Contraception Flashcards by Sumaya L

What does the combined contraceptive pill contain?

synthetic versions of the female hormones oestrogen and progestogen.

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How does the combined contraceptive pill work?

suppress the release of gonadotrophins (LH and FSH) from the pituitary gland, preventing the maturation and release of an egg from the ovaries.

Progesterone thickens the cervical mucus

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How to adminster contraceptive pill?

Taken orally once daily, ideally at the same time each day

there is no medical benefit from having a withdrawal bleed. Options include never having a pill-free interval or ‘tricycling’ - taking three 21 day packs back-to-back before having a 4 or 7 day break. Can be taken for 21 days with a 4 or 7 day hormone-free interval (HFI),

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What are the indications of the COCP?

Contraception
Dysmenorrhoea
Acne and hirsuitism

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What guides eligibility for COCP?

UK Medical Eligibility Criteria (UKMEC). This scale categorises the potential cautions and contraindications according to a four point scale

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What is UKMEF1?

no restriction for the use of the contraceptive method

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What is UKMEC 2?

advantages generally outweigh the disadvantages

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What is UKMEC3?

Disadvantages outweigh advantages

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What is UKMEC4?

Unacceptable health risk

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When is additional contraception required when taking combined pill?

Starting COCOP other than first 5 days of cycle

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Can unprotected intercourse be safe when in pill fre period?

intercourse during the pill-free period is only safe if the next pack is started on time

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When is efficacy of COC pill reduced?

*vomiting within 2 hours of taking COC pill
*medication that induce diarrhoea or vomiting may reduce effectiveness of oral contraception (for example orlistat)
*if taking liver enzyme-inducing drugs (CRAPGPS)

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When are extra precautions advised for COCOP use?

for the duration of antibiotic treatment and for 7 days afterwards, especially with enzyme induced like rifampicin

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What are the UKMEC3 conditions for contraception?

*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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What are the UKMEC4 conditions for COCP use?

*more than 35 years old and smoking more than 15 cigarettes/day
*migraine with aura
*history of thromboembolic disease or *thrombogenic mutation
*history of stroke or ischaemic heart disease
*breast feeding < 6 weeks post-partum
*uncontrolled hypertension
*current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)

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How is diabetes considered in UKMEC?

Over 20 years diagnosis is classified as UKMEC 3 or 4 depending on severity

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What are the benefits of COCP?

Reduces risk of ovarian and endometrial cancer, including decades after cessation
Reduces colorectal cancer risk
Protect against pelvic inflammatory disease
Reduces ovarian cyst, acne and benign breast disease

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What are the disadvantages of COCP?

increased risk of venous thromboembolic disease
increased risk of breast and cervical cancer
increased risk of stroke and ischaemic heart disease (especially in smokers)
User dependent and no protection from STI’s

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What are the side effects of COCP?

headache, nausea, breast tenderness may be seen

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What is the guidance on smoking and COCOP use as UKMEC3?

Smoker over age of 35 who smokes <15 cigarettes a day, or anyone over age of 35 who stopped smoking <1 year ago

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What is the UKMEC guidance for migraine?

History of migraine with aura 5 years ago or more at any age is UKMEC3

Current migraine is UKMEC4

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What is the BP for UKMEC3?

Well controlled hypertension, and hypertension with SBP >140-159 mmHg or DBP <90-99 mmHg

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What is in UKMEC2?

Migraine no aura
Cervical cancer
Lomg QT
Superficial venous thrombosis
Undiagnosed breast symptoms like mass
Insulin dependent diabetes
Inflamaogory conditions like IBD, sickle cell, SLE and rheumatoid and IIH

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What obesity level is UKMEC 2?

Obesity (BMI >30-34 kg/m2)

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What smoking is UKMEC2?

Smokers under the age of 35, and people aged over 35 who stopped smoking over 1 year ago

Which cancers are UKMEC3?

Carriers of known gene mutations associated with breast cancer Past breast cancer

Which postpartum factors are UKMEC3?

Carriers of known gene mutations associated with breast cancer Past breast cancer

What UKMEC is diabetes with vascular complication?

UKMEC3

What VTE history is UKMEC2?

Family history of VTE in first-degree relative aged >45 years

What is the BP for UKMEC2?

History of raised blood pressure in pregnancy

What is postpartum factors for UKMEC2?

Breast feeding between 6 weeks-6 months postpartum Not breastfeeding and between 3-6 weeks postpartum without other risk factors for VTE

What to do for 1 missed COCP pill?

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

What to do for 2 missed COCP pill?

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.

What to do if COCP is missed in week 1 of cycle?

Day 1-7 emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1

What to do if COCP is missed in week 2 of cycle?

Days 8-14 after seven consecutive days of taking the COC there is no need for emergency contraception*

What to do if COCP is missed in week 3 of cycle?

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

What obesity level is UKMEC3?

BMI >= 35 kg/m²

Which patients can never have oral concrtraceptipn?

Patients who have had a gastric sleeve/bypass/duodenal switch cannot have oral contraception ever again due to lack of efficacy, including emergency contraception

What is the age bracket for UKMEC2 in COCP?

Age over 40

What is the benefit for COCP use in older woemn?

COCP use in the perimenopausal period may help to maintain bone mineral density COCP use may help reduce menopausal symptoms

What is reccomended for managing

What is reccomended for COCP in women over 40?

a pill containing < 30 µg ethinylestradiol

How long can COCP be continued?

Up to59 years old before switching to non-hormonal or progestogen-only method

How long to avoid COCP after birth?

Can only take COCP from 21 days postpartum if not breastfeeding, but additional contraception should be used for the first 7 days

What is the advice for COCP use when breastfeeding!

the combined oral contraceptive should be offered with caution due to the reduced volume of breast milk production when taking AFTER 6 weeks but this is UKMEC2

What to reccomended for contraception in women’s ith current breast cancer!

Completely avoid hormonal methods of contraception due to stimulation of hormone sensitive cancer cells

When is emergency contraception indicated for COCP?

unprotected sex during the pill-free interval or 2 pills missed in week 1

What to do if two pills are missed between days 8-14 of cycle?

no emergency contraception is required, as long as the previous 7 days of COCP have been taken correctly, Barrier contraception or sex abstaining is advised as there is risk of pregnancy when not taking COCP for seven consecutive days

What to do if 2 pills of COCP are missed in weeek3?

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

What to do if 7 consecutive days of COCP has been missed!

Treating as new start contraception, with today being day 1 of the pill packet and using condoms for the next 7 days

When is emergency contraception required for COCP pill use!

if the pills are missed in week 1 and she has had unprotected sex in the pill-free interval or week 1.

Which contraceptive is best for women with a history of breast or gynaecomastia cancers?

Hormone free contraceptive like IUD

Which contraceptive is safe to take at any point while breastfeeding immediately?

Progesterone only pill

When can IUD/IUS be used after birth.

48 hours of childbirth or after 4 weeks

What does unopposed oestrogen increase the risk for?

Endometrial cancer

What contraceptive is contraindicated in pelvic inflammatory disease?

IUD or IUS

What is a common side effect of POP?

Irregular bleeding

When is vaginal bleeding with POP a concern

further investigation is needed if this bleeding is *present longer than the first 3-months, *pregnancy and sexually transmitted infections are not excluded *Late smear *no symptoms suggesting another underlying disease

Which method of contraception that is most associated with weight gain?

Injectable Depo provers

Which contraception works only by thickening cervical mucus?

Progestogen-only pill excluding desogestrel

Which POP is the only one to inhibt ovulation?

Desogestrel

What is the primary contraceptive action of the IUS?

Prevents endometrial proliferation

What describe the efficacy of a method of contraception?

Pearl index which is the number of pregnancies that would be seen if one hundred women were to use the contraceptive method in question for one year

How long does mirena coil last for contraception?

8 years

How long do COCP take to be effective?

7 days

How long does the levonorgestrel intrauterine device take to work?

7 days

What part of COCP increases risk of endometrial cancer?

Oestrogen

Which cancers are at greater risk with COCP?

Breast and cervical, that have screening

What contraceptive to avoid with pelvic inflammatory disease?

IUD or IUS due to risk of complications, such as further infections or discomfort with insertion

What is more common in women under 30: pelvic inflammatory disease or endometriosis?

Endometriosis

What causes A fixed, retroverted uterus with pelvic pain, dysmenorrhoea, dyspareunia and subfertility?

Endometriosis

How to manage COCP before surgery?

Stop 4 weeks prior and switch to porogestogen only pill

Which epilepticus drug had different UKMEC guidance?

Lamotrigine

Which condition is an absolute UKMEC4 for COCP?

Any history of ischaemic heart disease Cirrhosis Nephropathy/retinopathy/neuropathy Raynaud's disease with lupus anticoagulant

What UKMEC is Smoker (10/day) over the age of 35?

UKMEC3 UKMEC4 is 15 cigs or more

What BP category is for UKMEC COCP?

Systolic 160mmHg or diastolic 95mmHg is UKMEC4

if she missed 2 or more pills in the third week

What does unopposed oestrogen increase the risk for.

Endometrial cancer due to the stimulation of the uterine lining

What is the contraceptive of choice for gastric sleeve/bypass/duodenal switch?

Non oral contraceptive like injectable and implant progesterone

When can intrauterine contraception be inserted after abortion?

Immediately after evacuation of the uterine cavity

What contraceptive is contraindicated in testosterone therapy.

combined oral contraceptive pill is contraindicated as it contains oestrogen - this can antagonise the effect of the testosterone therapy Vaginal ring containing oestrogen

Which contraceptive is best for patients on testosterone therapy?

Progesterone based contraceptives

Which contraceptive is more effective for heavy menstrual bleeding with fibroids?

IUS which is first line

What UKMEC is immobility from wheelchair use?

UKMEC3

What UKMEC is family history of thromboembolic disease in first degree relatives under < 45 years?

UKMEC3

What UKMEC is gallbladder disease?

UKMEC3

What UKMEC means contraception cant be prescribed.

UKMEC3

What does tamoxifen increase the risk for?

Endometrial cancer; treats breast cancer

What UKMEC is migraine with aura?

progestogen-based methods of contraception and the levonorgestrel-releasing intrauterine device

What contraceptive is best for young people other than pill.

Progesterone only implant

What type of stroke is associated with COCP?

Ischaemic stroke

What to do if missed two or more of the last seven pills in her packet in week 3?

Only retake one and omit pill free break

Which contraception to offer that is non hormonal and does not require patient to remember!

Copper coil

What is the contraceptive advice if using tretinoin?

Must use either One user-independent form such as an intrauterine device or implant user-independent form such as an intrauterine device or implant) OR two complementary user-dependent forms like COCP AND condoms

What should be recorded and documented prior to initiating combined hormonal contraception in all women?

BMI Women with a BMI >35 kg/m2 generally should not use combined hormonal contraception.

How to manage COCP use in women with a family history of breast cancer?

The use of combined hormonal contraception is acceptable, only contraindicated if BRCA mutation as breast cancer is very common and most women have a history of familial breast cancer

When is emergency contraception indicated for missed pill?

Two missed pills and it has been over 72 hours since the last pill was taken.

Contraception Flashcards

(98 cards)