What is the COCP protective against?
- ovarian and endometrial cancer
- colorectal cancer
- PID
- reduces ovarian cysts, benign breast disease, acne vulgaris
What does the COCP increase the risk of?
- no protection against STI
- VTE
- breast and cervical cancer
- stroke and ischaemic heart disease
- temporary side effects: headache, nausea, breast tenderness
UKMEC 3 conditions contraindicating COCP:
disadvantages outweigh advantages
->35yo and smoking less than 15 cigarettes/day
-BMI >35kg/m2
-FHx of thromboembolic disease in first degree relatives <45 years
-controlled HTN
-immobility e.g. wheel chair
-known gene mutations associated with breast cancer
-current gallbladder disease
(diabetes)
UKMEC 4 conditions contraindicating COCP: (unacceptable health risk)
-more than 35yo and smoking more than 15 cigarettes/day
-migraine with aura
-history of thromboembolic disease or thrombogenic mutation
-history stroke or ischaemic heart disease
-breast feeding <6weeks post-partum
-uncontrolled HTN
-current breast cancer
-major surgery with prolonged immobilisation
(diabetes)
COCP MOA:
inhibits ovulation
POP MOA:
thickens cervical mucus
Injectable contraceptive (medroxyprogesterone acetate) MOA:
- primary: inhibits ovulation
- also: thickens cervical mucus
Implantable contraceptive (etonogestrel) MOA:
- primary: inhibits ovulation
- also: thickens cervical mucus
Intrauterine contraceptive device MOA:
decreases sperm motility and survival
Intrauterine system (levonorgestrel) MOA:
- primary: prevents endometrial proliferation
- also: thickens cervical mucus
Ullipristal MOA and use as emergency contraception:
- selective progesterone receptor modulator (EllaOne)
- emergency contraception
- inhibits ovulation
- 30mg asap no later than 120 hours
- not with levonorgestrel
- can be used more than once in same cycle
- care with asthma
- breastfeeding delayed one week after
Use of levonorgestrel as emergency contraception:
- emergency contraception
- efficacy decreases with time
- within 72 hours of unprotected SI
- single dose 1.5mg (progesterone)
- double dose if BMI>26
- 84% effective
- repeat dose if vomiting within 3 hours
- can be used more than once in menstrual cycle
Use of intrauterine device as emergency contraception:
- can be inserted within 5 days of UPSI
- IUD may be fitted up to 5 days after likely ovulation date
- inhibits fertilisation or implantation
- 99% effective
- may be left in situ
What is the most effective form of contraception?
implantable contraceptives
How long can implantable contraceptives last?
3 years
ADR implantable contraceptives:
- irregular heavy bleeding
- can co-prescribed COCP
- progesterogen effects: headache, nausea, breast pain
Fertility with injectable contraceptives:
can have delay in return to fertility up to 12 months
ADR injectable contraceptives:
- irregular bleeding
- weight gain
- may increase risk of osteoporosis
- not quickly reversible and fertility
Contraindications injectable contraceptives:
breast cancer
Types of intrauterine contraceptive devices:
IUD - copper intrauterine devices
IUS - mirena, levonorgestrel releasing intrauterine systems (also used to manage menorrhagia)
IUD MOA:
- prevents fertilisation by decreasing sperm motility and survival
- works immediately
- effective for 5-10 years
IUS MOA:
- works after 7 days
- most common effective for 5 years
IUS ARD:
- longer, heavier more painful periods
- uterine perforation 2 in 1000
- expulsion 1 in 20 in first 3 months
- small increased risk infection
POP ADR:
irregular vaginal bleeding
