afsha Pre- Reg > contraception, hormonal > Flashcards

contraception, hormonal Flashcards

(55 cards)

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1
Q

2 types of hormonal contraception

A
  • combined hormonal contraception (oestrogen + progestogen)
  • progestogen only
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2
Q

combined hormonal contraception contains

A
  • oestrogen
  • progestogen
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3
Q

when is hormonal contraception used in adolescents

A

after menarche

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4
Q

when prescribing contraceptives to <16s, it is good practice follow…

A

fraser guidelines

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5
Q

contraception in pt taking teratogenic potential medicines

A
  • females of CB potential need to use highly effective contraception if they/their male partner is taking teratogenic drugs
  • use during treatment and for recommended duration after discontinuation to avoid unintended pregnancy
  • pregnancy tests before to exclude pregnancy, repeat testing may be required
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6
Q

highly effective contraception examples

A
  • male and female sterilisation
  • LARC: Cu-IUD, LNG-IUS, IMP (progestogen-only implant)
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7
Q

What is LARC and how often does it require admin

A

long acting reversible contraceptive: requires administration less than once per cycle or month

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8
Q

Important point to consider with IMP (P-only implant)

A

IMP = progestogen only implant
do not take any interacting drugs that could reduce contraceptive effectiveness

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9
Q

failure rate if used perfectly for CHCs

A

<1%

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10
Q

3 factors that can contribute to CHC contraceptive failure

A
  • weight
  • malabsorption (COC only)
  • drug interactions
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11
Q

true or false - Rx of up to 12 months supply for CHC initiation or continuation may be appropriate to avoid unwanted discontinuation and increased risk of pregnancy

A

true

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12
Q

It is recommended that CHC is not continued after …. years of age as there are safer alternatives

A

50

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13
Q

Which 3 forms are CHC available as

A
  • tabs
  • patches
  • vaginal rings
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14
Q

health benefits associated with CHC use

A
  • reduced risk ovarian, endometrial and colorectal cancer
  • predictable bleeding patterns
  • reduced dysmenorrhea and menorrhagia
  • management of symptoms of PCOS, endometriosis, PMS
  • improvement of acne
  • reduced menopausal symptoms
  • maintaining BMD in perimenopausal females <50
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15
Q

Monophonic vs multiphase COCs

A

mono = fixed amount of oestrogen and progestogen in each tablet
multi = varying amounts of the two hormone

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16
Q

most common oestrogen component in COCs

A

ethinylestradiol

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17
Q

ethinylestradiol content of COCs ranges from

A

20-40mcg

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18
Q

Monophonic prep containing …….. ethinylestradiol in combination with …….. (as the progestogen), (to minimise CV risk) is generally used as 1st line

A
  • 30mcg or less ethinylestradiol
  • levonorgestrel or noresthisterone as the progestogen
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19
Q

forms of COC to consider in women who weigh 90kg or more

A

Consider non topical options (vaginal ring, COCs) or use additional precautions with patches

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20
Q

two types of regimen with CHC

A
  • traditional 21 day CHC regimen with monthly withdrawal bleed during 7 day hormone free interval (HFI)
  • tailored CHC regimen (unlicensed)
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21
Q

what are the 4 different tailored CHC regimens that can be used (unlicensed)

A
  • shorted HFI: 21 days continuous use, then 4 days HFI
  • extended use (tricyling): 9 weeks continuous, then 4 or 7 days HFI
  • flexible extended: 21 days or more continuous, then 4 day HFI when breakthrough bleeding occurs
  • continuous: no HFI
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22
Q

are withdrawal bleeds the same as physiological menstruation

A

no

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23
Q

which regimen mimics the natural menstrual cycle

Study These Flashcards
A

traditional 21 days continuous, 7 days HFI

24
Q

if it more efficacious or safer to use traditional 21 day regimen over extended or continuous regimens

Study These Flashcards
A

no difference in efficacy or safety

25
disadvantages of traditional regimen
- heavy or painful withdrawal bleeds - headaches - mood changes - increased risk incorrect use with subsequent unplanned pregnancy
26
do withdrawal bleeds reassure pregnancy status
No, withdrawal bleeds during traditional CHC use has been reported in pregnant females!
27
what needs to be checked annually on CHC
BP and BMI
28
Surgery - when to stop CHC
- at least 4 weeks before major elective surgery, any surgery to legs or pelvis, any surgery that involved prolonged immobilisation of lower limbs
29
What to do if discontinuation of CHC is not possible and surgery is needed
consider thromboprophylaxis
30
When can CHC be restarted after surgery
2 weeks after full remobilisation
31
what are the 4 forms that progestogen only contraceptive is available in
- oral - injectable - subdermal - intrauterine
32
Failure rate of prosterogen only contraceptives if used perfectly
<1%
33
progestognenic effects leading to contraceptive action
○ Changes to cervical mucus affecting sperm penetration ○ Endometrial changes affecting implantation ○ Effects on tubal motility ○ Ovulation suppression
34
oral progestogen only contraceptives contain...
- levonorgestrel - norethisterone - desogestrel
35
factors that may contribute to contraceptive failure (oral progestogen contraceptives)
- incorrect use - vomiting - severe diarrhoea - drug interactions
36
Comparing progestogen only contraceptives
Desogestrel suppresses ovulation more consistently and may improve symptoms of dysmenorrhoea, but there is insufficient evidence to compare contraceptive effectiveness of oral POCs with each other
37
what are the parenteral long acting progestogens
- injections: medroxyprogesterone acetate (MPA), norethisterone enantate - implant: etonogestrel
38
how do the long acting reversible parenteral POCs work
primarily by suppressing ovulation along with other progestognenic effects
39
benefit of parenteral POCs
May benefit those with menstrual problems e.g. heavy bleeding or dysmenorrhoea as they often lead to reduced bleeding or amenorrhoea
40
Failure rate for injectable POC during the first year with perfect use vs failure rate with typical use
~0.2% ~6% (typical failure rates are higher compared to other LA methods, maybe due to relative freq of repeat injections?)
41
how often is depot (SC) MPA administered
every 13 weeks
42
MPA and BMD
- associated with small loss of BMD - largely recovers after discontinuation - however due to concerns and uncertainties around bone loss, there is some advice
43
MPA - advice due to concerns and uncertainties around bone loss
- associated with small loss of BMD (largely recovers after discontinuation) - females <18 may use depot MPA after all options have been discussed and are considered unsuitable or unacceptable - review every 2 years and continuation benefits and risks discussed - females 50 and over should switch to another contraceptive - females with significant RF for osteoporosis should consider other forms of contraceptive
44
advice about fertility and conception after discontinuation of MPA
- can be a delayed return of fertility of up to 1 year after discontinuation of depot MPA - pt who discontinue and do not wish to conceive should be advised to start alternative contraceptive method before or at the time of their next scheduled injection
45
noresthisterone enanate
- Less commonly used in UK - Used for short term contraception (8 weeks) for females whose partners undergo vasectomy until vasectomy is effective, and after rubella immunisation
46
name the implant
Etonogestrel implant inserted sub dermally
47
how long does the etonogestrel implant provide effective contraception for
up to 3 years
48
contraceptive failure for both perfect and typical use of the etonogestrel implant
~0.05% in first yr of use
49
when to advice pt to see their HCP regarding their implant
if it cannot be felt, or problematic bleeding occurs
50
intrauterine progestogen only systems (IUS) - how long
- IUS containing levonorgestrel are LARD options that have licensed duration of use that ranges from 3-10 years depending on the system used
51
intrauterine progestogen only systems (IUS) - contraceptive action
- progestognenic effects - foreign body effect may also be a contributing factor
52
ovulation suppression in females who use IUS
- not suppressed in majority of females (75%+)
53
IUS releasing 20mcg/24h of levonorgestrel may also have the following health benefits
- improving pain associated with dysmenorrhoea, endometriosis, adenomyosis
54
Seek medical advice if pt using IUS develop symptoms of
- pelvic infection - pain - abnormal bleeding - non palpable threads - can feel stem of IUS
55
which contraceptive forms are suitable in pt undergoing surgery
- progestogen only pills - injections - implants - IUS
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