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Flashcards in Contraception non-LARC Deck (33):
1

what reasons other than contraception might someone use CHC

heavy periods
painful periods
acne
irregular periods
premenstrual symptoms
endometriosis
menstrual migraine (no aura)

2

what do CHC contain

estrogen and prog

3

types of CHC

combined oral contraceptive pill 20-35 ug EE
combined transdermal patch 33ug EE
combined vaginal ring 15 ug EE

4

CHC mode of action

inhibiting ovulation via hypo-pit axis to reduce LH and FHS
endometrium and mucous affected

5

CHC failure rate

0.3% perfect
9% typical

6

how is COC taken

taken for 21 days then stopped for 7 days - withdrawal bleed due to shedding of endometrium
first 7 pills inhibit ovulation the rest 14 maintain an ovulation
follicular activity resumes after 9 pills have been omitted

7

CTP application

1 patch per week for 3 weeks
1 week off for withdrawal bleeding
suppress ovulation

8

CVR regime

placed and left for 21 days
7 days off to induce withdrawel bleed
new ring

9

what factors affect CHC

impaired absorption - GI conditions for COC

impaired metabolism - liver enzyme induction, drug interaction

forgetting

10

missed pills protocol

take the missed pill as soon as remembered - over 24 hours less than 48 hours

2 or more pills - take the recent missed pill, take the rest at correct times, use condoms/abstain till 7 pills have been taken consecutively

11

more than 48 hours without pills

days 1-7 consider EC
days 8-14 no extra instructions
days 15-21: omit pill free interval

12

patches
removal
how long can it be worn
how long can it be off

can remain off for 2 days
can be worn for 9 days
can be extended till 9 days

for all 3 EC or extra precautions may be needed

13

TVR
how long can it be left out
how long can ti be worn
how long can the ring free interval be

48 hours
4 weeks
9 days

14

risks of CHC

venus thrombosis
arterial thrombosis
adverse effect on some cancers

15

metabolic affect of CHC

alteration in clotting factor levels induced by EE may be thrombogenic
in px with significant arterial wall dx EE may also prove superimposed arterial thrombosis
increased fibrinolytic activity but reversed in heavy smokers

16

unwanted circulatory effects in CHC and risk factors for it

another unwanted affect and the monitoring for it

another one

venous thromboembolism
obesity, smoking, age, known thrombophilia, VTE in first degree relative <45 years, up to 6 weeks post natal

trekking, long haul flights, reduced mobility, anti phospho syndrome, other conditions causing VTE risk


systemic hypertension
check initially and then 3 months then annually

arterial disease - MI esp in smokers - those who take COC

17

what can work as a contraceptive but is not licensed as one and what is it licensed for

cyproterine acetate

acne and hirsutism treatment

18

migraine and link to CHC

migraines with aura increase the risk of ischeamic stroke
CHC use in individual with migraine with aura further increases the risk of stroke and is contra indicated

19

what is an aura

change occurring 5-20 mins before the onset of a headache
visual/altered sensation/smell/taste/hemiparesis

20

unwanted affect - malignancy in CHC

breast cancer risk
if personal history then CHC contra indicated
FH - UKMEC1
BRACA-UKMEC 3

cervical cancer - small risk with long term use, discuss HPV/condom, keep up to date with cervical screening

21

examination before prescribing CHC

record BP and BMI before first prescription
check smear status if relevant

22

protection against what with CHC

20% reduction of ovarian cancer for every 15 years of use to 50% reduction after 15 years of use
20-50% reduction in endometrial cancer
benefit for both may last decade after stopping CHC

23

CHC and acne

all CHC beneficial for acne

24

what are some other non contraceptive benefits of CHC

pre menstrual syndrome
PCOS
functional ovarian cysts
bleeding - withdrawal bleeding

25

SE of CHC

CTP
CVR

unscheduled bleeding - up tp 20% experience, usually settles with time
mood changes - no signs of it leading to depression tho
weight gain - insufficient evidence

CTP - breast pain, nausea, painful periods than COC/CVR

CVR - less bleeding problems, acne, irratibility/mood changes

26

when is CHC started

up to and including day 5 of the cycle without the need for additional contraception

beyond day 5 a woman can start the COC at any other time provided she is not pregnant and uses condoms/anstains for 7 days

27

after EC

levonelle (prog) - abstain/condoms for 7 days

ulipristal acetate(anti prog) - avoid starting contraception for 5 days

28

POP types
mode of action primary and secondary

levonorgestrel. norethisterone, etonergestrel

primary - thickening of mucous, suppression of ovulation
secondary - suppression of ovulation, decrease in endometrial receptivity to blastocyte, reduction in cilia activity in fallopian tube

29

POP risks

little effect on metabolism
can be given in most circumstances
UKMEC 4 - current breast cancer

30

POP interactions

liver enzyme inducers 0 cytochrome P450
effect continues for 28 days after stopping

31

how to take a POP

L, N - daily at the same time, no break, within 24-27 hours of last dose

E - daily at the same time within 24-36 hours of last dose, no break

32

POP missed pills

one missed dose plus UPSI = EC and 2 day of extra protection

33

POP efficacy

perfect use 0.3% failure
typical use 9%