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CONTRACEPTION (COMBINED OESTROGEN-PROGESTOGEN METHODS (pills, transdermal…
CONTRACEPTION
COMBINED OESTROGEN-PROGESTOGEN METHODS (pills, transdermal patch and intravaginal ring)
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Most currently available COC pills contain ethinyloestradiol (EE) and progestogens (synthetic progesterone), which include levonorgestrel and norethisterone (2nd gen), desogestrel and gestodene (3rd gen) and drospirenone (4th gen)
deaths in COC users over 35 are 8x more common in smokers (so 35 recommended to use alternative contraception)
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HOW TO TAKE COC
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can be started up to and including day 5 of the menstrual cycle to provide immediate contraceptive protection. if started after - need condoms for next 7 days
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withdrawal bleed usually occurs during pill free interval due to withdrawal of hormones = induce endometrial shedding
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in general one pill can be missed at any time without loss in efficacy or need to use barrier contraception
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DRUG INTERACTIONS
liver enzyme inducing drugs (such as carbamazepine, some antiretrovirals, griseofulvin, rifampcin and st john's wort) accelerate the hepatic break down of contraceptive steroids = may reduce efficacy = may need to inc dose of EE (2 pills per day), may need to reduce pill free period
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FOLLOW UP
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12 Month supply can be given at first visit, some women may need 3 mth follow up
COC should be stopped and replaced with alternative at least 6wks before major surgery wher eimmobilisation is expected
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PATCH
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can be started up to and including day 5 of the menstrual cycle to provide immediate contraceptive protection. if started after - need condoms for next 7 days
INTRAVAGINAL RING
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can be started up to and including day 5 of the menstrual cycle to provide immediate contraceptive protection. if started after - need condoms for next 7 days
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EMERGENCY CONTRACEPTION
ulipristal acetate
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not recommended if using a liver enzyme inducing drug, have severe asthma, or severe hepatic impairment
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efficacy may be reduced by antacids, PPI, H2 recep antaf
can do quick start long term contraception AT OR AROUND THIS TIME -takes 7 days PLUS A FURTHER 7. POP TAKES USUAL 2 DAYS PLUS 7 to allow effect of UPA on progest recep to reverse
Cu-IUD (most effective, but invasive)
can be inserted up to 5 days later after predicted date of ovulation [may be more than 5 since UPSI]
Women who attend following UPSI more than 5 days previously can be offered CUIUD if within 5 days of her expected date of ovulation = up to day 19
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