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Yr 5: Things I forget > O&G contraception > Flashcards

O&G contraception Flashcards

1
Q

Emergency contraception: Levonorgestrel (Levonelle)

A
  • mode of action not fully understood - acts both to stop ovulation and inhibit implantation
  • should be taken as soon as possible - efficacy decreases with time
  • must be taken within72 hours of unprotected sexual intercourse (UPSI)*
  • single dose of levonorgestrel 1.5mg (a progesterone)- the dose should be doubled for those with a BMI >26 or weight over 70kg
  • 84% effective is used within 72 hours of UPSI
  • levonorgestrel is safe and well-tolerated. Disturbance of the current menstrual cycle is seen in a significant minority of women. Vomiting occurs in around 1%
  • ifvomiting occurs within 3 hours then the dose should be repeated
  • can be used more than once in a menstrual cycle if clinically indicated
  • hormonal contraception can be started immediately after using levornogestrel (Levonelle) for emergency contraception
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2
Q

Emergency contraception: Ulipristal acetate (EllaOne)

A
  • aselective progesterone receptor modulator
  • primary mode of action is thought to be inhibition of ovulation
  • 30mg oral dose taken as soon as possible, no later than120 hours after intercourse
  • concomitant use with levonorgestrel is not recommended
  • Ulipristal may reduce the effectiveness of hormonal contraception.Contraception with the pill, patch or ring should be started, or restarted, 5 days after having ulipristal. Barrier methods should be used during this period
  • caution should be exercised in patients with severe asthma
  • repeated dosing within the same menstrual cycle was previously not recommended - however, this has now changed andulipristal can be used more than once in the same cycle
  • breastfeeding should be delayed for one week after taking ulipristal. There are no such restrictions on the use of levonorgestrel
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3
Q

Emergency contraception: copper IUD

A
  • a copper IUD is themost effective method of emergency contraception and should be offered to all womenif they meet the criteria
    • if the criteria for insertion of a copper IUD are not met or is not acceptable to the woman, oral emergency contraception should be considered
    • in practice the vast majority of women choose oral emergency contraception, but it is important to offer the choice to all women given how effective copper IUDs are
  • must be inserted within 5 days of UPSI, or
  • if a woman presents after more than 5 days thenan IUD may be fitted up to 5 days after the likely ovulation date
  • may inhibit fertilisation or implantation
  • prophylactic antibiotics may be given if the patient is considered to be at high-risk of sexually transmitted infection
  • is 99% effective regardless of where it is used in the cycle
  • may be left in-situ to provide long-term contraception. If the client wishes for the IUD to be removed it should be at least kept in until the next period
  • may be offered after this period as long as the client is aware of reduced effectiveness and unlicensed indication
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4
Q

Post partum contraception: POP

A

Contraception needed ONLY after day 21

  • the FSRH advise ‘postpartum women (breastfeeding and non-breastfeeding) canstart the POP at any time postpartum.’
  • after day 21 additional contraception should be used for the first 2 days
  • a small amount of progestogen enters breast milk but this is not harmful to the infant
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5
Q

Post partum contraception: COCP

A
  • absolutely contraindicated - UKMEC 4 - if breastfeeding < 6 weeks post-partum
  • UKMEC 2 - if breastfeeding 6 weeks - 6 months postpartum*
  • the COCP may reduce breast milk production in lactating mothers
  • should not be used in the first 21 daysdue to the increased venous thromboembolism risk post-partum
  • after day 21 additional contraception should be used for the first 7 days
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6
Q

Post partum contraception: lactational amenorrhoea method (LAM)

A

98% effective providing the woman is fully breast-feeding (no supplementary feeds), amenorrhoeic and < 6 months post-partum

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7
Q

Post partum contraception: IUD/IUS

A

The intrauterine device or intrauterine system can be inserted within48 hours of childbirth or after 4 weeks

Aninter-pregnancy interval of less than 12 monthsbetween childbirth and conceiving again is associated with an increased risk of preterm birth, low birth weight and small for gestational age babies

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8
Q

Mode of action of contraception: COCP

A

Inhibits ovulation

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9
Q

Mode of action of contraception: POP

A

Thickens cervical mucus

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10
Q

Mode of action of contraception: Desogestrel-only pill

A

Primary: Inhibits ovulationAlso: thickens cervical mucus

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11
Q

Mode of action of contraception: Injectable contraceptive (medroxyprogesterone acetate)

A

Primary: Inhibits ovulationAlso: thickens cervical mucus

only contraception associated with weight gain officially

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12
Q

Mode of action of contraception: Implantable contraceptive (etonogestrel)

A

Primary: Inhibits ovulationAlso: thickens cervical mucus

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13
Q

Mode of action of contraception: Intrauterine contraceptive device

A

Decreases sperm motility and survival

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14
Q

Mode of action of contraception: Intrauterine system (levonorgestrel)

A

Primary:Prevents endometrial proliferation
Also: Thickens cervical mucus

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15
Q

Method of action of EMERGENCY contraception: Levonorgestrel

A

Inhibits ovulation

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16
Q

Method of action of EMERGENCY contraception: Ulipristal

A

Inhibits ovulation

17
Q

Method of action of EMERGENCY contraction: Intrauterine contraceptive device

A

Primary: Toxic to sperm and ovum
Also: Inhibits implantation

18
Q

Missed pill: POP

A 
Traditional POP ((Micronor, Noriday, Nogeston, Femulen):
If less than 3 hours lateno action required, continue as normal
If more than 3 hours late (i.e. more than 27 hours since the last pill was taken): action needed

Cerazette (desogesterol):
If less than 12 hours late: no action required, continue as normal.
If more than 12 hours late (i.e. more than 36 hours since the last pill was taken): action needed

Action:

  • take the missed pill as soon as possible. If more than one pill has been missed just take one pill. Take the next pill at the usual time, which may mean taking two pills in one day
  • continue with rest of pack
  • extra precautions (e.g. condoms) should be used until pill taking has been re-established for 48 hours
  • If in first 48 hours of beginning —> emergency contraception
19
Q

Missed pill: COCP

A

If 1 pill is missed (at any time in the cycle):

  • take the last pill even if it means taking two pills in one day and then continue taking pills daily, one each day
  • no additional contraceptive protection needed

If 2 or more pills missed:

  • take the last pill even if it means taking two pills in one day, leave any earlier missed pills and then continue taking pills daily, one each day
  • the women should use condoms or abstain from sex until she has taken pills for 7 days in a row. FSRH:‘This advice may be overcautious in the second and third weeks, but the advice is a backup in the event that further pills are missed’
  • if pills are missed inweek 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1
  • if pills are missed inweek 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception
  • if pills are missed inweek 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval

Yr 5: Things I forget (14 decks)

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