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Flashcards in Contraception Deck (26):
1

Time until contraceptives are effective (if not 1st d of period) (3)

instantly: IUD

2d: POP

7d: COC, implant, injection, IUS

2

Features of IUD (2)

inhibits implantation/fertilisation, copper is poisonous to sperm. it decreases their motility and survival

can be used as emergency contraception <120h

3

Problems w. IUD (3)

may be rejected by nulliparous/distorted uterus

increased risk of pelvic infection and subfertility following STI.

may develop menorrhagia and dysmenorrhoea

4

CIs for IUD (4)

pregnancy: 50% chance of miscarriage

current Pelvic infection/STI or w/i last 3mo

ovarian/endometrial/cervical ca.

distorted uterus

(caution in HIV due to increased risk of STIs)

5

Insertion of IUD (2)

sublingual misoprostol 1hr before to dilate cervix

insert uterine sound to measure length of uterus and insert device into fundus

6

Mechanism of IUS

mirena (levonorgestrel)

prevents endometrial proliferation+thickens cervical mucus

may have initial spotting then bleeding becomes absent

7

Other uses for the IUS (3)

endometriosis/adenomyosis: relieves pain

fibroids

endometrial hyperplasia

8

Mechanism of action of combined contraceptive (microgynon)

oestrogen+progesterone -vely feeds back to inhibit LH and prevent ovulation

9

how to take COCP (4)

ideally on 1st day of period-works instantly

if started on any other time, use barrier methods for 7d

use =/>2wks after being fully mobile post-major surgey

may mask menopause so ideally stop at 50yrs and use non-hormonal methods (however can help maintain bone density throughout menopause)

10

If two pills missed (4)

take last pill even if it means taking two in one day. leave any earlier missed pills and continue taking pills daily. use condoms until pills have been taken for 7d

If missed in wk 1, consider emergency contraception

if missed in wk 2 after 7 consecutive days of taking the pill, there is no need for emergency contraception

if missed in wk3, finish pills in current pack and start new pack omitting pill-free break

11

benefits of COCP (5)

good for heavy periods

less PMS

improves menopausal Sx

improves acne

decreased risk of ovarian/endometrial ca.

12

risks of COCP (2)

increased risk of aterial and venous disease

increased risk of breast/cervical ca.

13

monitoring while on COCP (2)

BP, BMI and health status after 3mo then annually

chlamydia screen if breakthrough bleeds

14

mechanism of action of POP (2)

low dose progesterone thickens cervical mucus

desogestrel (cerazette) inhibits ovulation

15

Process of taking POP (2)

must take at same time of day +/- 3hrs or +/-12hrs for desogestrel

no pill free break

16

CI for POP (2)

breast ca. in last 5yrs

pregnancy

(can be used in most women w. CI for COCP)

17

SEs of POP (3)

irregular bleeding

risk of ovarian cysts

hormonal Sx: decreased libido, breast swelling, fluid retention

18

Other uses for POP

norethisterone can be used to put off periods. start 3d before you want bleeding to stop till the day itself

19

Depot contraceptives, mechanisms (4)

methoxyprogesterone acete (depot provera):
-take days 1-5 of cycle
-IM 12-weekly

norethisterone enanthate-8wkly IM

thickens cervical mucus and inhibits ovulation

use condoms if injections >2wks late

20

CIs for depot contraceptives (6)

pregnancy

breast ca.

undiagnosed vaginal bleeding

acute liver disease

severe cardiac disease

trophoblastic disease

21

SEs of depot contraceptives (3)

vaginal bleeding-settles around 6wks>amenorrhoea

wt. gain

takes a while for fertility to return

22

Indications for depot contraceptives (4)

sickle cell-reduces incidence of crises

covering major surgery

epileptics-reduces incidence of fits and doesn't interact w. enzyme inducers

bowel disease where oral absorption is compromised

23

Features of implant contraceptive (4)

progesterone implant>3yrs contraception

non-dominant arm, subdermal

nexplanon contains etonorgestrel

inhibits ovulation and thickens cervical mucus

24

SEs of implants (2)

infrequent/heavy/absent bleeding

progesterone-only side effects: headache, breast pain, nausea

25

CIs for implantable contraceptive (4)

current breast ca.

may not be effective in 3rd yr in obese women

enzyme inducers

UKMEC 3:
-ischaemic HD/stroke
-severe liver cirrhosis
-liver ca.
-past breast ca.
-unexplained vaginal bleeding
-antiphospholipid syndrome

26

Features of contraceptive patches (3)

oestrogen+progesterone

may experience breast pain and breakthrough bleeds in first 2 cycles

affected by enzyme inducers