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Flashcards in Contraception Deck (7):
1

List the Short and Long term contraceptive options for someone worried about becoming pregnant?

Short Term Barrier Methods:

  • condom
  • diaphragm (personally fitted 6 hours following sex)
  • female condom - cervical cap

Long Term IUD:

  • Copper
  • Mirena (implanted during menstruation, every 5 year replaced, review annually and check 2-3months)
  • Implanon - (estonogestrel implant) - unpredictable bleed, progesterone SE (breast tender, weight change), - insertion (adrenaline and local anaesthetic
  • Depot-Provera (IM progestogen) - bone density, return to fertility in 1-2years (6month delay), injection every 12weeks

ST options:

  • POP - (minipill - same time everyday) unpredictable bleeding patterns
  • COCP - monophasic or triphasic - oestrogen and progesterone SEs

2

What is the first line treatment for dysmenorrhoea in a non-currently sexually active women?

Pain relief Mefenamic acid (NSAID) aka Ponstan or paracetamol

3

What are some important contraindications for the OCP?

  1. CVD complications (DVT, HTN, smoking, diabetes, age, lipids, risk of stroke/IHD)
  2. migraine with aura
  3. hormone dependent cancers
  4. thrombophilia (anyone in the family with bleeding disease)
  5. liver disease
  6. medications (antiepileptics, TB drugs, antibiotics for acne)
  7. Others: post partum avoid for at least 21 days (no other VTE factors) Breastfeeding (not recommended until 6 weeks postpartum)

4

What is the difference between monophasic and triphasic COCP?

  • monophasic has a single dose of synthetic estrogen (ethinyl estradiol) and progestins throughout 21 days.
  • Biphasic has two different progestins, while triphasic has three different doses of progestins.
  • monophasic has decreased side effects triphasic has increased amenorrhea

5

What are the side effects related to progesterone?

  • Progesterone
  • Amenorrhoea / breakthrough bleeding
  • HA
  • Breast tenderness
  • ↑appetite
  • ↓libido
  • Mood Δ
  • HTN
  • OP
  • Androgenic SE = levonorgestrel > norethisterone > > > more recent progestins that are
  • antiandrogenic (cyproterone, drospirenone [less so] --- or have low androgenic activity = desogestrel, gestodene)
    • Acne / oily skin
    • Hirsutism
    • Weight gain

6

What are the side effects related to oestrogens?

  • Nausea
  • Breast Δ (tenderness, enlargement)
  • Fluid retention / bloating / oedema
  • Migraine / HA
  • TE events (DVT)
  • Breakthrough bleeding
  • Rare - Weight gain (NO WEIGHT GAIN) and Liver adenoma

7

Outline the Insertion of Implanon, what is involved and what are some risks? 

  • inserted subdermally on the inner side of the non-dominant arm around 8-10cm above the medial epicondyle. (marked with a marker) 
  • clean with antispetic 
  • anaethetise the insertion site 
  • angle less than 30 degrees 
  • applicator to hoizontal and slide 
  • verify the presence of the implant 
  • apply adhesive and pressure bandage to minimise bruising - keep dry for 24 hours and try not to heavy lift. 
  • itching, tenderness and bruising can occur. Can sometimes leave a scar. 

Things to Note: 

  • lasts for 3 years 
  • 99% effective 
  • it increases the thickness of mucus of the cervix and stops egg release from ovary. 
  • it is a 4cm long plastic rod that contains progesterone.
  • Its done on days 1-5 of your cycle. Can be done 21 days after birth and can be used while breastfeeding. 

CI:

  • breast or ovarian cancer
  • DVT
  • liver disease
  • pregnancy possibility
  • allergic reaction to local anaesthetic  

SE: 

- insertion - soreness, scarring, local anaesthetics. May scar 

- changes in bleeding (20% none, 25% infrequent, 30% regular, 20% prolonged). 

- progesterone related side effects. settle down.