sexual health

emergency contraception in patient who takes enzyme inducing medications

copper coil

however if does not want it in epilepsy then double levonorgestrel dose to 3mg

what is the treatment if experience unscheduled bleeding on progesterone injections

COCP for 3 months

COCP missed pill rules

week 1 - take EC + condoms

weeks 2 - no need for EC, condoms

week 3 - miss the empty week + condoms

missed pill for POP

if desogestrol missed by > 12 hours - EC + condoms for 2 days

if other POP missed by > 3 hours - EC + condoms for 2 days

percentage of chlamydia patients that are asymptomatic

70%

Implant perfect and typical failure rate

0.05 for both

female sterilisation perfect and typical failure rate

0.5 for both

COCP and POP perfect and typical failure rate

perfect use 0.3%

typical 9%

dose of oestrogen in COCP

<30 nm

which cancers does COCP increase or reduce risk of?

reduces risk of endometrial and ovarian

increases risk of breast and cervical

What are the generations of progesterone, examples and one with highest VTE score

1 - norethisterone

2 - lenovogestrel

3 - desogestrel - highest risk

other - drospirenone

Which anti epileptic medication does COCP affect?

lamotrigine - switch to another contraception

BMI and COCP UKMEC

UKMEC 4 - BMI >35 and smokes >15/day

UKMEC 3 - BMI >35

UKMEC 2 - BMI >30

COCP and post partum

breastfeeding

• <6 weeks UKMEC 4

• 6 weeks to 6 months UKMEC 2

not breastfeeding

• < 3 weeks with other risk factors for VTE UKMEC 4

• 3 weeks to 6 months without RF UKMEC 2

COCP and breast cancer

active breast cancer UKMEC 4

past breast cancer UKMEC 3

Nephropathy/retinopathy and COCP

UKMEC 3

background risk of VTE vs second vs third generation of COCP

background 2 in 10 000

second generation 5 in 10 000

third 9-12 in 10 000

Which progesterone is used in patch vs ring COCP?

patch - norelgestromin

ring - etonogestrel

enzyme inducing drugs and COCP

increase oestrogen dose to 50

risks with intrauterine contraception

• expulsion

• perforation

expulsion 1 in 20

perforation 1 in 1000 (x6 fold in breastfeeding)

if COCP, mirena and POP started after 5 day of menses how long should you use condoms for

COCP and mirena - 7 days

POP 2 days

how long does IUD last for?

if has 52 mg eg mirena

• 8 years for contraception

• 5 years endometrial protection

  • 10 years if started after 45yo

how long does progesterone implant and copper coil effective for?

implant 5 years

copper coil 10 years

symptomatic of PID with actinomyces - whats the treatment?

Amoxicillin for > 8 weeks

note if no symptoms don’t treat

Contraception preferred with enzyme inducing medication

• IUD

• IUS

• depot provera

how frequently does depo provera need to be taken and what is the rule for missed injection

every 12 weeks

if delay by 2 weeks ie >14 weeks consider EC and 7 day condoms

which contraception is not advised after 50yo

COCP due to cardiovascular

depot due to bone density