FSRH Responses to Things….this is all those seemed relevant Flashcards
How did FSRH respond to Fitzpatrick study re CHC/POC 2023?
Possible that POC does increase risk breast cancer slightly in current/recent users
However breast Cancer rare in young population so although 20-30% increased risk, absolute risk is small
Extra 8 cases observed per 100,000 age 16-20
Extra 265 cases per 100,000 age 35-39
Weigh against benefits of
1. Unplanned Pregnancy
2. Other benefits eg possible decreased endometrial and ovarian cancer
What’s the deal with nsaids and chc?
Possible small increased risk VTE when both taken….but….chc should be ruled out in any case in people who have RF VTE so likely minimal impact
What’s the situation re Zoely and MHRA alert nomegestrol associated with méningioma?
Zoely is 2.5mg nomegestrol and estradiol
Evidence related to higher doses
However:
No Zoely if have/had meningioma
Warn re possible small risk
Report to MHRA if occurs
What about cyproterone acetate as part of dianette (MHRA re meningioma)
Low dose (2mg) used as part of dianette
However association plausible
History meningioma do not use
If no history use only if acne/hirsutism and tell patient cannot exclude may be small increased risk
MHRA Extension of mirena licence how does it affect practice?
Use now advised 8 years contraception only (new/in situ)
No change to other 52mg at present
No change to 5 yr recommendation for HRT
No change re HMB
Announcing 24/4 Slynd (drospirenone 4mg POP) Jan 2024….and what?
There is less *unscheduled bleeding
24 hour missed pill window may facilitate correct use
Notes:
Start D1 (or 7 days condoms)
Suppresses ovulation primarily (but also mucus/endometrium)
Caution if K+ RF
Mildly anti-androgenic
May have mildly bp reductive effect
In copper coil shortage what can be advised?
If 35+ Consider extended use of a 10 year to 12 years if pt prefers if no replacement available
Consider oral EC if pre ovulation by long shot
What’s good about syreni-ring?
Same make up as nuva ring (EE 2.7mg and etonorgestrel 11.7mg)
BUT can dispense a year as no refrigeration requirement
Nuvaring refrigerated could only be dispensed 3/12 and had to be used within 4/12
Another study about non enzyme inducing abx and hc failure?
FSRH siiiiiigh not again.
It’s a rubbish study and we have reviewed all the evidence multiple times. Non enzyme inducing abx do not require additional contraceptive precautions if using HC
A study on the very specific situation that you miss d 5,6,7 CHC after HFI, established on CHC and want to take UPA EC and keep taking cocp what did it add?
So LNG an option obv and restart pill immediately plus 7 days condoms
But also if had taken pill but then miss 2-7 pills in first week after HFI you could take UPA EC and restart COCP plus condoms 7 days and have a lower risk of ovulating in this cycle than if you waited 5 days to restart it (what the study showed)
UPA should not be combined with immediate HC in any other scenario…..wait 5 days or consider LNG if want to quick start in any other situation
WHO recommendations re HIV IUD and hormonal contraception 2019 how did FSRH guidance change?
All hormonal methods became ukmec 1 if high risk HIV
DMPA and IUD had been ukmec 2
FSRH statement in weight gain and contraception. What’s the bottom line?
Women of reproductive age tend to gain weight contraception or not
Very individual
Reassure evidence indicates IUC/POP/CHC/implant do not cause weight gain
V limited evidence suggests DMPA is associated with weight gain especially > BMI 30 <18 yo however data too limited to confirm or exclude causative effect. If gain >5% first 6/12 maybe more likely to continue
What do BASHH say about doxy PEP?
Cannot recommend but some evidence for 200mg taken within 24hrs
70% decrease in syphilis and chlamydia msm
Ask about abx use specifically for STI (up to 10% may be using) and advise only doxy effective/caution re pregnancy and SE
