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Women's Health > OCP > Flashcards

OCP Flashcards

1
Q

What is the MoA of COCs?

A

Contain low dose oestrogen and moderate dose progestogen. Inhibition of hypothalamic and pituitary function leading to anovulation.

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2
Q

What are the norethisterone group of progestogens?

A

-norethisterone acetate
-ethynodiol acetate
-lynestrenol
Converted to norethisterone (NET) before exerting any contraceptive activity

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3
Q

What is the preferred progestogen? WHY?

A

Levonorgestrel. 10x more potent than NET, has less effect on the coagulative pathway.

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4
Q

What are the gestogens?

A 
3rd gen progestogens
-desogestrel
-gestodene
-norgestimate
-cyproterone acetate
Less androgenic than NET and LNG
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5
Q

What is the aim of COC commencement?

A

Provide good cycle control and effective contraception with the least side effects using a pill of the lowest dose

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6
Q

What is a suitable first choice COC?

A

Monophasic pill containing 30mcg ethinyloestradiol (EO) with levonorgestrel or norethisterone e..g Level ED, Nordette

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7
Q

What should high dose monophonic be reserved for?

A

50mcg oestrogen, high dose COC reserved for:

  • breakthrough bleeding on low dose
  • control or menorrhagia
  • concomitant use of enzyme using drugs
  • low dose pill failure
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8
Q

COC in epilepsy?

A

Use COC with high dose oestrogen (e.g. 50mcg)

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9
Q

COC in hirsute women?

A

Less androgenic preparation e.g. Diane-35, Estelle-35

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10
Q

COC in women 35+?

A
  • Low dose monophonic (unless smoker)
  • Controls hot flushes of perimenopause if continued until ~30y
  • Cease pill around 51y, wait several weeks and check FSH/oestradiol
  • if FSH high and oestradiol low, presume menopause
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11
Q

Absolute contraindications to COC?

A
  • Pregnancy
  • First 2 weeks post partum
  • Hx of thromboembolic disease / thrombophilia
  • Cerebrovascular disease
  • Focal migraine
  • Coronary artery disease
  • Oestrogen dependent tumours
  • Active liver disease
  • Polycythemia
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12
Q

Relative contraindications to COC?

A
  • Heavy smoking
  • > 35 + smoking / other CV RFx
  • Undiagnosed abnormal vaginal bleeding
  • Breastfeeding
  • 4 weeks before surgery, 2 weeks post
  • GB/liver disease
  • HTN / DM / hyperlipidemia
  • Chloasma
  • Severe depression
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13
Q

Circulatory disorders linked with COC use?

A

Venous: DVT, PE (+rare = mesenteric, hepatic, renal thrombosis)
Arterial: MI, thromboembolic/haemorrhagic stroke (+rare = retinal and mesenteric thrombosis)

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14
Q

What causes increased circulatory d/o risk in COCs?

A

Oestrogen content. Now reduced as doses have been reduced to 20mcg etc

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15
Q

Which cancers may be influenced by COC use?

A

Very low risk: cervix, breast

Protective: endometrial, epithelial ovarian

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16
Q

Mx breakthrough bleeding on low dose COC?

A

Usual to have breakthrough bleeding in first 2 months. If minor, continue. If major, cease and start new pill, usually with 50mcg ethinyloestradiol

17
Q

Advice when starting pill?

A
  • Periods often become shorter and lighter
  • No break is necessary
  • Drugs that may affect pill: antacids, purgatives, vitamin C, antibiotics, anticonvulsants
  • D/V may reduce effectiveness: if vomits within 2h taking pill, take another active pill
  • Return yearly for review
18
Q

Advice re missed pills?

A

Just keep going: take a pill as soon as possible then resume usual schedule
IF >2x20 or >3x30 EO pills are missed, use condoms / abstinence for 7 days

19
Q

7 day rule for missed or late pill?

A
  • take forgotten pill asap, even if you take 2 the next day
  • if >12h late, increased risk of pregnancy so use another contraceptive method for 7 days
  • if these 7d run beyond last hormone pill in pack, miss the inactive pills and start next pack
  • you may miss a period (at least 7 hormone tablets should be taken)
20
Q

Delaying a period?

A

Skip sugar pills, continue taking hormone pills until end of next pack

21
Q

What is the mini pill?

A

Progestogen only pill e.g. levonorgestrel 30mcg/day

22
Q

Side effects mini pill?

A

No serious AEx. Compliance a problem due to cycle irregularity, irregular bleeding.
Often decreases cycle length

23
Q

Indications for POP?

A
  • > 45y
  • smokers 45y+
  • CIx to or intolerance of oestrogen (migraines, DM, chloasma, lactation, HTN)
24
Q

What is the injectable contraceptive?

A

Depo-provera. Only IM contraceptive in Aus.

150mg injection every 12 weeks

25
Q

What is the implanon?

A

Subdermal contraceptive implant containing etonogestrel (progestogen). Inhibits ovulation and has anti mucous effect.
3y system

26
Q

Absolute IUD contraindications?

A
  • Known or suspected pregnancy
  • Active PID
  • Undiagnosed genital tract bleeding
  • Previous ectopic
  • Severe uterine cavity distortion
27
Q

Problems with IUD?

A
  • Pregnancy / ectopic pregnancy
  • PID
  • Extrusion, perfortaion or uterus, translocation
  • Bleeding
  • Pain

Women's Health (39 decks)

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