Contraception Flashcards
(36 cards)
What are the types of non-hormonal contraception?
are all HIGHLY effects forms of contraception
male and female sterilisation
long acting reversible contraception: copper IUD, levonorgestrel IUD or progestogen only implant
What are the types of hormonal contraception?
Combined:
1 - COC: ethinylestradiol, desogestrel
2 - transdermal patch: evra
3 - vaginal ring: nuvaring
Progestogen only:
1 - oral: northisterone, desogestrel
2 - parenteral: medroxyprogesterone, etonogestrel (implant)
3 - intrauterine device: levonorgestrel
What are the benefits of combined hormonal contraception?
reduced risk of ovarian, endometrial and colorectal cancer
predictable bleeding patterns
reduced dysmenorrhea and menorrhagia
management of PCOS, endometriosis, PMS
improvement of acne
reduced menopausal symptoms
maintenance of bone mineral density in peri-menopausal women < 50 years
When should CHC be discontinued before surgery?
CHC use should be discontinued at least 4 weeks prior to major elective surgery, any surgery to the legs or pelvis, or surgery that involves prolonged immobilisation of a lower limb
CHC may be recommenced 2 weeks after full remobilisation
What are the types of CHC preparation?
1st line: monophasic preparation containing 30 micrograms or less of ethinylestradiol in combination with levonorgestrel or norethisterone
2nd line: multiphasic preparation containing varying amounts of oestrogen and progestogen
What are reasons to immediately discontinue CHC or HRT?
sudden, severe chest pain (PE)
sudden breathlessness (PE)
unexplained swelling or severe pain in the calf of one leg (DVT)
severe stomach pain
severe neurological effects: prolonged headaches, loss of vision (Stroke)
hepatitis, jaundice, liver enlargement
hypertension: BP >160/95
prolonged immobility after surgery or leg injury
migraines: any increase in headaches
What is a missed pill?
> 24 hrs for COC (12 hrs for Zoely and Qlaira)
> 24 hrs for drospirenone
12 hrs for desogestrel
3 hrs for desogestrel
How does vomiting affect POP?
< 2 hrs - missed pill
How does vomiting and diarrhoea affect COC?
vomiting: < 3hrs - missed pill
diarrhoea: > 24hrs - missed pill, protection until 7 days after recovery
What are the risks associated with CHC use?
increased risk of VTE
increased risk of MI and ischaemic stroke
increased risk of breast cancer: reduced after stopping
increased risk for cervical cancer: if used for >5 yrs, reduced after stopped and not increased 10 yrs after stopping
At what age is CHC use no longer allowed? At what age is POP no longer allowed?
CHC: > 50 yrs
POP: > 55 yrs
What is the MHRA warning for medroxyprogesterone?
risk of meningioma
- discontinue if diagnosed
What are side effects associated with medroxprogesterone (injectable POP)?
increased loss of bone mineral density: risk of osteoporosis
weight gain
delay of unto 1yr in return of fertility
What is a MHRA warning for IUD use? What are the red flags associated with IUD use?
risk of uterine perforation
report:
severe pelvic pain
pain or bleeding after insertion
sudden changes in period
pain during intercourse
unable to feel threads
increased risk of pelvic inflammatory disease
What factors affect hormonal contraception?
weight
BMI
drug interactions
What are the side effects associated with emergency contraception?
headache
nausea
altered bleeding pattern
Tell me about levonorgestrel
- dose
- efficacy
- effect of weight and BMI
- breastfeeding and pregnancy
- vomiting
- when to start hormonal contraception after
- how long is protection needed for after
- dose: 150mcg stat
- efficacy: can be used upto 72 hrs post UPSI
- effect of weight and BMI: give alternate if weight >70kg or BMI >26
- breastfeeding and pregnancy: avoid nursing 8hrs after
- vomiting: < 3hrs missed pill
- when to start hormonal contraception after: immediately
- how long is protection needed for after: 7 days if CHC or 2 days if POC
Tell me about ulipristal
- dose
- efficacy
- effect of weight and BMI
- breastfeeding and pregnancy
- vomiting
- when to start hormonal contraception after
- how long is protection needed for after
- dose: 30mg stat
- efficacy: can be used unto 120 hrs after
- effect of weight and BMI: no effect
- breastfeeding and pregnancy: avoid nursing for 1 week after use
- vomiting: > 3 hrs missed pill
- when to start hormonal contraception after: wait 5 days to restart CHC or POC
- how long is protection needed for after: 12 days if CHC (5 days + 7 days) or 7 days if POC (5 days + 2 days)
When should a pregnancy test be taken after taking emergency contraception?
if next period is delayed > 7 days
lighter than usual
associated with abdominal pain atypical to usual dysmenorrhoea
Which forms of contraception are NOT affected by enzyme inducers?
parenteral POC: IM norethisterone, IM/SC medroxyprogesterone
copper IUD
continue to use for for 4 weeks after stopping interacting drugs
Which medications induce abortion?
gemeprost
misoprostol
mifepristone
What medications induce labour?
dinoprostone
oxytocin
misoprostol (unlicensed)
What medication are used to control haemorrhage from miscarriage?
ergometrine
oxytocin
carboprost
How should POP be taken? When should it be started?
take continuously, no hormone free interval
if started in the first 5 days of cycle: NO extra precaution
if started after the first 5 days of cycle: needs extra precautions for 2 days
