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OBST GYN 712 > coc guidelines > Flashcards

coc guidelines Flashcards

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1
Q

What should women be informed about regarding tailored CHC regimens?

A

Women should be given information about both standard and tailored CHC regimens to broaden contraceptive choice.

ommitng placebo week is more effective preventing pregnancy

Tailored regimens are outside the manufacturer’s licence but supported by FSRH.

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2
Q

When can CHC containing ethinylestradiol (EE) be started?

A

CHC containing EE can be started by medically eligible women up to and including Day 5 of a natural menstrual cycle without additional contraceptive protection.

It can also be quick started at any other time with advice to use additional contraceptive precaution for 7 days.

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3
Q

What is the contraceptive effectiveness of CHC?

A

Contraceptive effectiveness of all CHC is similar. If used perfectly 0.3

With typical use 0.9

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4
Q

What should women who have had bariatric surgery be advised regarding COC?

A

Women who have had bariatric surgery should be advised that the effectiveness of COC could be reduced.

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5
Q

How does lamotrigine interact with CHC?

A

Women taking lamotrigine should be advised that CHC may interact with lamotrigine, potentially reducing seizure control or causing lamotrigine toxicity.

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6
Q

Do antibiotics that do not induce enzymes affect CHC effectiveness?

A

Additional contraceptive precautions are not required when antibiotics that do not induce enzymes are used in conjunction with CHCs.

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7
Q

What should women using COC be advised regarding vomiting or severe diarrhoea?

A

Women using COC should be advised that contraceptive effectiveness could be reduced by vomiting or severe diarrhoea.

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8
Q

Is there an association between weight/BMI and effectiveness of COC?

A

Most evidence suggests no association between weight/BMI and effectiveness of COC.

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9
Q

What is the risk associated with CHC use regarding venous thromboembolism (VTE)?

A

Current use of CHC is associated with increased risk of VTE; some CHC formulations have a greater risk than others.

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10
Q

What health benefits are associated with CHC use?

A

Use of CHC can reduce heavy menstrual bleeding (HMB), menstrual pain, and improve acne.

It may also benefit women with PMS symptoms and reduce the risk of endometrial and ovarian cancer.

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11
Q

What is the risk of breast cancer associated with CHC use?

A

Current use of CHC is associated with a small increased risk of breast cancer which reduces with time after stopping CHC.

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12
Q

What should be assessed in an initial CHC consultation?

A

Assessment of medical eligibility for CHC should include medical conditions, lifestyle factors, and family medical history.

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13
Q

What is the recommendation regarding BMI and blood pressure before CHC prescription?

A

BMI and blood pressure should be documented for all women prior to CHC prescription.

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14
Q

What is the recommended duration of CHC prescription?

A

HCP can prescribe up to 12 months’ supply of CHC for women who are initiating or continuing CHC.

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15
Q

What should women be advised regarding CHC use and surgery?

A

Women should be advised to stop CHC and switch to an alternative contraceptive method at least 4 weeks prior to planned major surgery or expected period of limited mobility.

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16
Q

Until what age can CHC be used by medically eligible women?

A

CHC can be used by medically eligible women for contraception until age 50 years.

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17
Q

Can CHC be used as an alternative to hormone replacement therapy (HRT)?

A

CHC can be considered for use by medically eligible women until age 50 as an alternative to HRT for relief of menopausal symptoms.

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18
Q

What is the estimated rate of pregnancy with correct and consistent use of combined oral contraceptives (COCs) during the first year?

A

< 0.3%

With typical use, the rate of pregnancy is 9%

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19
Q

What is a reasonable choice for a first-time COC user?

A

A formulation containing ≤ 35 micrograms ethinylestradiol with either levonorgestrel or norethisterone

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20
Q

In which patients should COCs be avoided due to risk factors for venous thromboembolism?

A

Patients aged over 35 years who smoke, have migraine with aura, or are likely to be immobile for a prolonged period

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21
Q

What are progestogen-only oral contraceptives commonly referred to as?

A

Progestogen-only pills (POPs)

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22
Q

When can COCs be initiated for breastfeeding patients?

A

From six weeks post-partum

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23
Q

What new recommendation was included in the updated guidance on contraception from New Zealand?

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A

Offering tailored regimens to all patients initiating or currently taking a COC

24
Q

What do COCs prevent besides pregnancy?

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A

Ovulation, thickening cervical mucus, altering the endometrial lining

25
What is the relative risk increase of venous thromboembolism (VTE) associated with COC use?
Three to 3.5-fold increase
26
What are some contraindications to COC use due to VTE risk?
* Current or past VTE * Thrombogenic mutations * Major elective surgery * Age ≥ 35 years and smoking * Fewer than three weeks post-partum with other risk factors
27
What is the risk of VTE per 10,000 females per year for COC users?
7 – 10
28
COC use is associated with an increased risk of which cardiovascular diseases?
* Myocardial infarction * Ischaemic stroke
29
What is the recommended age limit for COC use?
Not recommended for those aged ≥ 50 years
30
What is the suggested starting dose of ethinylestradiol for a first-time COC user?
30 – 35 micrograms
31
What are some suggested actions for managing acne as an adverse effect of COCs?
* Increase oestrogen * Decrease progestogen * Select a less androgenic or anti-androgenic progestogen
32
What is the conventional method for initiating a COC?
Within the first five days of menses onset
33
What should be done if a COC is initiated on a day other than the first five days of the menstrual cycle?
Use additional protection for the first seven days
34
What is the risk of myocardial infarction associated with COC use among 10,000 females per year?
One additional case
35
What is the risk of VTE for pregnant and post-partum women?
20 – 30 per 10,000 females per year
36
What should be considered if a patient experiences adverse effects with one COC formulation?
Trial another formulation
37
What is a caution for COC use in patients with a history of migraine?
Migraine with aura is a contraindication; new onset migraine without aura during COC use is to be assessed cautiously
38
What is the 'quick start' method for initiating COCs?
COCs can be initiated on any day of the cycle if it's reasonably certain the patient is not pregnant; additional protection should be used for the first seven days if not initiated during the first five days of menstruation. ## Footnote A pregnancy test should be offered 21 days after the last instance of unprotected sexual intercourse.
39
What is the standard regimen for taking COCs?
21 active hormone pills followed by a hormone-free interval of seven days. ## Footnote Withdrawal bleeding occurs during the hormone-free interval.
40
What are the potential benefits of omitting the hormone-free interval in COC regimens?
* Improved contraceptive effectiveness * Reduced heavy bleeding * Improved symptoms associated with withdrawal bleed (e.g., bloating, headache, mood changes) ## Footnote There is no evidence of endometrial thickening or histological abnormalities with extended or continuous regimens.
41
What should be done if breakthrough bleeding persists for three to four days when taking pills continuously?
Stop the pills for four days and then resume. ## Footnote Breakthrough bleeding risk increases with continuous pill use but declines over time.
42
What is a tailored regimen for COC use?
A regimen that may involve shortening the hormone-free interval or omitting it entirely to improve effectiveness and reduce the risk of contraceptive failure. ## Footnote Tailored regimens are unapproved but recommended by professional organizations.
43
What is the duration of hormone-free intervals in different COC regimens?
* Standard: 7 days * Shortened: 4 days * Extended: 4-7 days (every 3-4 packets) * Continuous: None
44
What cancers are associated with COC use?
* Reduced risk: endometrial, ovarian, colorectal cancers * Increased risk: breast, cervical cancers ## Footnote The increased risk of breast and cervical cancer only applies to current and recent users.
45
What percentage of colorectal, endometrial, and ovarian cancers were estimated to be prevented by COC use in a UK study?
* 19% of colorectal cancers * 34% of endometrial cancers * 34% of ovarian cancers
46
What is the relationship between COC use and mood changes?
Evidence is variable; some women may experience negative mood changes, but causation has not been established. ## Footnote Most studies suggest no increase in depression incidence with COC treatment.
47
Is weight gain associated with COC use?
Most evidence suggests no association between COC use and weight gain. ## Footnote A Cochrane review concluded that any effect on body weight or composition is likely to be small.
48
What is the average age at recruitment for the longitudinal study on COC use?
Approximately 28 years. ## Footnote 82% of participants had at least one child at the time of recruitment.
49
Fill in the blank: The hormone-free interval in a standard COC regimen lasts ______ days.
7
50
True or False: Omitting the hormone-free interval completely is recommended for all patients taking COCs.
False ## Footnote Patients can choose to shorten the hormone-free interval instead.
51
When is a COC pill considered missed?
If it is not taken in the 24 hours after it should have been taken
52
Is missing a single COC pill sufficient to reverse ovarian suppression?
No
53
What could theoretically increase the risk of ovulation when using COC pills?
Missing several pills or extending the HFI by missing pills at the end of a packet or forgetting to restart the new packet on time
54
Fill in the blank: Missing a single COC pill is _______ to reverse ovarian suppression.
insufficient
55
True or False: Forgetting to restart a new packet of COC pills on time can increase the risk of ovulation.
True

OBST GYN 712 (18 decks)

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