Contraception

What are the 2 types of hormonal contraception?

Combined and progestogen-only

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What is the difference between a monophasic and multiphasic combined oral contraceptive?

Monophasic - fixed amount of estrogen and progestogen throughout
Multiphasic - different amounts of estrogen and progestogen throughout

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Combined oral contraceptives slightly increase ______________ risk.

Cardiovascular

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Why is the combined pill taken for 21 days with a hormone free interval (HFI) of 7 days?

To mimic natural menstruation - allows for a withdrawal bleed every month

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How often should a review, BMI and BP be checked when on CHC?

Annually

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What formulations can combined contraception come in?

Tablet
Patch
Vaginal ring

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What formulations can progestogen only contraception come in?

Tablet
Depot injection
Implant

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What are the 2 intrauterine devices that can be offered?

copper intrauterine device (Cu-IUD)
levonorgestrel intrauterine system (LNG-IUS)

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What are the 3 different barrier methods that can be used?

Male condom
Female condom
Diaphragms and caps

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What needs to be used alongside diaphragms and caps?

Spermicide

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How long after using spermicide will you need to reuse due to it wearing off?

3 hours

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Male sterilisation is called tubular occlusion and female sterilisation is called vasectomy.
True/False?

False - other way about

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Which 4 methods of contraception are long-acting?

The 2 IUDs and the progestogen-only implant and depot injection

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What side effect can occur in some women in their 7 day pill free period due to a drop in oestrogen levels?

Headache

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Up to 12 months supply of the pill can be given on a prescription. Why would this be the case?

To ensure continuation of treatment

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Oral progestogen-only pills include either one of which 3 hormones?

Norethisterone
Levonorgestrel
Desogestrel

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In which 3 ways does combined contraceptive work to prevent pregnancy?

Prevents release of eggs from ovaries (ovulation)
Thickens mucus on cervix wall making it harder for sperm to reach egg
Thinning the endometrium (reduces chance of implantation)

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When is the combined oral contraceptive effective from the 1st pill?

If taken within 5 days of menstrual cycle

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If taking the first pill outwith first 5 days of menstruation, how long until effective contraception is achieved?

After 7 consecutive days of taking the combined pill

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What 4 circumstances can affect effectiveness of contraception with combined pill?

Missing more than 1 active pill in a pack
Longer than 7 days hormone free interval
Drug interactions
Vomiting and diarrhoea

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What should be done as a precaution if any of these apply?

Use barrier method

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Taking oestrogen and progesterone increases the levels of these hormones essentially tricking the body into thinking it is pregnant therefore preventing ovulation.
T/F?

True

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The increase in these hormones causes ________ feedback which decreases levels of ___ and LH.

negative
FSH (follicle stimulating hormone)

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Which is the only method of contraception that can prevent transmission of STIs?

Barrier method (male and female condoms only - diaphragms and caps do not protect from this)

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Combined contraceptives are contraindicated in people who suffer from migraine with aura.
T/F?

True

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Other contraindications for combined contraceptives include current ______ cancer, significant ___ and cardiovascular risk factors and severe _____ disease.

breast
VTE
liver

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Oestrogen/progesterone increases risk of VTE?

Oestrogen

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How is the combined patch used?

Change patch every 7 days for 3 weeks then 1 week patch free

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Which combined patch is the only licensed patch available in the UK?

Evra patch

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How is combined vaginal ring used?

Insert ring for 21 days then 7 day ring-free

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Which combined vaginal ring is the only licensed ring available in the UK?

NuvaRing

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What is the missed pill window for desogestrel, norethisterone, levonorgestrel and drospirenone?

Desogestrel - 12 hrs
Norethisterone - 3 hrs
Levonorgestrel - 3 hrs
Drospirenone - 24 hrs

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All progestogen only pills (POPs) are taken daily with no HFI except drospirenone which has a 7 day interval.
T/F?

False - drospirenone has a 4 day HFI

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POPs are safe post-partum and when ____________.

Breastfeeding

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If a patient has unprotected sex and were late taking their pill but it was within the missed pill window, do they require emergency contraception?

No

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Why is it important to either avoid sex or use extra contraception for 2 days after remembering to take a missed dose of POP?

Not protected against pregnancy - it takes 2 days for the cervical mucus to thicken again

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If a patient has UPSI within these 2 days, would they require emergency contraception?

Yes - they are not protected within this time

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Should a patient take another dose of the POP if they have missed a pill - even if it is on the same day as their next usual dose?

Yes

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Some PILs may advise that the patient should use extra contraception for 7 days after remembering to take a missed dose pill. Why is this?

Because it takes 7 days for the pill to stop ovulation

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For combined oral contraceptive pills (COCPs), how many hours after a missed dose that it is classed as a 'missed pill'?

24 hrs

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If you miss 1 pill in a pack or start taking a new pack 1 day late, you are not protected against pregnancy.
T/F?

False - you still are protected if these apply

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If a patient misses a COCP, should they take the dose as soon as they remember even if it is on the same day as their next usual dose?

Yes

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If a patient has missed 2 days or more or started a new pack 2 or more days late, then their protection against pregnancy may be affected.
T/F?

True

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If this is the case, the patient should use extra contraception/avoid sex for how many days?

The next 7 days - to allow pill to inhibit ovulation again

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The patient should take however many doses was missed as soon as they remember even if it is on the same day as their next usual dose.
T/F?

False - They should take the last missed dose even if it is on the same day as their next usual dose and leave any earlier missed doses

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If 2-7 doses are missed in the 1st week of the pack and the patient has had unprotected sex, would they need emergency contraception?

Yes

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If 2-7 doses are missed in the 2nd week of the pack and the patient has had unprotected sex, would they need emergency contraception?

No

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If 2-7 doses are missed in the 3rd week of the pack and the patient has had unprotected sex, would they need emergency contraception?

No

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If 2-7 doses are missed in the 3rd week of the pack, what should the patient do in terms of their 7-day HFI?

They should skip this and start a new pack of active pills the day after finishing their active pills in the current pack

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If a patient missed 8 or more pills one day after the other, they will not be protected against pregnancy. If they have had UPSI within this time, would they require emergency contraception?

Yes

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Levonorgestrel needs to be taken within 72hrs of UPSI and ulipristal within 120hrs of UPSI to be effective. How do these drugs prevent a pregnancy?

Large dose of hormone delays ovulation and so any sperm in the uterus will become non-viable before fertilisation can occur

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Levonorgestrel and ulipristal have minimal effect after ovulation has already occured.
True/False?

True

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EllaOne effectiveness is reduced when taken alongside progesterone hormones. How long after taking EllaOne does the patient need to wait before starting/restarting regular hormonal contraception?

5 days

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Why does progesterone interfere with ulipristal effectiveness?

Progesterone and ulipristal will both be competing for progesterone receptors.

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Why does progesterone hormones not interfere with the MOA of levonorgestrel?

Levonorgestrel is a progesterone hormone in itself

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If progesterone hormone has been taken within 7 days prior to EHC, which pill should be given and why?

Levonorgestrel as progesterone can interfere with ulipristal MOA

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When should a pregnancy test be taken after EHC to ensure patient is not pregnant?

3 weeks

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However, if the patient bleeds before then it can be assumed they are not pregnant.
T/F?

False - this may not represent a normal period and pregnancy test should still be taken

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Contraception

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