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OnG Active > Gynae: Contraception > Flashcards

Gynae: Contraception Flashcards

1
Q

What are the types of contraception available?

A
  • Barrier: male/female condoms, diaphragms & caps +/- spermicides
  • Hormonal:
    • Combined hormonal: COCP, patch, vaginal ring
    • Progesterone only: POP, implant, depot injection, IUS
  • IUD (copper)
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2
Q

What is the failure rate of typical use of male condoms?

A

16%

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3
Q

What is the failure rate of typical use of female condoms?

A

21%

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4
Q

What is the failure rate of typical use of diaphragms & caps?

A

16%

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5
Q

Summarise the use of spermicides, how they work & their risks & contraindications

A
  • Used in conjunction with barrier contraception, esp diaphragm/caps (not alone due to low efficacy)
  • Jelly/cream/pessary containing nonoynol-9 → poisons any sperm that enter the vagina
  • RISKS: May increase STI transmission due to irritation of mucosa
  • → contra-indicated in HIV
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6
Q

Name some progestogens used in hormonal contraception

A

Progestogens can be:

  • 2nd generation (levonorgestrel, norethisterone),
  • 3rd generation (desogestrel) or
  • 4th generation (drospierenone)
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7
Q

What is the name of the oestrogen used in hormonal contraceptives?

A
  • ethinylestradiol
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8
Q

How do combined contraceptives work?

A
  • Combined hormonal contraceptives primarily create a level of oestrogen and progesterone that is constantly inhibitory on the HPG axis
    • This prevents the LH surge → prevents ovulation
  • Progesterone also:
    • inhibits proliferation of endometrium (to prevent implantation)
      • increases thickness/acidity of cervical mucus (to prevent passage of sperm)
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9
Q

Name the types of combined contraceptives

A
  • COCP
  • patch
  • vaginal ring
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10
Q

What are the 2 types of COCP?

A
  • monophasic - most common
  • phasic
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11
Q

How are monophasic pills taken? Give some examples

A
  • Every pill contains the same levels of oestrogen and progesterone
  • Taken once daily for 21 days, then a 7-day break (withdrawal bleed)
  • Microgynon 30: 30ug ethinylestradiol and 15ug levonorgestrel - most common
  • Brevinor: 35ug ethinylestradiol and 0.5mg norethisterone
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12
Q

How are phasic pills taken? Give some examples

A
  • Contain varying amount of oestrogen and progesterone across the cycle → can be biphasic, triphasic or quadraphasic depending on the number of different active tablets
  • Pills must be taken in the correct order
  • Qlaira: quadraphasic COCP
    • Taken every day for 28 days with no break; 26 active pills and 2 inactive
  • BiNovum: biphasic pill
    • Taken for 21 days with 7-day break
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13
Q

Describe the contraceptive dermal patch. How is it used?

A
  • combined contraceptive
  • 5x5cm patch that can be stuck to the upper arm, abdomen, buttock or back → delivers oestrogen and progestogens
  • Changed every 7 days over 3 weeks (21 days), then 7 patch-free days
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14
Q

Describe the use of the contraceptive vaginal ring

A
  • combined contraceptive
  • Plastic ring inserted into vagina for 21 days; removed for 7 days
  • May be removed for a couple of hours to be cleaned (then replaced)
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15
Q

Advantages of combined contraceptives?

A
  • Highly effective if taken correctly - when taken correctly: >99% effective
  • Menses tends to become regular, lighter and less painful;
  • Allows control over timing of menses
    • E.g. pill can be taken back to back to prevent menses → often advised for women with dysmenorrhoea/headaches during pill-free interval (tricycling – 3 packs back to back)
  • Reduces risk of: ovarian/endometrial cancer, benign breast disease, fibroids, functional ovarian cysts
  • Normal fertility returns immediately after stopping usage
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16
Q

Disadvantages of combined contraceptives?

A
  • Doesn’t protect against STIs
  • User-dependent → missed pills are common
  • Side effects and complications
17
Q

What are the SEs of combined contraceptives?

A

SEs of all types:

  • Headache
  • Breast tenderness
  • Mood changes
  • Weight gain (no evidence)
  • Unexpected bleeding → may settle with time

Complications of all types:

  • Increased BP
  • Increased risk of VTE (related to oestrogen dose; increased with 3rd/4th gen progestogens)
  • Small increased risk of stroke, MI, breast/cervical cancer

COCP-specific:

  • Headaches on pill-free week → can take back-to-back

Patch-specific:

  • Skin sensitivity
18
Q

Contraindications of combined contraceptives?

A
  • BMI >35
  • Breastfeeding
  • Smoking over the age of 35
  • HTN
  • History or FHx of VTE
  • Prolonged immobility due to surgery or disability
  • DM with complications, e.g. retinopathy
  • History of migraines with aura
  • Breast cancer or primary liver tumours
19
Q

What advice must be given on starting combined contraceptives?

A
  • Start on the 1st day of menstruation (no additional contraception needed); otherwise condoms for 1 week
  • COCP: take daily for 21d then 7d break; take within 12hr window; can take up to 3 packets back-to-back (tricycling)
  • Extra contraception needed for 7 days if taking certain antibiotics or enzyme-inducing drugs

Missed pills, patches and rings:

  • Missed pills (incl D&V):
    • If taken late (<24hrs): take ASAP, no problems
    • If 1 pill missed (24-48hrs late): take ASAP, take remaining pills at usual time
      • EC not usually needed → consider if other pills have been missed recently
    • If 2 or more pills missed (>48hrs late): take most recent pill ASAP, take remaining pills at usual time, use condoms for 7 days
      • Pills missed in 1st week (pills 1-7): consider EC if sex occurred in pill-free interval or in the 1st week of pill taking
      • Pills missed in 2nd week (pills 8-14): EC not needed if preceding 7 pills taken correctly
      • Pills missed in 3rd week (pills 15-21): omit the pill-free interval by starting a new pack when current pack ends
  • Patch not applies for 48hrs/ring not applied for 3hrs → condoms for 7 days
    • EC if unprotected sex has occurred
20
Q

What are the types of progesterone only contraceptives?

A
  • POP
  • implant
  • depot
  • IUS

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