Term
| after giving birth women require contraception after day?... |
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Definition
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Term
| advice for POP postpartum |
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Definition
women can start POP at anytime postpartum
after 21 days additional contraception needs to be used for 2 days
a small amount of progesterone enters breast milk but it is not harmful to baby |
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Term
| a mother is breastfeeding and is < 6 weeks postpartum. which contraception is absolutely CI? |
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Definition
COCP
it may reduce breast milk production in lactating mothers |
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Term
| postpartum what advise would you give to someone start COC? |
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Definition
can be started from day 21 so long as they are not breastfeeding
after day 21 you need barrier methods for 7 days |
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Term
what is the lactational amenorrhoea method? LAM?
this is valid for 6 months! |
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Definition
| if a women is fully breastfeeding including night feeds, is less than 6 months postpartum and is having no periods then this is 98% effective as contraception |
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Term
35 year old diagnosed with breast cancer. she is using COC. what needs to happen.
she still wants contraception. what wold you recommend? |
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Definition
| recommend the copper IUD because breast cancer is an absolute CI to all hormonal forms of contraception |
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Term
| what guides the decision to start someone on COC? |
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Definition
UK medical eligibility criteria
UKMEC |
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Term
| describe different stages of UKMEC |
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Definition
UKMEC 1- no restriction for contraception
UKMEC 2 - advantages outweigh disadvantages
UKMEC 3 - disadvantages generally outweigh advantages
UKMEC 4 - unacceptable health risk |
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Term
| give some examples of UKMEC4 conditions |
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Definition
> 35 and smoking >15
migraine with aura
hx of thromboembolic disease/mutation
hx of stroke/IHD
breastfeeding <6 weeks postpartum
uncontrolled HTN
current breast cancer
major surgery with prolonged immobilisation |
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Term
| if a person is > 35 and smoking < 15 cigarettes which category UKMEC are they? |
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Definition
they are MEC3
UKMEC4 is > 35 and >15 cigarettes |
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Term
| BMI >35 falls into which UKMEC category? |
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Definition
| UKMEC3 - disadvantages generally outweigh benefits |
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Term
| which injection contraceptive is associated with delayed return to fertility? |
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Definition
Depo-Provera
it can take several months for fertility to return back to normal |
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Term
| features of Depo Provera? |
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Definition
contains 150mg of progesterone
given IM injection every 12 weeks
can be given up to 14 weeks after last injection without needing extra contraception
MOA: inhibits ovulation
counselling: cannot be reversed once given and fertility can take up to 12 months to return back to baseline
SE:irregular bleeding, weight gain, risk of osteoporosis, cannot be reversed once given, delay in return to fertility |
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Term
| there is another injection called Noristerat that is licensed in the UK. how often is this given? |
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Definition
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Term
| which method of contraception has a proven association with weight gain? |
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Definition
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Term
what advice would you give to someone on POP who has missed her pill more than 3 hours ago
what different advise is there for cerazette? |
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Definition
if it has been < 3 hours and you have missed 1 pill no action is needed. just take the pill
if it has been > 3 hours and you have missed one pill then take the missed pill. take the next pill at the usually time. this may mean taking 2 pills in one day. used barrier methods for 48 hours
cerazette has a long missed pill gap of 12 hours. so if it is > 12 hours then you should follow the advice stated above |
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Term
| COC work by inhibiting ovulation whereas POP work mainly by thickening cervical mucus. however there is one POP that works primarily by inhibiting ovulation. which one is this? |
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Definition
desogestrel
MOA: inhibits ovulation
also thickens cervical mucus |
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Term
POP mainly work by thickening cervical mucus
however the injectable progesterone, implantable progesterone and desogestrel POP work in another way what is it? |
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Definition
they inhibit ovulation
and also thicken cervical mucus |
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Term
| how do desogestrel, IM depo and implant differ from the rest of the POP? |
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Definition
POP mainly work to thicken cervical mucus
however desogestrel, IM injection and implant primarily inhibit ovulation whilst also thickening cervical mucus |
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Term
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Definition
toxic to sperm and ova
also inhibits implantation |
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Term
| MOA of both types of contraceptive pill? |
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Definition
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Term
| MODE of action for IUS eg mirena? |
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Definition
| prevents endometrial proliferation (thus reduces bleeding) and also thickens cervical mucus |
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Term
| I am an IUS called mirena what is my mode of action? |
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Definition
I prevent endometrial proliferation. this is why I can reduce bleeding
I also thicken cervical mucus |
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Term
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Definition
> 35 age and < 15 cigarettes
BMI > 35
controlled HTN
migraine without aura
1st degree relative with Hx of DVT/PE < 45 years
Brca 1/2 gene
immobility eg in wheelchair |
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Term
| prescribing the COCP to someone who has a family hx of breast cancer but with no brca1 mutation falls into which UKMEC ? |
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Definition
MEC1
you can prescribe it for them |
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Term
| what advice should be given to all women who are on enzyme inducing drugs? |
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Definition
to use a reliable method that isn't affected by the drug these include:
Copper coi
IM depo
mirena
copper first choice as it has no hormones.
if lady is obese ward away from depot as it causes weight gain |
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Term
| what could you do in a person on enzyme inducing drugs who wishes to take COCP? |
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Definition
advise that effectiveness is decreased and there is an increased chance of pregnancy.
you can increase oestrogen to 50mcg with no pill free interval or reduce gap from 7 days to 4 days. this reduces the chance of ovulation |
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Term
| nexplanon implant features |
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Definition
valid for 3 years
effective immediately if implanted upto day 5 of period
if inserted after day 5 use condoms for first 7 days
no association with weight gain
se: irregular bleeding for 3months or more |
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Term
| what is the window period for missing desogestrel? |
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Definition
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