Contraceptives Flashcards
(47 cards)
1
Q
What is meant by the lactational amenorrhoea method (LAM) of contraception? How does it work?
A
- breastfeeding reduces the possibility of pregnancy by temporarily suppressing fertility
- infant sucking inhibits ovulation by disrupting the release of GnRH, FSH, LH and oestrogen
2
Q
How effective is LAM in preventing pregnancy?
A
- less than 2% chance of pregnancy in first 6 months if:
- fully breastfeeding (no supplementary feeds or solids)
- amenorrhoea
- less than 6 months post birth
3
Q
What are other names for the progesterone only pill?
A
- the mini pill
- levonorgestrel (Microlut)
- norethisterone (Locilan 28, Micronor, Noriday 28)
4
Q
What are the benefits of the progesterone only pill?
A
- suitable for breastfeeding women
- may be commenced any time after birth
5
Q
What are the disadvantages of the progesterone only pill?
A
- should be taken at the same time each day (within 3 hours)
6
Q
What may interfere with the efficacy of the progesterone only pill?
A
- if taken late: an alternative method should be used if sex within 3 pills/48 hours
- vomiting within 2 hours of taking pill
- severe diarrhoea
- some medications - particularly antibiotics, anti-retroviral and anti-epileptic
7
Q
Does the progesterone only pill have any inactive pill days?
A
No, it contains 28 pills of the same dose taken every day without any break
8
Q
What is the mode of action of the progesterone only pill?
A
- thickens cervical mucosa making it impenitrable to sperm
- alters the endometrium to inhibit implantation
- may prevent ovulation in some women
9
Q
How effective is the progesterone only pill in preventing pregnancy?
A
96-97% effective depending on compliance
10
Q
What are the contraindications to using the progesterone only pill?
A
- breast cancer
- altered liver function
- taking some medications
- CVD and hypertension
- abnormal lipids
- undiagnosed bleeding
- generally thought to have fewer side effects than combined oral contraceptive
11
Q
What are the most common side effects of the progesterone only pill?
A
- irregular bleeding
- amenorrhoea
- headaches
- weight changes
- mood changes
12
Q
What are the recommendations around commencing the progesterone only pill after birth?
A
- may be commenced at any time, but no contraception required for 21 days postpartum
- effective immediately if breastfeeding and within 21 days of birth or or day 1-5 of cycle if menstruation has returned
- otherwise exclude pregnancy if necessary, effective after 48 hours/3 pills
- recommend annual followup with GP or family planning service
13
Q
What are the active ingredients in the combined oral contraceptive pill?
A
synthetic estrogens and progestegens
14
Q
What is the mode of action of the combined oral contraceptive pill?
A
- inhibits FSH, LH release preventing follicle maturation and ovulation
- thickens cervical mucous and reduces fallopian tube motility
15
Q
When is the combined oral contraceptive pill not recommended?
A
- while breastfeeding and within the first 6 months after birth (may alter milk composition, suppress prolactin and reduce supply)
- within 21 days of birth due to risk of thrombosis
- for women with increased risk of thrombosis (smoker, obesity, advanced age, diabetes, hypertension, reduced mobility)
- History of heart disease, stroke, VTE, DVT, pulmonary emobolism
- migraines with aura
- current breast cancer
- advanced diabetes
- efficacy reduced by some medications (antibiotics, liver enzyme altering drugs, antiepileptic drugs and st johns wort)
16
Q
Does the combined oral contraceptive pill have any inactive pill days?
A
Yes, they generally contain 21 days of hormones and 7 days of placebo tablets
17
Q
What different combined oral contraceptive pill types are available?
A
- may be monophasic (active pills all contain same formulation), biphasic (two-phases), tri-phasic (three-phases)
18
Q
How effective is the combined oral contraceptive pill?
A
91-99.7% effective
19
Q
What are the most common side effects of the combined oral contraceptive pill?
A
- breakthrough bleeding
- breast tenderness
- lowered libido
- mood changes
- headache
- nausea
- weight gain
- bloating
20
Q
What risks may be associated with taking the combined oral contraceptive pill?
A
- increased risk of gallbladder disease
- VTE
- stroke
- heart attack
- cervical cancer
21
Q
What are the recommendations around commencing the combined oral contraceptive pill after birth?
A
- not recommended if breastfeeding prior to 6 months postpartum
- not recommended before 21 days postpartum
- if menstruation has returned effective immediately if commenced day 1-5
- otherwise exclude pregnancy if required
- effective in 7 days
22
Q
What contraceptive methods can be considered postpartum?
A
- Lactational amenorrhoea method
- condoms
- diaphragms and cervical caps
- progesterone only pill
- combined oral contraceptive pill
- implanon
- Depo-provera
- copper or hormonal IUD
23
Q
When can condom use be commenced postnatally?
A
- can be used immediately with no impact on breastfeeding
24
Q
When can use of diaphragms and cervical caps be commenced postnatally?
A
- > 6 weeks after birth when vaginal tone returns
- now less common, very little consistancy in terms of products
25
What to do if a combined oral contraceptive pill is late or missed?
- within 24 hours, take pill ASAP, then continue as usual
- after 24 hours late, take most recent pill and use another form of contraception until 7 days/pills
- missing more than 4 pills is considered stopping the pill
26
What is the trade name of Depot medroxy-progesterone acetate (DMPA) or the progestogen only injection?
Depo-Provera
27
What is Depo-provera?
- an injectable contraceptive
| - progestagen is injected deep IM every 12 weeks
28
What is the mode of action for Depo-provera in preventing pregnancy?
- inhibits GnRH secretion
- prevents follicle maturation and ovulation
- increases thickness of cervical mucous
- changes lining of the uterus
29
What recommendation would you give a woman about Depo-provera?
- 99.8% effective when given every 12 weeks
- need to see a doctor every 3 months for an injection (cost?)
- important not to massage injection site as this can decrease duration
- not usually commenced before 6 weeks postpartum due to risk of increased vaginal bleeding
- ensure not pregnant before commencing
- suitable for breastfeeding
30
What are common side effects associated with Depo-provera?
- lighter or heavier than usual periods
- some women don't get periods at all
- weight changes
- headaches
- abdominal discomfort
- mood changes
- reduced libido
- fluid retention
- breast tenderness
- acne
- may increase long term risk of osteoporosis
- potential for anaphylaxis
31
What advice would you give a woman about the return of her fertility after using Depo-provera?
- once injection is given, hormone cannot be removed for 3 months
- periods may take 6-12 months to return after ceasing injections
- 50% of women fall pregnant within 12 months and >90% within 2 years
32
What are some advantages of Depo-provera?
- highly effective
- don't need to remember to take a pill every day (but need to see doctor for injection)
- may get lighter or no periods
- may reduce risk of ovarian cancer, endometrial cancer, endometriosis and pelvic infection
- is not affected by stomach upsets
- appropriate for breastfeeding women (may actually increase prolactin and milk supply in some women, but may also decrease, safe for baby)
33
When is Depo-provera not recommmended?
- women with coagulation disorders or on anticoagulants
- undiagnosed bleeding
- already pregnant
- wanting to become pregnant within 12 months
- certain other medical conditions
34
What is the trade name of the etonogestrel (progestogen) implant? What is it? how long does it last?
- Implanon
- 4cm long, 2mm diameter polymer rod impregnated with synthetic estrogen
- implanted just under skin of arm
- lasts for 3 years
35
What are some advantages of implanon?
- highly effective (failure rate of 0-0.7 per 100 women)
- low cost (about $38) with medicare
- suitable for breastfeeding women
- can be implanted any time after birth
- lasts 3 years, don't have to remember to take pill
- may cause lighter than usual or absent periods
- rapid return to fertility
- can be removed at any time
36
What is the mode of action for the progestogen implant (implanon)?
- inhibits ovulation
- changes thickening of the endometrium to make less hospitable to implantation
- increases viscosity of cervical mucous
37
What are some disadvantages/side effects of the progestegen implant (implanon)?
- irregular or frequent bleeding
- some women have no periods
- weight changes
- mood changes
- acne
- abdominal pain
- painful periods
38
When will Implanon not be recommended?
- if woman may be pregnant
- recent breast cancer
- undiagnosed vaginal bleeding
- unable to take progestogens
- recent thrombosis or DVT
39
What recommendations would you give a woman about when Implanon can be commenced?
- any time after birth
- effective immediately if inserted from day 1-5 of menstrual cycle
- if after day 5 effective after 7 days
- exclude pregnancy if appropriate
40
What kinds of intrauterine devices are available?
- copper
| - Mirena
41
What is Mirena?
- an intrauterine system (IUS)
- a T shaped device containing levonorgestrel (progestogen)
- at implantation releases around 20mcg per day, reduced to 10mcg/day at 5 years, mean 14mcg/day
42
What is the mode of action of Mirena?
- changes to the endometrium - less hospitable to implantation
- decreased GnRH and estrogen
- thickening of cervical mucous
- inhibits ovulation in some women
43
What are the advantages of Mirena?
- highly effective (0.7% failure rate at 5 years)
- very low daily dosage due to localised effect
- lasts for 5 years
- often very light or absent periods, unlike copper IUDs that often cause heavy bleeding (particularly good for women with heavy periods)
- appropriate for breastfeeding women
- quick return to fertility after removal
44
What is the only contraceptive that prevents STIs?
CONDOMS
45
When can mirena be used after birth?
- it is recommended that it should be implanted after 6 weeks after birth, particularly when breastfeeding due to slightly increased risk of perforation and spontaneous expulsion
- exclude pregnancy
- effective within 7 days
46
What are the side effects/risks of Mirena?
- changes in bleeding patterns (may cause spotting, shorter, longer or absent periods particularly in first 6 months)
- headache
- abdominal/pelvic/back pain
- vulvovaginitis
- mood changes
- decreased libido
- nausea
- acne
- breast tenderness
- weight changes
- may increase susceptibility to infections
- possible expulsion
- very rarely perforation (breastfeeding and insertion up to 36 weeks post birth are risk factors)
- lost threads
- ectopic pregnancy
- ovarian cysts (usually asymptomatic)
- removal threads may be felt by partner during intercourse
47
What are contraindications to using mirena?
- pregnancy
- pelvic inflammatory disease
- vaginal, cervical or uterine infection
- postpartum endometritis
- cervical dysplasia
- some cancers (particularly uterine, cervical or some breast)
- undiagnosed bleeding
- uterine anomolies such as fibroids in some cases
- increased susceptibility to infection
- liver disease
- inability to take progestogens
- not the first choice for young nulligravid women or postmenopausal women due to difficulty of insertion
