Contraception Flashcards
(43 cards)
Name some non-hormonal contraceptives
Condoms, diaphragms, cervical caps
Petroleum jelly, baby oil and oil based products can damage barrier methods listed above
List some progesterone only pills (generic name)
Levonorgestrel, Noresthisterone, Desogestrel
Main features of Progesterone only pills
No pill free period
No additional precaution needed if started in first 5 days of cycle
Need two days precaution if taken after that
Take the same time every day
Desogestrel needs to be taken within 12 hours or considered ‘missed pill’
Other POP’s need to be taken within 3 hours of considered ‘missed pill’
List different types of parenteral progesterone only contraceptives
- Injections (99.8% effective if correct usage)
e.g. Depot medroxyprogesterone acetate - every 13 weeks - Implants (99.95% effective if correct usage)
e.g Etongesterel (nexplanon)
What are side effects of the medroxyprogesterone acetate injections
Loss of bone density may occur
Delayed return of fertility for up to one year after treatment cessation
What are the side effects of the implant?
MHRA: neurovascular injury and migration of the implant - remove ASAP
How long does the injection and the implant last?
Injection: 13 weeks
Implant: 3 years
What methods of combined hormonal contraceptives are there?
Tablets, Patches, Vaginal rings
What are the health benefits of the combined oral contraceptive?
Reduces risk of ovarian, endometrial and colorectal cancer
Aligns bleeding patterns
Reduces dysmenorrhea and menorrhagia
Manages symptoms of polycystic ovaries, endometriosis and premenstrual syndrome
Improves acne
Reduces menopausal symptoms
Maintains bone density in peri-menopausal females under 50
When should combined Hormonal contraceptives be avoided?
Hypertension
Age of 35 years who smoke
Women with multiple risk factors for cardiovascular problems e.g. smoking, hypertensiom, High BMI, dyslipidaemias, diabetes
Migraine with aura
New onset of migraines without aura during the use of CHC
What extra precaution is needed when switching to a combined hormonal contraceptive from….
FROM CHC: no additional contraception
FROM POP: 7 days extra precaution
FROM LNG-UD: 7 days extra precaution
FROM COPPER IUD: If CHC started up to day 5 of cycle: no additional contraception
If CHC started after day 5: 7 days extra precaution
OTHER NON-HORMONAL METHODS: same as copper IUD
What extra precaution is needed when switching from a combined hormonal contraceptive to….
Week 1 (or day 3-7 of hormone free interval) and NO UPSI since HFI:
- Cu-IUD: no extra precaution
- POP: 2 days precaution
- Others: 7 days precaution
Week 1 (or day 3-7 of HFI) and UPSI since start of HFI:
- Carry on with CHC until 7 consecutive days taken
- Then act as week 2 or 3
Week 2 or 3: no extra precaution needed
Reasons to stop
- Urgent medical review
o Calf pain, swelling and/or redness (DVT)
o Chest pain and/or breathlessness and/or coughing up blood (PE)
o Loss of motor sensory function (stroke)
o Severe stomach pain (hepatotoxicity)
o Very high blood pressure (haemorrhagic stroke)
When should you seed advice or a medical review?
o Signs of breast cancer (lump, nipple pain/discharge)
o New onset migraine
o Persistent unscheduled vaginal bleeding
o High blood pressure
o High BMI (>35)
o DVT or PE
o Blood clotting abnormalities
o Angina, heart attack, stroke, or peripheral vascular disease
o AF
o Cardiomyopathy
o Includes previous points
Aged 50+
Newly developed contraindication
When should the CHC be discontinued before surgery and restarted after surgery?
- Discontinued at least 4 weeks prior for
o Major elective surgery, any surgery to the legs or pelvis
o Surgery that involves prolonged immobilisation of a lower limb = DVT risk - Use an alternative method of contraception
- CHC recommenced 2 weeks after full remobilisation
- If discontinuation is not possible (trauma) / patient is still on CHC:
o Consider thromboprophylaxis
What are the side effects of hormonal contraceptives?
- Headache
- Unscheduled bleeding (breakthrough bleeding)
- Mood change
- Weight gain
- Libido change
What is classed as a missed pill when you have diarrhoea or vomit?
Missed pill rules apply if a patient omits or has vomited / had diarrhoea within 2 hours of taking COC or POP (unless desogestrel = 12 hours) – take another one ASAP to aim to be within time period
What is considered a missed pill if you dont take it with the POP?
Considered missed if >12hours for desogestrel or > 3 hours for rest
Take pill as soon as you remember
Take the next pill at the usual time (can mean 2 in a day)
Need protection up to 48 hours of pills taken correctly (7 days for desogestrel)
Need emergency contraception if UPSI happened between missed pill and 2 days after restarting medication
What is considered a missed pill if you dont take it with the CHC?
Late start after HFI (>9 days since last active pill)
- Emergency contraception if UPSI has occurred
- Take immediately and use condom till 7 consecutive days taken
1 missed pill (48-72 hours since last active pill)
- Take ASAP – no further action needed (providing consistent use inn previous 7 active pills)
2+ missed pills (72+ hours since last active pill)
- Week 1 of cycle: consider emergency contraception if UPSI happened within HFI and week 1 —- take ASAP and use condom until 7 consecutive doses taken
-Week 2-3 of cycle: no emergency contraception needed — take ASAP and used condom for 7 days
- If 2+ pills missed in 7 days before HFI — carry on taking pill throughout HFI
What is the first line emergency contraception?
Copper IUD
How many hours after UPSI or ovulation can the copper IUD be inserted?
up to 120 hours (5 days) after the first UPSI
Up to 5 days after the earliest estimated ovulation date
Whats first line oral emergency contraception?
Ulipristal 30mg
Whats the latest Ella ONE can be taken after UPSI
120 hours (5 days)
What is the latest Levonorgestrel 1.5mg can be taken after UPSI?
72 hours (3 days)
