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PHA332 > Contraception > Flashcards

Contraception Flashcards

1
Q

What are the two main classes of HC?

A

Combined hormonal contraception (CHC)
Progestogen only contraceptives (POP)

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2
Q

What is the MOA of CHC’s?

A

To prevent ovulation

  • The oestrogen & progestogen components of the CHCs act on the hypothalamo-pituitary ovarian axis to suppress Lh and FSH production therefore ovulation does not occur
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3
Q

When cervical mucus is increased what happens?

A

Acts as a mechanical barrier for sperm

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4
Q

What are the functions of oestrogen and progestogen?

A

Oestrogen causes the endometrium to proliferate and grow
Progestogen prevents hyperplasia (excessive growth) of the endometrium

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5
Q

Why does a withdrawal bleed occur?

A

7-day pill-free interval causes oestrogen and progestogen concentrations to fall

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6
Q

What do COC’s contain?

A

Oestrogen & progestogen

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7
Q

What are the differences in COC preparations?

A

Monophasic (first line) - oestrogen & progestogen amount constant throughout the cycle
Phasic - amounts vary over the 21 day cycle
(Biphasic - two different sets of active tabs, Triphasic - three, Quadraphasic - four)

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8
Q

When are phasic COCs used?

A

Women who do not have a withdrawal bleed/women who have breakthrough bleeding with monophasic

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9
Q

What is the general dose of ethinylestradiol given?

A

30-35mcg

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10
Q

What are the two types of preparations of COC pills?

A

Standard - 21 active tablets, no tablet taken for 7 days (HFI)
ED preparations - 21 active, 7 placebo to allow withdrawal bleed

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11
Q

What are the preparations of COC to be aware of?

A

Qlaira - quadriphasic used for heavy menstrual bleeding, 28 days taken continuously

Dianette- not used solely for contraception, increased risk of VTE

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12
Q

What are the rules for monophasic COC initiation?

A

Day 1 up to & including day 5 of cycle - no additional contraception needed, start on day 1

Day 6 and onwards - additional precautions needed for 7 days (9 days for qlaira)

Postpartum - up to and including day 21 postpartum no additional contraception needed

Termination/miscarriage - started immediately/up to day 5 no contraception needed

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13
Q

What can the HFI interval be shortened to?

A

4 days

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14
Q

What to consider if COC has been missed?

A
  • When the pill was missed
  • How many pills the patient has missed
  • Where they are in the cycle (pack)
  • Which pill is being taken
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15
Q

What action should be taken if COC pill missed?

A
  • If one active pill missed (>48-72hrs)
    Missed pill should be taken as soon as remembered
    Remaining pills continued at same time
  • If two or more (max 7) pills missed >72 hours late
    Take as soon as remember, continue pills as normal, condoms for 7 days
    Consider EC if UPSI is during HFI or week 1
  • If over 9 days
    Consider EC, missed pill taken, avoid sex/barrier until 7 pills taken as normal
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16
Q

What are the advantages and disadvantages of COC?

A
  • Prevent pregnancy
  • Menstrual bleeding lighter
  • Reduced risk of cancer (ovary, uterus, colon)
  • Reduced acne

Disadvantages
- Headaches, nausea, breast tenderness, mood changes
- BP may increase
- No protection against STIs

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17
Q

What drugs interact with COCs?

A

Enzyme-inducing drugs (rifampicin, rifabutin, carbamazepine, phenobarbital, phenytoin, St John’s Wort, lamotrigine) reduce the effectiveness of COC

  • Advise other contraceptive method or use barrier method whilst taking and for 4 weeks after
  • Breakthrough bleeding can occur as low serum oestrogen concentrations

Note lamotrigine dose may need to be increased

18
Q

What if vomiting/diarrhoea occurs within 3 hours of taking pill?

A

Take another pill ASAP

19
Q

What are the risks of COC?

A
  • MI/stroke
  • Increased risk of VTE
  • Breast cancer/cervical cancer
  • Age (>35 years, avoid >50 years)
20
Q

Reasons to stop COC?

A
  • Sudden severe chest pain
  • Sudden breathlessness
  • Severe pain in calf/one leg
  • Severe stomach pain
  • Neuro effects
  • Hepatitis/jaundice/liver enlargement
21
Q

What is the combined contraceptive patch?

A

Evra (1 patch applied once weekly for 3 weeks, then 7 day free interval)

If patch detached < 48hrs re-apply, no add precaution
If patch detached > 48hrs start new cycle (now week 1 and the new day for patch changes), use barrier for 7 days

22
Q

What is the MOA of POP pill?

A

Alter the cervical mucus making it more viscous and impenetrable to sperm

23
Q

What is the MOA of desogestrel?

A

Inhibition of ovulation

24
Q

What are the different POP pills?

A
  • Traditional: no break, 3 hour window for missed pills e.g. Noriday, Micronor, Norgeston
  • Desogestrel: no break, 12 hour window for missed pills, usually first line
25
Q

How to inititate a POP?

A
  • Day 1 and up to day 5 of cycle: no additional precaution
  • Day 6 onwards: additional precautions
  • Postpartum: up to & including day 21 postpartum, no addition precaution
  • Termination/miscarriage: start immediately/up to day5, no additional precautions
26
Q

What is the missed pill guidance for POPs?

A

<3 hours late (12 hours for desogestrel)
- Take as soon as possible
- Continue taking as normal (even if 2 in same day)
- No additional protection needed

> 3 hours late (12 hours for desogestrel)
- Take as soon as possible (other missed pills disregarded)
- Continue taking as normal
- Use additional contraception until pills taken for 2 days consecutively
- Consider EHC if UPSI within 2 days of missed pill

27
Q

What are the disadvantages of POP?

A
  • Higher failure rate
  • Not as effective as COC
  • Small increased risk of breast cancer
  • Increased risk of ovarian cysts (30%)
28
Q

What are the interactions with a POP pill?

A

Desogestrel can increase serum lamotrigine, risking lamotrigine toxicity
- Monitor lamotrigine levels when progestogen stopped

29
Q

What are the 2 POP pills available OTC?

A

Hana, Lovima
1st supply - 3 months
Repeat - up to 12 months
< 18 (max 3 months supplied)

29
Q

How many hours if vomiting/diarrhoea occurs with a POP pill?

A

Within 2 hours

30
Q

What to do when switching from a COC to a POP?

A
  • Ideally complete COC omitting HFI
  • Start POP the next day
  • No additional contraception needed
31
Q

What to do when switching from a POP to a COC?

A

Traditional POP
- Start the COC after POP
- Avoid sex for 7 days (9 days with qlaira)

Desogestrel
- Start COC after desogestrel
- No additional contraception needed

32
Q

How does the Depot injection work?

A

Prevents ovulation, administered every 12 weeks

Small loss of bone density

33
Q

How long can fertility be affected after injection?

A

1 year for return of infertility after stopping

34
Q

How long does the progestogen-only implant last?

A

3 years, no evidence in delay of return of fertility

35
Q

How does the progestogen-only intrauterine system (IUS) work? (e.g. Mirena, Kyleena, Jaydess, Levosert)

A
  • Release LNG directly into uterine cavity
  • Prevent endometrial proliferation, thickening of cervical mucus & suppressing ovulation in some women

Normal fertility returns when removed

36
Q

How does the copper intrauterine device (Cu-IUD) work?

A

Inhibits fertilisation by copper’s toxic effects on sperm & ova
Inhibits implantation due to local endometrial inflammatory reaction

Last 5-10 years

37
Q

Do trans men require contraception?

A

Yes, testosterone therapy or GnRH cannot be depended on
Usually a Cu-IUD as no interference with hormone regimens or POP, NOT COC

38
Q

What should a trans woman (male at birth) undergo?

A

Orchidectomy/vasectomy or condoms as non-permanent form

39
Q

What is the benefit of using condoms?

A

Prevent STIs

PHA332 (14 decks)

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