Flashcards in Contraceptives Deck (47)
What is meant by the lactational amenorrhoea method (LAM) of contraception? How does it work?
- breastfeeding reduces the possibility of pregnancy by temporarily suppressing fertility
- infant sucking inhibits ovulation by disrupting the release of GnRH, FSH, LH and oestrogen
How effective is LAM in preventing pregnancy?
- less than 2% chance of pregnancy in first 6 months if:
- fully breastfeeding (no supplementary feeds or solids)
- less than 6 months post birth
What are other names for the progesterone only pill?
- the mini pill
- levonorgestrel (Microlut)
- norethisterone (Locilan 28, Micronor, Noriday 28)
What are the benefits of the progesterone only pill?
- suitable for breastfeeding women
- may be commenced any time after birth
What are the disadvantages of the progesterone only pill?
- should be taken at the same time each day (within 3 hours)
What may interfere with the efficacy of the progesterone only pill?
- if taken late: an alternative method should be used if sex within 3 pills/48 hours
- vomiting within 2 hours of taking pill
- severe diarrhoea
- some medications - particularly antibiotics, anti-retroviral and anti-epileptic
Does the progesterone only pill have any inactive pill days?
No, it contains 28 pills of the same dose taken every day without any break
What is the mode of action of the progesterone only pill?
- thickens cervical mucosa making it impenitrable to sperm
- alters the endometrium to inhibit implantation
- may prevent ovulation in some women
How effective is the progesterone only pill in preventing pregnancy?
96-97% effective depending on compliance
What are the contraindications to using the progesterone only pill?
- breast cancer
- altered liver function
- taking some medications
- CVD and hypertension
- abnormal lipids
- undiagnosed bleeding
- generally thought to have fewer side effects than combined oral contraceptive
What are the most common side effects of the progesterone only pill?
- irregular bleeding
- weight changes
- mood changes
What are the recommendations around commencing the progesterone only pill after birth?
- may be commenced at any time, but no contraception required for 21 days postpartum
- effective immediately if breastfeeding and within 21 days of birth or or day 1-5 of cycle if menstruation has returned
- otherwise exclude pregnancy if necessary, effective after 48 hours/3 pills
- recommend annual followup with GP or family planning service
What are the active ingredients in the combined oral contraceptive pill?
synthetic estrogens and progestegens
What is the mode of action of the combined oral contraceptive pill?
- inhibits FSH, LH release preventing follicle maturation and ovulation
- thickens cervical mucous and reduces fallopian tube motility
When is the combined oral contraceptive pill not recommended?
- while breastfeeding and within the first 6 months after birth (may alter milk composition, suppress prolactin and reduce supply)
- within 21 days of birth due to risk of thrombosis
- for women with increased risk of thrombosis (smoker, obesity, advanced age, diabetes, hypertension, reduced mobility)
- History of heart disease, stroke, VTE, DVT, pulmonary emobolism
- migraines with aura
- current breast cancer
- advanced diabetes
- efficacy reduced by some medications (antibiotics, liver enzyme altering drugs, antiepileptic drugs and st johns wort)
Does the combined oral contraceptive pill have any inactive pill days?
Yes, they generally contain 21 days of hormones and 7 days of placebo tablets
What different combined oral contraceptive pill types are available?
- may be monophasic (active pills all contain same formulation), biphasic (two-phases), tri-phasic (three-phases)
How effective is the combined oral contraceptive pill?
What are the most common side effects of the combined oral contraceptive pill?
- breakthrough bleeding
- breast tenderness
- lowered libido
- mood changes
- weight gain
What risks may be associated with taking the combined oral contraceptive pill?
- increased risk of gallbladder disease
- heart attack
- cervical cancer
What are the recommendations around commencing the combined oral contraceptive pill after birth?
- not recommended if breastfeeding prior to 6 months postpartum
- not recommended before 21 days postpartum
- if menstruation has returned effective immediately if commenced day 1-5
- otherwise exclude pregnancy if required
- effective in 7 days
What contraceptive methods can be considered postpartum?
- Lactational amenorrhoea method
- diaphragms and cervical caps
- progesterone only pill
- combined oral contraceptive pill
- copper or hormonal IUD
When can condom use be commenced postnatally?
- can be used immediately with no impact on breastfeeding
When can use of diaphragms and cervical caps be commenced postnatally?
- > 6 weeks after birth when vaginal tone returns
- now less common, very little consistancy in terms of products
What to do if a combined oral contraceptive pill is late or missed?
- within 24 hours, take pill ASAP, then continue as usual
- after 24 hours late, take most recent pill and use another form of contraception until 7 days/pills
- missing more than 4 pills is considered stopping the pill
What is the trade name of Depot medroxy-progesterone acetate (DMPA) or the progestogen only injection?
What is Depo-provera?
- an injectable contraceptive
- progestagen is injected deep IM every 12 weeks
What is the mode of action for Depo-provera in preventing pregnancy?
- inhibits GnRH secretion
- prevents follicle maturation and ovulation
- increases thickness of cervical mucous
- changes lining of the uterus
What recommendation would you give a woman about Depo-provera?
- 99.8% effective when given every 12 weeks
- need to see a doctor every 3 months for an injection (cost?)
- important not to massage injection site as this can decrease duration
- not usually commenced before 6 weeks postpartum due to risk of increased vaginal bleeding
- ensure not pregnant before commencing
- suitable for breastfeeding