Contraception Flashcards
(57 cards)
What is UKMEC 4 for COCP
BP >160/100
Smoking >15 cigarette and >35
Current vascular disease
History of VTE or known thrombogenic disease
Migraine with aura
AF
Current breast cancer
ALSO (but less common): breastfeeding under 6 weeks postpartum, major surgery with prolonged mobilisation, severe cirrhosis or liver cancer
What is the UKMEC category for BMI >35?
UKMEC 3 (relative contraindication)
This means there are some risks involved, but the benefits may still outweigh them in certain situations.
What type of contraception should patients on teratogens be on?
LARC (Long-Acting Reversible Contraception)
CHC (Combined Hormonal Contraception) is not effective enough in these cases.
Which medications should be avoided when taking CHC?
Enzyme inducers or lamotrigine
These can lower the seizure threshold.
In what condition should contraceptive pills be avoided?
Malabsorptive state
Examples include post-bariatric surgery.
What is the annual risk of developing VTE on CHC?
2/10,000, which increases around 3x on CHC
This risk is still much lower than during pregnancy.
What is the annual risk of death from VTE on CHC?
1-2/100,000
This is much lower compared to other lifestyle risks, e.g., driving a car (80/100,000).
Which generation of formulations appears to have a lower risk for VTE?
2nd generation formulations e.g. levonogestrel
They seem to present a lower risk than 3rd and 4th generation formulations.
What is a small risk associated with higher estrogen doses?
Arterial thrombosis
Higher doses increase the risk of this condition.
What are the two types of regimens for starting combined hormonal contraception?
Traditional (licensed) regimens and tailored or extended regimens
Tailored regimens involve fewer, shorter, or no hormone-free intervals.
What does the traditional regimen for CHC involve?
21 days of pill-taking followed by a 7-day break
This is the standard licensed method.
What is an example of a scheduled extended cycle?
Taking 2-3 packs consecutively followed by a 4-7 day hormone-free interval
This method helps reduce bleeding and side effects.
What is continuous pill-taking?
Taking a pill daily whether bleeding occurs or not
This approach can be used to manage menstrual cycles.
Ehat is an unscheduled extended cycle?
Taking pills continuously for >21 days after which when/if breakthrough bleeding occurs, take a 4-7d break
Before starting CHC we check medical eligibility and counsel regarding side effects efficacy etc. Why two things do we need to measure
BP
BMI
What is the recommended first-line formulation for CHC?
≤30mcg pill with a 1st or 2nd generation progestogen e.g. Microgynon
Consider alternatives based on patient experience, tolerance, or preference.
What is the maximum supply duration for CHC prescriptions?
Up to 12 months, except for the vaginal ring which is only 3 months due to shelf life
This ensures medication efficacy and safety.
When can CHC be started if there is no risk of pregnancy?
Immediately up to day 5 of the natural menstrual cycle
Extra precautions are required after day 5.
What precautions should be taken after starting CHC post day 5 of the menstrual cycle?
Use extra precautions for 7 days
This is essential to prevent unintended pregnancy.
What should be done if swapping from an alternative form of contraception?
Use extra precautions for 7 days if the previous method was not anti-ovulant
Methods include implant, depot, or POP.
What are the starting instructions after oral emergency contraception with Levonorgestrel?
Start CHC immediately, use extra precautions for 7 days, and perform a pregnancy test at 3 weeks
This ensures safety and confirms non-pregnancy.
What should not be done after Ulipristal emergency contraception?
Do NOT start CHC until 5 days after giving ulipristal
Followed by using extra precautions for a further 7 days.
What is the exception for established CHC users regarding emergency contraception?
If they miss 2-7 days of pills/patch/ring in the first week after the hormone-free interval, ulipristal can be given and CHC can be restarted immediately
Extra precautions are still required for 7 days and pregnancy test at 3 weeks
What should be reviewed annually for CHC users?
Compliance, any problems, and reassess eligibility including BP, BMI, and smoking status
This helps ensure ongoing safety and effectiveness of the CHC.
