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Flashcards in Contraception Non- LARC Deck (19)
1

In what three ways is CHC available

COC 20-35ug EE
patch 33ug EE
ring - 15ug EE

2

what is the main component of CHC

ethinyl estradiol

3

How effective is the CHC

perfect use - 0.3 percent
typical use 9 percent
for the patch if a woman weighs more than 90kg- decreased efficacy

4

what is the primary mode of action of chc

inhibits ovulation by reducing LH and FSH
also alters cervical mucous and endometrium

5

describe how the pill regime results in anovulation

first 7 pils inhibit ovulation
remain 14 maintain anovulation

6

after home many omitted pils can follicular activity resume

9

7

what is the standard patch regime

One patch is applied and worn for 1 week to suppress ovulation. Thereafter the patch is reapplied weekly for a further 2 weeks. The fourth week is patch-free to allow a withdrawal bleed. A new patch is applied after 7 patch-free days

8

what is the standard ring regime

A ring is placed into the vagina and left continuously for 21 days. After a ring-free interval of 7 days to induce a withdrawal bleed, a new ring should be inserted

9

What factors may affect the efficacy of CHC

GI conditions(Coc)
increased metabolism
drug interactions

10

What are the risks of taking the CHC

venous thrombosis
arterial thrombosis
increased risk of some cancers

11

How is EE thrombogenic

Alteration in clotting factor levels induced by EE may be thrombogenic eg reduces levels of antithrombin III and protein S
In patients with significant arterial wall disease EE may also promote superimposed arterial thrombosis
There is increased fibrinolytic activity but reversed in heavy smokers

12

what are the risk factors for VTE

obesity
smoking
age
known thrombophilia
VTE in 1st degree relative less than 45 yrs
up to 6 wks post natal
trekking >4,500m for >1 wk
long haul flights
reduced motility
antiphospholipid syndrome

13

which product have the lowest risk of VTE

levonorgestrel, northisterone, norgestimate

14

When is CHC contraindicated

migraine with aura
personal history of breast cancer

15

What things are a UKMEC 3

BRACA gene

16

What cancers are at an increased risk when using chc

breast
cervival - with long term use, returns to baseline 10yrs after stopping

17

What are the non contraceptive beneftis of CHC

reduced ovarian cancer
reduced endometrial cancer
acne- cyproterone acetate liscenced for acne and not contraception but does both
lighter periods - don't need to have period at all
functional ovarian cysts
PMS
PCOS

18

what are the side effects of CHC

unscheduled bleeding - don't change before 3 mths as usually settles
mood changes
weight gain

19

When can CHC be started

Standard Advice – COC’s can be started up to and including Day 5 of the cycle without the need for any additional contraception
Beyond Day 5 a woman can start the COC at any other time (off licence) provided she is ‘reasonably certain’ she is not pregnant and use condoms/abstinence for 7 days – ‘quick start