Contraception Flashcards
(36 cards)
How long a supply can oral contraceptives be prescribed for and why?
Up to 12 months in order to avoid unwanted discontinuation and increased risk of pregnancy.
What must be done before supplying another 12 months of oral contraception?
Review of medical eligibility, satisfaction, adherence, drug interactions, and consideration of alternative contraception.
BP and BMI must also be recorded annually.
Who is the combined oral contraceptive not suitable for?
> 50
Diabetes with comorbidity
Migraine with aura
CVD or multiple risk factors
Obese (BMI>35kg/m^2)
Hypertension
VTE - curent or history, not recommend if family history or immobile.
Smoking - not recommended
Menopause - not recommended
Lamotrigine - reduces lamotrigine
Who is the IUD not recommended for?
Abnormal vaginal bleeding
Pelvic inflammatory disease
STI
When should someone with vomiting/diarrhoea follow the missed pill rule?
If vomiting occurs within 3 hours of taking or severe diarrhoea occurs within 24 hours.
How does COC work?
Oestrogen and progesterone inhibit ovulatoin by acting on the hypothalamo-pituitary axis to reduce leutinising hormone (LH) and follicile-stimulating hormone (FSH) production.
What are the types of COC pill?
Monophasic - fixed amount of oestrogen and progesterone in each pill. 21-day dosing schedule.
Multiphasic - varying amounts of the 2 hormones in each table. 28-day dosing schedule. Can be biphasic, triphasic, or quadraphasic.
What are the active ingredients in COC?
Oestrogen in the form of ethinylestradiol
Progesterone in the form of levonorgestrel or norethisterone.
What are the different possible regimens for the monphasic COC?
Traditional - 21 days continuous use, 7-day hormone-free interval (HFI).
Shortened HFI - 21 days continuous use, 4-day HFI.
Tricycyling - 9 weeks continuous use followed by 4 or 7 day HFI.
Flexible extended use - continuous use followed by 4-day HFI when breakthrough bleeding occurs.
Continuous - continuous use with no HFI.
Is it better to use the traditional regimen over tailored regimens of COC?
There is no difference in efficacy or safety of using the traditional regimen which mimics the natural menstrual cycle over a tailored regimen.
In fact, traditional regimen may be associated with disadvantages such as heavy/painful withdrawal bleeds, headaches. mood changes, and increased risk of incorrect use with sibsequent unplanned pregnancy.
What are some adverse effects associated with COC?
Nausea
Bloating
Irritability
Increased risk of breast cancer
What are some benefits of COC?
Reduced risk of ovarian, endometrial, and colorectal cancer.
Reduced dysmenorrhoea and menorrhagia.
Management of PCOS, endometriosis, and PMS.
Improvement of acne
Reduced menopausal symptoms.
Maintaining bone density in peri-menopausal female under 50 years.
When should women start using the COC?
At any time, unless:
Postpartum breastfeeding - 6 weeks, 7 day barrier method.
Postpartum not breastfeeding - day 21, 7 day barrier method.
Miscarriage/abortion - gestation <24 weeks, within 5 days, no barrier. Gestation >24 weeks, 6 weeks, 7 day barrier method.
When do women require barrier method when starting COC?
Depends on the stage of their cycle:
Day 1 (day 1 of period) - no barrier.
Day 2-5 - no barrier unless taking Qlaira (9 days barrier) or Zoely (7 days barrier).
Any other time - 7 days barrier, 9 for Qlaira.
What is the active ingredient in POPs?
Progesterone in the form of either:
Levonorgestrel
Norethisterone
Desogestrel
Drospierenone.
Which forms of progesterone tend to be better?
Desogestrel and drospirenone suppress ovulation more consistently and may improve symptoms of dysmenorrhoea.
How should the POP be taken?
At the same time every day.
If vomit within 2 hours, take another ASAP. If vomiting and diarrhoea lasts for a while, follow missed pill rules and use contraception for 48 hours.
What are some adverse effects of POP?
Headaches and migraines
Breast tenderness and breast cancer
CVD
Menstrual irregularities - 50% prolonged bleeding, 70% spotting
Ectopic pregnancy (except desogestrel)
Ovarian cysts
Libido changes
When do women require barrier method when starting POP?
Drospirenone:
Day 1 - no barrier
Any other day - 7 days barrier
Other POPs:
Day 1-5 - no barrier
Any other day- 2 days barrier
When should women start using the POP?
At any time unless:
Postpartum - start immediately with no barrier within 21 days. If after 21 days, use barrier for 2 days or 7 if on drosperinone.
When is a combined pill classed as a missed pill?
After 12 hours
In the case of a missed combined pill, what should someone do?
1 pill - take missed pill ASAP and continue remaining pills at usual time. No EHC or barrier.
2 pills - take missed pill ASAP and continue remaining pills at usual time. If UPSI occurred in:
HFI - no EHC or barrier.
Day 1-7 - consider EHC. Use barrier for 7 days.
Day 8-14 - no EHC needed. Continue taking as normal. Use barrier for 7 days.
Day 15-21 - no EHC needed. Continue taking but omit HFI and start new pack straight after current one. Use barrier for 7 days.
When is a progesterone only pill classed as a missed pill?
Levonorgestrel or Norethisterone - >3 hours late
Desogestrel - >12 hours late
Drospirenone - >24 hours late
How should a missed POP be managed?
Take one ASAP, then continue at normal time. Avoid sexual intercourse of use barrier method for 2 days, or 7 if taking drospirenone.
