Short acting reversible contraception

Question 1

Name 3 examples of short acting contraception

Answer 1

Combined hormonal contraception (CHC)
Progesterone only pill (POP)
Emergency hormonal contraception (EHC)

Question 2

What are non-contraceptive benefits of CHC?

Answer 2

Heavy menstrual bleeding
Painful periods
Acne
Irregular periods
Premenstrual symptoms
Endometriosis
Menstrual migraine (no aura)

Question 3

What are the 3 types of CHC available?

Answer 3

Combined oral contraceptive 20-30ug EE
Combined transdermal patch 33ug EE
Combined vaginal ring 15ug EE

Question 4

What is the CHC mode of action?

Answer 4

Inhibiting ovulation via action on hypothalmic-pituitary-ovarian axis to reduce luteinising and follicle-stimulating hormones
Alters cervical mucous
Renders endometrium unfavourable for implantation

Question 5

What is the standard regime for the Combined oral contraceptive?

Answer 5

Daily for 21 days
stop for 7
first 7 inhibit ovulation and remaining 14 maintain anovulation
Follicular activity may resume after 9 pills have been omitted.

Question 6

What’s the standard regime of Combined transdermal patch?

Answer 6

One patch applied for 1 week to suppress ovulation

Question 7

What is the standard regime for the combined vaginal ring?

Answer 7

Ring placed in vagina and left for 21 days

Ring free interval for 7 days

Question 8

What 3 factors should be taken into account when prescribing CHC?

Answer 8

Absorption
Metabolism
Metabolic effects

Question 9

What may affect absorption?

Answer 9

GI conditions

Question 10

What may affect metabolism?

Answer 10

Liver enzyme induction

Drug interaction

Question 11

What do you do if you forget one pill?

Answer 11

Relax, take as soon as remembered

Take rest as normal

Question 12

What do you do if you forget 2 pills in a row?

Answer 12

Take most recent
Take rest at normal time
Use condoms or abstain until 7 pills have been taken consecutively

Question 13

What do you do if you’ve went more than 48 hours without taking a pill?

Answer 13

Days 1-7: Consider EC
Days 8-14: No extra instructions
Days 15-21: Omit free pill interval

Question 14

How long does the patch have high efficacy?

Answer 14

up to 9 days (7 days + 48hrs)

Question 15

How long can the patch free interval be before efficacy is reduced?

Answer 15

9 days (7 days + 48hrs)

Question 16

How long can the ring be left out of the vagina before efficacy is reduced?

Answer 16

48 hours

Question 17

How long can the vaginal ring be worn before efficacy is reduced?

Answer 17

4 weeks

Question 18

What are the added risks of CHC?

Answer 18

Venous thrombosis
Arterial thrombosis
Adverse effects on some cancers

Question 19

What levels do CHC reduce?

Answer 19

Antithrombin III and protein S (Alteration in clotting factor)

Question 20

What can happen with CHC and patients with significant arterial wall disease?

Answer 20

Superimposed arterial thrombosis

Question 21

What is increased with CHC?

Answer 21

Fibrinolytic activity (Redcued in heavy smokers)

Question 22

What is a major side effect of CHC?

Answer 22

venous disease (Venous thromboembolism)

Question 23

What are risk factors for a VTE?

Answer 23

Obesity
Smoking
Age
Known thrombophilia
VTE in first degree relatives
Up to 6 weeks post natal

Question 24

Describe Cypoterone Acetate?

Answer 24

Co-cyprindiol
Acne and hirsutism treatment
Ethinyl-estradiol 35ug/cyproterone acetate 2mg

Question 25

What else can the combined oral contraceptive cause?

Answer 25

Systemic hypertension Cut off is 140/90 Arterial disease

Question 26

What is an aura/ (migraine aura)

Answer 26

Scotoma Altered sensation Smell or taste hemiparesis

Question 27

What examinations are performed before prescribing a contraceptive agent?

Answer 27

BP and BMI Smear test status Risk factors

Question 28

What cancers does the pill help prevent against?

Answer 28

Ovarian and Endometrial

Question 29

What else can the pill help with?

Answer 29

``` Acne Small breasts Hirsutism ovarian cysts and PCOS bleeding premenstrual syndrome ```

Question 30

What are side effects of the pill?

Answer 30

Unscheduled bleeding Mood changes Weight gain

Question 31

What are the side effects of the combined transdermal patch?

Answer 31

Breast pain Nausea Painful periods

Question 32

What are side effects of the vaginal ring?

Answer 32

Less bleeding problems acne irritability mood changes

Question 33

What is the emergency contraception?

Answer 33

``` Levonelle 1500 (progesterone) Ulipristal acetate (anti-progesterone) - hormonal contraception interferes with action of ulipristal acetate ```

Question 34

How long should contraception be avoided for after emergency contraception?

Answer 34

5 days

Question 35

What is the Progesterone Only Pill (POP)?

Answer 35

levonorgestel norethisterone

Question 36

What is the longer lasting POP?

Answer 36

Etonorgestrel

Question 37

What is the mode of action of a POP?

Answer 37

Thickening of cervical muscous | Etonorgestrel suppresses ovulation

Question 38

What are the secondary effects of the POP?

Answer 38

Levongestrel suppresses ovulation Decreased endometrial receptivity to blastocyst Reduction in cilia activity in fallopian tube

Question 39

What are the risks of POP?

Answer 39

Little effect on metabolism

Question 40

What interactions involve the POP?

Answer 40

liver enzyme inducers - cytochrome P40

Question 41

What are suitable alternatives for the POP?

Answer 41

DMPA IUS Cu-IUD

Question 42

How do you take the POP?

Answer 42

Daily at same time no break within 24-27 hours of last dose

Question 43

How do you take the longer lasting POP?

Answer 43

Daily at same time no break within 24-36 hours of last dose

Question 44

What do you do if you miss one POP?

Answer 44

Emergency contraception plus 2 days extra protection

Question 45

Which type of POP is has higher efficacy?

Answer 45

Etonorgestrel