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afsha Pre- Reg > contraception, hormonal > Flashcards

contraception, hormonal Flashcards

1
Q

2 types of hormonal contraception

A
  • combined hormonal contraception (oestrogen + progestogen)
  • progestogen only
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2
Q

combined hormonal contraception contains

A
  • oestrogen
  • progestogen
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3
Q

when is hormonal contraception used in adolescents

A

after menarche

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4
Q

when prescribing contraceptives to <16s, it is good practice follow…

A

fraser guidelines

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5
Q

contraception in pt taking teratogenic potential medicines

A
  • females of CB potential need to use highly effective contraception if they/their male partner is taking teratogenic drugs
  • use during treatment and for recommended duration after discontinuation to avoid unintended pregnancy
  • pregnancy tests before to exclude pregnancy, repeat testing may be required
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6
Q

highly effective contraception examples

A
  • male and female sterilisation
  • LARC: Cu-IUD, LNG-IUS, IMP (progestogen-only implant)
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7
Q

What is LARC and how often does it require admin

A

long acting reversible contraceptive: requires administration less than once per cycle or month

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8
Q

Important point to consider with IMP (P-only implant)

A

IMP = progestogen only implant
do not take any interacting drugs that could reduce contraceptive effectiveness

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9
Q

failure rate if used perfectly for CHCs

A

<1%

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10
Q

3 factors that can contribute to CHC contraceptive failure

A
  • weight
  • malabsorption (COC only)
  • drug interactions
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11
Q

true or false - Rx of up to 12 months supply for CHC initiation or continuation may be appropriate to avoid unwanted discontinuation and increased risk of pregnancy

A

true

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12
Q

It is recommended that CHC is not continued after …. years of age as there are safer alternatives

A

50

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13
Q

Which 3 forms are CHC available as

A
  • tabs
  • patches
  • vaginal rings
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14
Q

health benefits associated with CHC use

A
  • reduced risk ovarian, endometrial and colorectal cancer
  • predictable bleeding patterns
  • reduced dysmenorrhea and menorrhagia
  • management of symptoms of PCOS, endometriosis, PMS
  • improvement of acne
  • reduced menopausal symptoms
  • maintaining BMD in perimenopausal females <50
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15
Q

Monophonic vs multiphase COCs

A

mono = fixed amount of oestrogen and progestogen in each tablet
multi = varying amounts of the two hormone

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16
Q

most common oestrogen component in COCs

A

ethinylestradiol

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17
Q

ethinylestradiol content of COCs ranges from

A

20-40mcg

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18
Q

Monophonic prep containing …….. ethinylestradiol in combination with …….. (as the progestogen), (to minimise CV risk) is generally used as 1st line

A
  • 30mcg or less ethinylestradiol
  • levonorgestrel or noresthisterone as the progestogen
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19
Q

forms of COC to consider in women who weigh 90kg or more

A

Consider non topical options (vaginal ring, COCs) or use additional precautions with patches

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20
Q

two types of regimen with CHC

A
  • traditional 21 day CHC regimen with monthly withdrawal bleed during 7 day hormone free interval (HFI)
  • tailored CHC regimen (unlicensed)
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21
Q

what are the 4 different tailored CHC regimens that can be used (unlicensed)

A
  • shorted HFI: 21 days continuous use, then 4 days HFI
  • extended use (tricyling): 9 weeks continuous, then 4 or 7 days HFI
  • flexible extended: 21 days or more continuous, then 4 day HFI when breakthrough bleeding occurs
  • continuous: no HFI
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22
Q

are withdrawal bleeds the same as physiological menstruation

A

no

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23
Q

which regimen mimics the natural menstrual cycle

A

traditional 21 days continuous, 7 days HFI

24
Q

if it more efficacious or safer to use traditional 21 day regimen over extended or continuous regimens

A

no difference in efficacy or safety

25
Q

disadvantages of traditional regimen

A
  • heavy or painful withdrawal bleeds
  • headaches
  • mood changes
  • increased risk incorrect use with subsequent unplanned pregnancy
26
Q

do withdrawal bleeds reassure pregnancy status

A

No, withdrawal bleeds during traditional CHC use has been reported in pregnant females!

27
Q

what needs to be checked annually on CHC

A

BP and BMI

28
Q

Surgery - when to stop CHC

A
  • at least 4 weeks before major elective surgery, any surgery to legs or pelvis, any surgery that involved prolonged immobilisation of lower limbs
29
Q

What to do if continuation of CHC is not possible and surgery is needed

A

consider thromboprophylaxis

30
Q

When can CHC be restarted after surgery

A

2 weeks after full remobilisation

31
Q

what are the 4 forms that progestogen only contraceptive is available in

A
  • oral
  • injectable
  • subdermal
  • intrauterine
32
Q

Failure rate of prosterogen only contraceptives if used perfectly

A

<1%

33
Q

progestognenic effects leading to contraceptive action

A

○ Changes to cervical mucus affecting sperm penetration
○ Endometrial changes affecting implantation
○ Effects on tubal motility
○ Ovulation suppression

34
Q

oral progestogen only contraceptives contain…

A
  • levonorgestrel
  • norethisterone
  • desogestrel
35
Q

factors that may contribute to contraceptive failure (oral progestogen contraceptives)

A
  • incorrect use
  • vomiting
  • severe diarrhoea
  • drug interactions
36
Q

Comparing progestogen only contraceptives

A

Desogestrel suppresses ovulation more consistently and may improve symptoms of dysmenorrhoea, but there is insufficient evidence to compare contraceptive effectiveness of oral POCs with each other

37
Q

what are the parenteral long acting progestogens

A
  • injections: medroxyprogesterone acetate (MPA), norethisterone enantate
  • implant: etonogestrel
38
Q

how do the long acting reversible parenteral POCs work

A

primarily by suppressing ovulation along with other progestognenic effects

39
Q

benefit of parenteral POCs

A

May benefit those with menstrual problems e.g. heavy bleeding or dysmenorrhoea as they often lead to reduced bleeding or amenorrhoea

40
Q

Failure rate for injectable POC during the first year with perfect use vs failure rate with typical use

A

~0.2%
~6% (typical failure rates are higher compared to other LA methods, maybe due to relative freq of repeat injections?)

41
Q

how often is depot (SC) MPA administered

A

every 13 weeks

42
Q

MPA and BMD

A
  • associated with small loss of BMD
  • largely recovers after discontinuation
  • however due to concerns and uncertainties around bone loss, there is some advice
43
Q

MPA - advice due to concerns and uncertainties around bone loss

A
  • associated with small loss of BMD (largely recovers after discontinuation)
  • females <18 may use depot MPA after all options have been discussed and are considered unsuitable or unacceptable
  • review every 2 years and continuation benefits and risks discussed
  • females 50 and over should switch to another contraceptive
  • females with significant RF for osteoporosis should consider other forms of contraceptive
44
Q

advice about fertility and conception after discontinuation of MPA

A
  • can be a delayed return of fertility of up to 1 year after discontinuation of depot MPA
  • pt who discontinue and do not wish to conceive should be advised to start alternative contraceptive method before or at the time of their next scheduled injection
45
Q

noresthisterone enanate

A
  • Less commonly used in UK
  • Used for short term contraception (8 weeks) for females whose partners undergo vasectomy until vasectomy is effective, and after rubella immunisation
46
Q

name the implant

A

Etonogestrel implant inserted sub dermally

47
Q

how long does the etonogestrel implant provide effective contraception for

A

up to 3 years

48
Q

contraceptive failure for both perfect and typical use of the etonogestrel implant

A

~0.05% in first yr of use

49
Q

when to advice pt to see their HCP regarding their implant

A

if it cannot be felt, or problematic bleeding occurs

50
Q

intrauterine progestogen only systems (IUS) - how long

A
  • IUS containing levonorgestrel are LARD options that have licensed duration of use that ranges from 3-10 years depending on the system used
51
Q

intrauterine progestogen only systems (IUS) - contraceptive action

A
  • progestognenic effects
  • foreign body effect may also be a contributing factor
52
Q

ovulation suppression in females who use IUS

A
  • not suppressed in majority of females (75%+)
53
Q

IUS releasing 20mcg/24h of levonorgestrel may also have the following health benefits

A
  • improving pain associated with dysmenorrhoea, endometriosis, adenomyosis
54
Q

Seek medical advice if pt using IUS develop symptoms of

A
  • pelvic infection
  • pain
  • abnormal bleeding
  • non palpable threads
  • can feel stem of IUS
55
Q

which contraceptive forms are suitable in pt undergoing surgery

A
  • progestogen only pills
  • injections
  • implants
  • IUS

afsha Pre- Reg (20 decks)

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