediate protection
What are the benefits of the POP?
It doesn’t have the same risks of oestrogen
What are the side effects of the POP?
- Irregular bleeding
- Acne
- Constipation
- Irritability
- Breast tenderness
- Mood changes
- Headache
What are the disadvantages of the POP?
- Very easy to forget to take
- Initial irregular bleeding - this can continue = most common complaint
- 20% = amenorrhoeic
- 40% = bleed regularly
- 40% = bleed irregularly
- Osteoporosis
- Ovarian cysts
What should a patient do if they miss doses of the traditional POP?
- <3 hours late = continue as normal
- 3+ hours late = take missed pill ASAP, continue with rest of pack + extra precautions/condoms until pill taking has been re-established for 48 hours
- If missed 2 pills = take last missed pill and next pill, and use barrier methods until pill-taking has been re-established for 48 hours
- Emergency contraception needed if UPSI during this interval
What should a patient do if they miss doses of the cerazette/desogestrol (POP)?
- <12 hours late = continue as normal
- >12 hours late = take missed pill ASAP, continue with rest of pack + extra precautions/condoms until pill taking has been re-established for 48 hours
What is the mechanism of the combined hormonal transdermal patch?
Thickens cervical mucus and prevents ovulation
What different ways can the combined hormonal transdermal patch be taken?
- Applied and replaced weekly for 3 weeks → 1 week off = withdrawal bleed
- Tricycle = Applied and replaced weekly for 9 weeks → 1 week off = withdrawal bleed
