contraception Flashcards
(57 cards)
forms of combined hormonal contraception (CHC)
pill, patch, vaginal ring
what hormones are in CHC
ethinyl estradiol
progestogen
how does CHC work
stops ovulation, also effects cervical mucous and endometrium
standard regime of CHC
21 days with hormone free week
tricyclic/continuous use CHC
no need for inconvenient withdrawal bleed and avoids forgetting to restart after break
when is CHC patch changes
weekly
when is CHC ring changed
every 3wks (can take out for 3hrs every day so may want to do that for sex)
non-contraceptive benefits of CHC
regulate/reduce bleeding - help heavy, painful periods
stop ovulation - help prementrual syndrome
reduction in functional ovarian cysts
50% reduction ovarian and endometrial cancer
improve acne/hirsutism
reduction in benign breast disease, rheumatoid arthritis, colon cancer and osteporosis
side effects of CHC
tender breasts nausea headache irregular bleeding first 3mo mood? casual or other live events weight gain - not causal
serious risks associated with CHC
venous thrombosis - PT, DVT (avoid if BMI>34, prev VTE)
arterial thrombosis - MI, stroke (avoid smokers >35, Hx, Age>50, BP >140/90)
risk cervical ca
risk breast ca (aviooid if Hx)
when is the progestogen only pill (POP) not a good idea
if they have frequent GI upset
how is progestogen only pill to be taken
same time everyday without a pill-free interval
desogestrel POP
12hr window
nearly all cycles no ovulation, also affects mucus
most bleed free
traditional LNG/PET POP
3hr window
1/3 anovulant, 2/3 rely on cervical mucus effect
1/3 bleed free, 1/3 irregular bleeds, 1/3 regular period
POP contraindications
personal history of breast cancer or liver tumour
POP side effects
increased appetite hair loss/gain mood change bloating or fluid retention headache acne
how is ‘the jag’ given
150ml 1mg IM injection into upper quadrant buttock every 13wks
how does ‘the jag’ work
prevents ovulation
alters cervical mucus making it hostile to sperm
makes endometrium unsuitable for implantation
pros of injectable progestogen
only need to remember every 12-14wks
70% amenohorrhoeic after 3 doses
oestrogen free so few contraindications
cons of injectable progestogen
delays in return to ferility - avg 9mo
reversible reduction to bone density
problematic bleeding esp 1st 2 doses
weight gain
pros of intrauterine contraception (the coil)
little user input after fitting
used for any age + parity
(side) effects immediately reversible upon removal
cons of the coil
1:1000 risk perforation
5:100 risk expulsion: check threads after period
not suitable if untreated pelvic infection or distorted endometrial cavity e.g. submucus fibroids
how does copper IUD work
toxic to sperm
stop sperm reaching egg
may sometimes prevent implantation of fertilised egg
con of copper IUD
may make periods heavier/crampier
