O&G: Contraception Flashcards by Katherine Neo

Emergency contraception

what are the 3 options

Levonorgestrel
Ulipristal
copper coil

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Emergency contraception

when can levonorgestrel be taken

within 72 hours of UPSI

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Emergency contraception

when can Ulipristal be taken

within 120 hours of UPSI

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Emergency contraception

when can the copper coil be inserted

within 5d of UPSI

or within 5d of the estimated ovulation

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Emergency contraception

can levonorgestrel and ulipristal be used more than once in a menstrual cycle

yes

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Emergency contraception

when is ovulation in a 26 day cycle

14d before the end of the cycle so day 12

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Emergency contraception

what may insertion of copper coil lead to

pelvic inflammatory disease

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Emergency contraception

when can copper coil be removed

until at least the next period or can be left in as long term contraception

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Emergency contraception

what is in levonorgestrel

progestogen (it delays or prevents ovulation)

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Emergency contraception

what can be started immediately after levonorgestrel

COCP or progestogen only pill

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Emergency contraception

dose of levonorgestrel if woman >70kg or BMI>26

double the dose!

usually 1.5mg so give 3mg

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Emergency contraception

woman vomits within 3h of taking levonorgestrel, what should you do

dose should be repeated

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Emergency contraception

can breastfeeding continue after taking levonorgestrel

NICE CKS advise that breastfeeding is avoided for 8 hours

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Emergency contraception

what is Ulipristal (EllaOne)

a selective progesterone receptor modulator (SERM) that works by delaying ovulation.

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Emergency contraception

how long should you wait before started the COCP or progestogen only pill after taking ulipristal

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Emergency contraception

woman vomits within 3h of taking Ulipristal, what should you do

repeat dose

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Emergency contraception

can breastfeeding continue with ullipristal

avoid for 1w

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Emergency contraception

which condition is Ullipristal CI’d in

pts with severe asthma

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COCP

what does it contain

oestrogen and progesterone

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COCP

3 ways it prevents pregnancy

preventing ovulation (primary mechanism of action)
progesterone thickens cervical mucus
progesterone inhibits proliferation of endometrium, reducing chance of successful implantation

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COCP

how does it prevent ovulation

Oestrogen and progesterone have a negative feedback effect on the hypothalamus and anterior pituitary, suppressing the release of GnRH, LH and FSH

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COCP

what are the 2 types

monophasic pills

- multiphasic pills

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COCP

what are monophasic pills

contain the same amount of hormone in each pill

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COCP

what are multiphasic pills

Study These Flashcards

contain varying amounts of hormone to match the normal cyclical hormonal changes more closely

COCP what is oestrogen aka

ethinylestradiol

COCP 1st line (lower risk of VTE)

pill with levonorgestrel or norethisterone first line (e.g. Microgynon or Leostrin).

COCP 1st line for premenstrual syndrome

Yasmin and other COCPs containing drospirenone Drospirenone has anti-mineralocorticoid and anti-androgen activity, and may help with symptoms of bloating, water retention and mood changes

COCP what pill to consider for acne and hirsutism

Dianette and other COCPs containing cyproterone acetate (i.e. co-cyprindiol) Cyproterone acetate has anti-androgen effects

COCP SEs

- Unscheduled bleeding is common in the first 3m - Breast pain and tenderness - Mood changes and depression - Headaches - Hypertension

COCP Risks

- VTE - small increased risk of breast and cervical cancer - small increased risk of MI and stroke

COCP reduces risk of?

endometrial, ovarian and colon cancer benign ovarian cysts

COCP what are the specific RFs that should make you avoid it (UKMEC 4)

- Uncontrolled HTN (particularly ≥160 / ≥100) - Migraine with aura (risk of stroke) - History of VTE - Aged >35 and smoking more than 15 cigarettes/day - Major surgery with prolonged immobility - Vascular disease or stroke - IHD, cardiomyopathy or AF - Liver cirrhosis and liver tumours - SLE and antiphospholipid syndrome

COCP BMI above 35 is UKMEC 3. Should you take the pill

probably not as risks generally outweigh the benefits

COCP if you start on the 1st day of your menstrual period, what contraception is required

No additional contraception is required if the pill is started up to day 5 of the menstrual cycle.

COCP if you start after day 5 of the menstrual cycle , what contraception is required

extra contraception (i.e. condoms) for the first 7 days of consistent pill use

COCP when switching between COCPs, when do you start the new one

immediately start the new pill pack without the pill-free period.

COCP advice when switching from POP

can switch at any time but 7 days of extra contraception (i.e. condoms) is required.

COCP why does switching from desogestrel require no additional contraception compared to a traditional POP

because desogestrel inhibits ovulation

COCP definition of missing one pill

when the pill is >24h late

COCP advice to give if one pill was missed (<72h since last pill was taken)

- Take the missed pill as soon as possible (even if this means taking two pills on the same day) - No extra protection is required provided other pills before and after are taken correctly

COCP advice to give if >1 pill missed (>72h since the last pill was taken)

- Take the most recent missed pill as soon as possible (even if this means taking two pills on the same day) - Additional contraception (i.e. condoms) is needed until they have taken the pill regularly for 7 days straight - consider emergency contraception depending what day of the packet

COCP if >1 pill missed (>72h since the last pill was taken) and on day 1-7 of the packet, do they need emergency contraception

yes if they have had UPSI

COCP if >1 pill missed (>72h since the last pill was taken) and on day 8-14 of the packet, do they need emergency contraception

COCP if >1 pill missed (>72h since the last pill was taken) and on day 15-21 of the packet, do they need emergency contraception

no, they should go back-to-back with their next pack of pills and skip the pill-free period.

COCP which medication may reduce the effectiveness of the pill

rifampicin

COCP is a day of vomiting or diarrhoea classes as a missed pill

yes

COCP how long should you stop the pill before a major operation (lasting >30 minutes) or any operation or procedure that requires the lower limb to be immobilised

4 weeks

postpartum and wants to start contraception immediately, what can be used?

POP

what is the only suitable option for a postpartum woman actively breast-feeding

POP

when can an IUS or IUD be inserted after giving birth

within 48 hours of birth, or four weeks postpartum

why can't COCP be given to women <6 weeks postpartum who are breast-feeding

- increased risk of VTE in the post-pregnancy state - contamination of breast milk - After 6 weeks, it becomes a UK MEC2

when can the lactation amenorrhea method for contracteption be used

- <6m postpartum - solely breastfeeding - has no periods

Absolute Contraindications to Contraception (UKMEC 4)

- Known or suspected pregnancy - smoker >35y who smokes >15 cigarettes - obesity - breast feeding <6 weeks post partum - Fx of thrombosis before 45y - breast cancer or cancer within last few years - BRCA genes

Disadvantages of a contraceptive outweigh the advantages (UKMEC 3)

- Breast feeding >6weeks post partum - Previous arterial or venous clots - continued use after heart disease or stroke - migraines with aura - active disease of liver or gallbladder

Advantages of a contraceptive outweigh the disadvantages (UKMEC 2)

- Initiation after current or past history of MI or stroke | - multiple risk factors for arterial cardiovascular disease

what is the the only acceptable form of contraception in women with active breast cancer or PMH of it

Copper intra-uterine device (IUD).

when should you double emergency contraception dose

In women with a BMI >26 or a weight >70kg, the dose of Levonelle must be doubled the dose of ellaOne should not be changed according to weight

when can the Copper intrauterine device (IUD) be used for emergency contraception

5d post UPSI or 5d post earliest possible ovulation - whichever is later.

how to calculate earliest possible ovulation

e.g. if 28 day cycle (28-14) + 5 = day 17

O&G: Contraception Flashcards

(59 cards)