Week 5 - Menstrual Disorders and Contraception Flashcards
What is the role of hormonal contraceptives in fertility control
Stop / prevent unwanted pregnancies
It is ONLY IMMEDIATELY EFFECTIVE if taken at START of CYCLE (day 1)
- if not taken at start of cycle need to take for 7-9 days + use additional contraception (barrier) for x amount of days = quick-starting
- until the effectivenes develops
How well they work / their effects can be affected by DDIs
- NEVER give Valproate in pregnancy causes defomration + development disorders
What is the role of hormonal contraceptives in menstrual disorders
- Can be used in dysmenorhagia (painful periods)
- makes periods lighter and less painful
- inhibits ovulation = ↓ prostaglandin synthesis = ↓ uterine contractility
- Can be used in menorrhagia (very heavy periods)
What is the UK criteria for contraceptive use (4 categories)
Category 1 = no restriction for the use
Category 2 = advantages of use outweigh the risks
Category 3 = risks outweight the advantages + requires expert clinical judgment + specialist imput
Category 4 = unacceptable risk if used
- breast feeding + < 6 weeks post-partum
- >35 years and smoking 15 cig. a diay
- consistently elevate BP
- migraine with aura
- diabetes with microvascular complications
- vascular disease, stroke
List the 4 types of contraceptives (pharmacological / drugs)
- Combined Hormonal Contraceptive (CHC)
- Progesterone Only Pill (POP)
- Emergency Contraception
- Non-hormonal devices
Combined Hormonal Contraception (CHC)
Inc. MoA, indication, risks, and comparative efficacy
Combined = EE (oestrogen) + progesterone
- Take for 3 weeks (21 days, the 1 week free (7 days) from pills = hormone free interval / pill free period
- during this interval will have period
- same for ALL formulations (pill, patch, ring etc.) - High flexibility ~ have 24 hr window (for missed pill)
- ↓ efficacy as it is user dependant
MoA:
1. Progesterone:
- thickens cervical mucus = prevent sperm entry
- thins endometrium lining (in uterus)
- prevents ovulation
2. Oestrogen:
- supresses endometrial proliferation
ORAL:
- Monophasic (same conc. of hormones in all pills) and Triphasic (conc. differs over the month ~ shown by diff. colour pills)
- Some boxes have 21 tab.
- Some have 28 (BUT 7 are placebos / NO hormone)
NON-ORAL:
- Patch: 1 every 7 days (3 for 21 days) + 7 day free
- Vaginal ring: 1 ring for 3 weeks + 7 days free
What are the adv. and disadv. for combined hormonal contraception
ADVANTAGES:
- lighter, less painful period
- ↓ acne
- ↓ risk of colon cancer + ovarian cysts
DISADVANTAGES:
- Nausea
- Weight gain
- Breakthrough bleeding
- Loss of libido
- ↑ risk of BP, MI, stroke, breast + cervical cancer, DVT
Progesetrone only pill (POP) contraception
Inc. MoA, indication, risks, and comparative efficacy
NO hormone free interval (but still have period) = take every day (28 days)
- Formulations inc. IUD, injection and tablets
- IUD releass hormone slowly over 3-5 years = LARC
- Flexibility: 3hr (traditional) and 12hr (newer)
- ↓ efficacy as it is user dependant
MoA:
- Supresses ovulation = no egg released
- Thickens cervical mucus
- delays ovum transport
- prevents implantation
- reduced cillia activity
ORAL:
- e.g. Norehisterone (traditional - low flexibility ~ 3 hr window if missed cant take dose = risk of pregnancy)
- Newer POP have more flexibility i.e. 12 hr window (for missed pil)
NON-ORAL:
- Includes injection and implant (LARC)
LARC - long acting reversible contraceptive
What are the adv. and disadv. for POP contraception
ADVANTAGES:
- Suitable when CHC can’t be used
- ↓ risk of endometrial cancer
DISADVANTAGES:
- Acne
- Depression
- Loss of libido,
- Weight gain
- Menstrual irregularites (e.g. no / few periods)
- ↑ risk of ovarian cyst / ectopic cancer
How do you change from COC to POP (oral) and vice versa
Before changing need to be aware of what day they are on in their cycle to determine whether additional precautions are required
- if quick starting need to give them additional advice
COC to POP
- for immediate cover take POP and have no pill free period
- if not use additional precautions for 2 days
POP to COC
- most require addtional precautions for 7 days (minimum)
Non-hormonal contraception (devices)
Inc. MoA, indication, risks, and comparative efficacy
Devices act as a barrier + protect against STIs
List the 2 Emergency hormonal contraception (EHC)
Inc. MoA, indication, risks, and comparative efficacy
Both are POP ~ supress / delay ovulation (by changing environement)
Efficacy of both ↓ the later you take it after unprotected sex
EHC is used after unprotected sex, contraceptive failure, ejaculation near / on external genitalia
- before dispensing need to assess whether patient needs it e.g. if took pill late but within window = don’t need EHC
- Levonelle
- Have to be over 16
- Taken up to 3 days after unprotected sex
- 1.5mg - Ellaone
- Licensed to anyone of childbearing age
- Taken up to 5 days after unprotected sex
- 30mg
- efficacy can ↓ if patient already takes POP (interaction)
ADRs:
- Headache
- Nausea
- Lower abdominal pain
- Irregular bleeding
What is a non-hormonal emergency contraception
Inc. MoA, indication, risks, and comparative efficacy
- Copper IUD
- need to have appointment before accessing it
- can be placed up to 10 days after unprotected sex
- fitted in a sexual health clinic
ADRs:
- Longer, heavier, painful periods
- cramping
- bacterial infection
- thrush
- ectopic pregancy
How does natural familly palnning work
- Use apps, have sex during times where chance of pregnancy is low (not when ovulating)
- LAM i.e. breastfeeding (only applies towomen who have just had a baby)
- LAM = lactational amenorrhoea
- 98% effectve if you meet the conditions required (fully / nearly fully brastfeeding + baby <6 months)
- Risk of pregnancy ↑: if ↓ breastfeeding, long intervals between feeds, night feeds stop
Amenorrhoea = absence of menstruation
What is the difference between primary and secondary dysmenorrhoea
Dysmenorrhoea = period / menstruation pain
CAUSE:
- ↑ conc. of prostaglandin (PGF + PGE) in menstrual fluid = ↑ myometrium (uterus wall) contractility + vasoconstriction
- arachadonic acid = precursor for prostaglandins
- Vasopressin released from pituitary leads to vasoconstriction
- Endothelins - vasoactive peptides = ↑ pain
- Primary dysmenorrhoea
- Occurs in teens to twenties
- Pain starts on 1st dat of menstruation (usually worst day)
- Nothing to worry about
Symptoms:
- Cramping, headaches, nausea, vomitting, fatigue, diarrohea - Secondary dysmenorrhoea
- Occurs in 30s to 40s
- Pain starts before and continues after period has ended
- Requires refferal
- Symptoms are similar to above BUT will have heavy feeling in pelvic area- painful intercourse
- intermenstrual bleeding
How do you manage primary dysmenorrhoea
- NSAIDs (inhibit prostaglandin = pain caused by contractility inhibited)
- OTC pain relief (analgesia)
- Hormonal contraception (inhibit ovulation = ↓ prostaglandin production = ↓ uterine contractility)
- Antispasmodics (not licensed OTC)
