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

what reasons other than contraception might someone use CHC

A
heavy periods
painful periods
acne
irregular periods
premenstrual symptoms 
endometriosis
menstrual migraine (no aura)
2
Q

what do CHC contain

A

estrogen and prog

3
Q

types of CHC

A

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

4
Q

CHC mode of action

A

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

endometrium and mucous affected

5
Q

CHC failure rate

A

0.3% perfect

9% typical

6
Q

how is COC taken

A

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
Q

CTP application

A

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

8
Q

CVR regime

A

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

9
Q

what factors affect CHC

A

impaired absorption - GI conditions for COC

impaired metabolism - liver enzyme induction, drug interaction

forgetting

10
Q

missed pills protocol

A

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
Q

more than 48 hours without pills

A

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

12
Q

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

A

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
Q

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

A

48 hours
4 weeks
9 days

14
Q

risks of CHC

A

venus thrombosis
arterial thrombosis
adverse effect on some cancers

15
Q

metabolic affect of CHC

A

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
Q

unwanted circulatory effects in CHC and risk factors for it

another unwanted affect and the monitoring for it

another one

A

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
Q

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

A

cyproterine acetate

acne and hirsutism treatment

18
Q

migraine and link to CHC

A

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
Q

what is an aura

A

change occurring 5-20 mins before the onset of a headache

visual/altered sensation/smell/taste/hemiparesis

20
Q

unwanted affect - malignancy in CHC

A

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
Q

examination before prescribing CHC

A

record BP and BMI before first prescription

check smear status if relevant

22
Q

protection against what with CHC

A

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
Q

CHC and acne

A

all CHC beneficial for acne

24
Q

what are some other non contraceptive benefits of CHC

A

pre menstrual syndrome
PCOS
functional ovarian cysts
bleeding - withdrawal bleeding

25
Q

SE of CHC

CTP
CVR

A

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
Q

when is CHC started

A

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
Q

after EC

A

levonelle (prog) - abstain/condoms for 7 days

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

28
Q

POP types

mode of action primary and secondary

A

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
Q

POP risks

A

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

30
Q

POP interactions

A

liver enzyme inducers 0 cytochrome P450

effect continues for 28 days after stopping

31
Q

how to take a POP

A

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
Q

POP missed pills

A

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

33
Q

POP efficacy

A

perfect use 0.3% failure

typical use 9%