Contraception ! Flashcards by Bethany Awdas

Explain the 4 levels of the UKMEC and what they are used for

Guiding the decision to start someone on the combined oral contraceptive pill

UKMEC 1 = No restriction in use
UKMEC 2 = Benefits generally outweigh risks
UKMEC 3 = Risks generally outweight benefits
UKMEC = Unacceptable risk (CI)

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What is a UKMEC 3 for the COCP?

More than 35 years old and smoking less than 15 cigarettes/day
BMI > 35 kg/m^2*
Family history of thromboembolic disease in first degree relatives < 45 years
Controlled hypertension
Immobility e.g. wheel chair use
Carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
Current gallbladder disease

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UKMEC 4 for the combined contraceptive pill

Uncontrolled hypertension (particularly ≥160 / ≥100)
Migraine with aura
History of VTE
History of stroke or IHD
Aged over 35 smoking more than 15 cigarettes per day
Current breast cancer
Major surgery with prolonged immobilisation
Systemic lupus erythematosus and antiphospholipid syndrome
Breast feeding < 6 wks post-partum

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Mechanismof action of the combined oral contraceptive pill (COCP)

Inhibits ovulation

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What advice is given if one COCP is missed (less than 72 hrs since last pill)

-Take missed pill as soon as possible (even if 2 on same day)
-No extra protection required provided other pills before where taken correctly

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Advice if 2 missed pills when on the COCP

-Take most recent missed pill
-Additional contraception needed until pill has been taken for 7 days straight
-If this was missed on day 1-7 of the packet and they have had unprotected sex they will need emergency contraception

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What are the 3 common regimes for taking the COCP?

21 days on and 7 days off
63 days on (three packs) and 7 days off (“tricycling“)
Continuous use without a pill-free period

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Give three risks of the COCP

Small risk of VTE
Small increased risk of breast and cervical cancer (returns to normal 10 yrs after stopping).
Small increased risk of MI and stroke

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If started within first 5 days of the cycle , when does the COCP offer protection ?

Straight away
No additional contraception needed

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If the COCP is started after day 5 of the menstrual cycle, how long is barrier contraception required for ?

7 days

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Advantages of the COCP

Reduced risk of ovarian and endometrial cancer
Reduced risk of colorectal cancer
Often makes periods regular, lighter and less painful

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Explain the cycle for the combined contraceptive patch

Worn for 4 weeks
First 3 weeks : patch worn every day and changed each week
No patch worn in week 4 = withdrawal bleed

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Explain precautions needed if there is a delay to changing the combined contraceptive patch in week 1 or 2

<48 hr delay : change immediately, no further precautions
Delay >48 hrs : chnage and use condoms for 7 days.

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Explain precautions needed if there is a delay to patch removal at end of week three

The patch should be removed as soon as possible and the new patch applied on the usual cycle start day for the next cycle, even if withdrawal bleeding is occurring.

-No additional contraception is needed.

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What is required if patch application is delayed at the end of a patch-free week

Additional barrier contraception should be used for 7 days following any delay at the start of a new patch cycle

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How doe traditional POPs work ?

Thickening the cervical mucus

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How does desogestrel work (POP) ?

Inhibiting ovulation
Thickening the cervical mucus

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If started on day 1-5 of the menstrual cycle, when does the POP provide protection ?

Immediately

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Potential SE of POP

Irregular vaginal bleeding

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If started after day 5 of the cycle, how long is barrier contraception required when on the POP

2 days

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Explain the precautions regarding missed pills with the traditional POP

If < 3 hours late: continue as normal
If > 3 hours : take the missed pill as soon as possible, condoms, should be used until pill taking has been re-established for 48 hours

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Explain the precautions regarding missed pills with desogestrel (Cerazette)

<12 hrs : take pill & no extra precautions
> 12 hrs : use condoms until pill taking has been re established for 48 hrs

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Mechanism of action of nexplanon

Primarily inhibits ovulation but ALSO thickens cervical mucus
Involves the hormone etonogestrel (progestogen)

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How long does nexplanon
last

3 yrs

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Adverse effects of nexplanon

- Irregular/heavy bleeding : sometimes managed with co-prescription of COCP

UKMEC 4 for nexplanon

current breast cancer

If not inserted on day 1-5 of cycle, how long is additional contraception needed for with nexplanon

7 days

Contents and mechanism of action of injectable contraceptives

- Inhibits ovulation but ALSO thickens cervical mucus and causes endometrial thinning - Contains medroxyprogesterone acetate 150mg

How often are injectable contraceptives given

Every 12 wks

How long can fertility be delayed once stopped injectable contraceptives

12 mnths

4 adverse effects of injectable contraceptives

- Irregular bleeding - Weight gain - Potentially increased risk of osteoporosis - Not quickly reversible and fertility may return after a varying time

Mechanism of action of IUD

- Prevention of fertilisation by causing decreased sperm motility and survival (possibly an effect of copper ions)

What is in the IUS and it's mechanism of action

levonorgestrel prevents endometrial proliferation and causes cervical mucous thickening

When do IUD being providing protection and how long dp they last

Immediately 5 years

When does IUS begin providing protection and how long do they last

7 days 5 years

SE of IUD

Heavier, longer and more painful periods

Se of IUS

Initial frequent uterine bleeding and spotting.

When can the IUD / IUS be inserted following childbirth

within 48 hours of childbirth or after 4 weeks.

When can the POP be started postpartum

Anytime After day 21 postpartum, condoms should be used for 2 days

Explain when the COCP is UKMEC 2 / 4 following childbirth

- UKMEC 4 if breastfeeding <6wks - UKMEC 2 if breastfeeding 6wks - 6mnths

How long can lactional amenorrhoea act as contraception

6 mnths but must be amenorrhoeic and soley breast feeding

What form of contraception is UKMEC 3 when on lamotrigine

COCP

What form of contraception is UKMEC 3 when taking phenytoin,carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine

COCP and POP

When can the COCP be taken up till and what should be done after this ages

- 50 yrs - If >=50 switch to non hormonal or progestogen-only method

When can the implant, POP and IUS be taken up till but what should be checked after this age

- Continued up to 50 - Can continue after this point BUT If amenorrhoeic check FSH and stop after 1 year if FSH >= 30u/l or stop at 55 years - If not ammenorrhoeic, investigate why

what should be done once >=50 yrs if using depo-provera contraception

Switch to a non-hormonal method and stop after 2 years of amenorrhoea

what is the dose of levonorgestrel (levonelle) and how long after unprotected sex can it be taken

- 1.5mg - 72hrs

when would the dose of levonorgestrel need to be doubled

- BMI > 26 or >70kg

When would the dose of levonorgestel need to be repeated

Vomiting within 3 hrs

when can hormonal contraception be started following levonorgestrel

Immediately

what dose of Ulipristal (Ellaone) is used for emergency contraception and how long after unprotected sex can it be taken

- 30mg - 120 hrs

How long after takin Ulipristal should you wait to recommence hormonal contraception

5 days

When should Ulipristal be avoided

Asthma

How long should breastfeeding be delayed if taking Ulipristal

1 wk

When can IUD be used for emergency contraception

Within 5 days of unprotected sex OR up to 5 days after likely ovulation date

What contraception is avoided in cervical and endometrial cancer

Mirena coil

what contraception is avoided in Wilson's disease

Copper coil

How long before fertility returns afer giving birth ?

21 days after birth

How long is contraception required in menopausal women ?

- For 2 yrs following last period in women <50 - For 1 yr following last period in women >50

When should the progestogen injection be stopped ?

- Before 50 yrs, due to risk of osteoporosis

When switching from a tradition progesterone only pill to a COCP, how many days of extra protection is required

7 days

When switching from desogestrel to a COCP, how many days of additional contraception is required ?

NON

When should the COCP be stopped prior to a major operation

4 weeks

When switching from a COCP to a POP, when isn no additional contraception require ?

IF : - > Have taken the COCP consistently for more than 7 days (they are in week 2 or 3 of the pill pack) -> Are on days 1-2 of the hormone-free period following a full pack of the COCP

What are the 2 SE unique to depot injections

- Weight gain - Osteoporosis

What advice is given to women before removal of the coil ?

abstain from sex or use condoms for 7 days, or there is a risk of pregnancy

Upon instertion, when does the copper coil become effective

Immediately (licensed for 5-10 yrs)

What does sterilisation in a female involve ?

- Occlusion of the fallopian tubes with 'Filshie clips' or tied and cut or removed all together

What does male sterilisation involve ?

- Cutting the vas deferens, preventing sperm travelling from the testes - Alternative contraception reuired for 2 mnths before sperm testing 12 wks post procedure

Advice regarding 2 missed pills on week 3

finish the pills in the current pack and start new pack immediately, omitting pill-free interval

what is the most effective method of emergency contraception that should be offered o all women as long as there are no CI ?

IUD

What contraception is not recommended in pts assigned female at borth and on testosteron therapy

COCP

what are acceptable options for contraception in transgender pts assigned female at birth

- IUD (however may exacerbate bleeding) - POP - Injections

Where is nexplanon inserted ?

Subdermal Non-dominant arm

Explain when the different methods of contraception become effective

- Instant: IUD - 2 days: POP - 7 days: COC, injection, implant, IUS

If wanting to start oral contraception within 21 days of giving birth BUT purely bottle feeding. Would you give the COCP or the POP

POP The COCP should not be used in the first 21 days due to the increased venous thromboembolism risk post-partum

what antibiotic can reduce the effectiveness of nexplanon ?

Rifampicin

Following a surgical abortion, when can an intrauterine contraceptive be inserted?

Immediately

Contraception ! Flashcards

(80 cards)