contraception Flashcards
(18 cards)
non-hormonal contraception methods
barrier methods - condoms, cervical caps etc.
- vaseline, baby oil - oil based products damage condoms
spermicidal contraceptives - used in ADDITION ONLY to condoms (not alone)
Intra-Uterine Devices (copper coil) - most effective
- c/i in pelvic inflammatory disease or unexplained vaginal bleeding
progesterone only contraceptives - imp points
levonorgestrel, norethisterone, desogestrel (better)
no pill free period - take every day
if you start within 5 days of period - protected immediately - don’t need additional precaution
if you start on any other day - will need additional precaution - backup condoms for 2 days
must be taken at same time each day - esp traditional POPs like norgesterone
if you miss a pill:
> 12 hours for desogestrel
OR
> 3 hours for other POPs
USE BACKUP CONTRACEPTION for 2 days
parenteral progesterone only contraceptives - imp points
injections - 99.8% effective
depot medroxyprogesterone acetate - every 13 weeks
- may cause loss of bone density
- delayed return to fertility of upto 1 year after treatment cessation
implants - 99.95% effective
- into upper arm
etonogestrel (nexplanon):
- lasts up to 3 years
- MHRA warning - neurovascular injury or migration of implant - remove ASAP
combined hormonal contraceptives - imp points
comes as tabs, patches, vaginal rings
don’t give if > 50 years - safer alternatives
health benefits:
- reduces risk of ovarian, endometrial and colorectal cancer
- aligns bleeding patterns
- improves acne
- manages symptoms of polycystic ovaries or endometriosis
- reduces dysmenorrhea and menorrhagia
- reduces menopausal symptoms
when to avoid CHCs?
hypertension
age 35+ who smokes
migraine with aura
new onset migraine without aura whilst on CHC
women with multiple risk factors for CVD:
- smoking
- hypertension
- BMI >30
- dyslipidaemias
- diabetes
CHC diff preparations
monophasic - fixed amount of oestrogen and progesterone in each active pill
multiphasic - varying amounts of each hormone
oestrogen - estradiol, ethinylestradiol, mestranol
21 day regimen, 7 day hormone free interval
- withdrawal bleed during free interval
switching to CHC
from another CHC - no precaution
from POP - 7 day precaution
from LNG-IUD - 7 day precaution
from copper-IUD:
- if CHC within 5 days of period - no precaution
- if started > day 5 - 7 day precaution
switching from CHC to others
week 1 (or day 3-7 of HFl) + no UPSI since HFI:
Cu-IUD - no extra precaution
POP - 2 days precaution
others - 7 days
week 1 (or day 3-7 of HFI) + UPSI since HFI:
- CHC needs to be taken for 7 consecutive days, then act as week 2/3
week 2 or 3 - no extra precaution needed
reasons to stop CHCs?
calf pain, swelling, redness (DVT)
chest pain/SOB/coughing up blood (PE)
loss of motor/sensory function (Stroke)
severe stomach pain (hepatotoxicity)
v.high blood pressure (haemorrhagic stroke)
aged 50+
DVT/PE
high BP
high BMI >30
angina, heart attack, stroke, AF
signs of breast cancer (lump/nipple pain)
new onset migraine
unexplained persistent vaginal bleeding
CHC and surgery - imp points
discontinued 4 weeks prior for:
- any major elective surgery, surgery to legs/pelvis
- surgery involves prolonged immobilisation of lower limb
use alternative method of contraception
recommence 2 weeks after full remobilisation
if can’t discontinue before surgery (trauma - non elective)
- consider thromboprophylaxis
SEs of hormonal contraceptives
headache
unscheduled bleeding
weight gain
mood change
libido change
missed doses in POC - imp points
if you forget or had vomiting/diarrhoea within 2 hours of taking COC/POC - take another asap
for POC:
- consider missed if >3 hours for POCs (12 hours for desogestrel)
- take pill as soon you remember
- take next pill at usual time (may have 2 in 24 hrs)
- backup contraception for 48 hrs/7 days for desogestrel
- if had UPSI during this time - may need emergency contraception
missed doses in COC - imp points
if late start after HFI (>9 days since last active pill):
- emergency contraception if had UPSI occured
- 7 day condom - extra protection
1 missed pill (48-72 hrs since last active pill):
- take ASAP - no further action needed
2+ missed pills (>72 hrs since last active pill):
week 1 - emergency contraception if UPSI b/w HFI and week 1
- take asap + 7 day condom
week 2-3 of cycle - no emergency contraception needed - take ASAP + 7 day condom
if 2+ pills are missed in the 7 days before HFI
- skip HFI break and start new pack - becomes week 1
emergency contraceptives - non hormonal method
copper IUD:
needs to be inserted/taken ASAP
1st line most effective form of contraceptive
can be inserted upto 120 hours (5 days) after first UPSI
can be inserted upto 5 days after earliest estimated date of ovulation
emergency contraceptives - hormonal methods
ulipristal 30mg
levonorgestrel 1.5mg
levonorgestrel - upto 3 days (72 hrs)
ulipristal - upto 5 days (120 hrs)
2nd dose needed if pt has vomiting/diarrhoea within 3 hours (2 hours in COC/POC)
ulipristal - more effective than levonorgestrel for emergency contraception
unlike CU-IUD, BMI may reduce effectiveness (esp in levonorgestrel)
- if BMI > 26 or weight > 70kg - give either ulipristal or a double dose of levonorgestrel
can take BOTH more than once in the same cycle - more SEs with levonorgestrel
when to re-initiate regular contraception after emergency contraception?
levonorgestrel:
- start taking immediately
- condoms till effective ( usually 2d POC, 7d COC)
ulipristal:
- wait 5 days after taking ulipristal - condoms for the 5 days
- if during 1st week of CHC - can start immediately after + condoms for 7 days
levonorgestrel vs ulipristal - imp points
levonorgestrel 1.5mg
- breastfeeding - no delay
- caution - in pts with malabsorption
- SEs breast tenderness, D&V, fatigue, haemorrhage
- avoid in severe liver impairment
ulipristal 30mg:
- breast feed - 1 week delay
- caution in asthmatics taking glucocorticoids
- SEs cycle irregularities, d&V, mood change, fatigue
- avoid in severe liver impairment
INTERACTIONS - CYP INDUCERS reduce efficacy of emergency contraceptives
CU-IUD imp points
MHRA warning - risk of uterine perforation
- severe pelvic pain after insertion
- sudden change in period
- pain during intercourse
- unable to feel threads
check up if can’t feel threads
replace every 5-10 years
removed in 1st trimester of pregnancy
levornorgestrel IUD - replace every 3-10 years
