Flashcards in Contraception - Progesterone Only Deck (53)
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1
What does progesterone only hormonal contraception use?
The female steroid hormone progesterone
2
What is the failure rate of progesterone only contraceptives with perfect use?
0.3%
3
What is the typical failure rate of progesterone only contraceptives?
9%
4
What are the different types of progesterone only contraceptives?
- Pill (POCP)
- Implant
- Injection
5
What are the types of POCP currently available in the UK?
- Femulen
- Norgeston
- Noriday
- Micronor
- Cerazette
6
What is the primary mechanism of action of POCP?
Thicken cervical mucus due to high levels of progesterone, which prevents the entry of sperm and therefore fertilisation of the oocyte
7
What are the secondary mechanisms of POCP?
- Suppression of ovulation (to varying degrees)
- Thinning of endometrium, inhibiting implantation
8
What does the degree to which the POCP suppresses ovulation vary based on?
The form of progesterone given
9
What are the advantages of the POCP?
- More effective than barrier methods when taken correctly
- Sex doesn't need to be interrupted to use contraception
- Can be used in many patients for whom the COCP is contraindicated
- May reduce risk of endometrial cancer
10
What are the disadvantages of the POCP?
- User dependant, and has to be taken at same time every day
- Can produce irregular menstruation or amenorrhoea
- Some adverse effects
- Increased risk of ovarian cysts
- Small increased risk of breast cancer
11
What proportion of women taking the POCP experience irregular mensuration?
4 in 10
12
What proportion of women taking the POCP experience amenorrhoea?
2 in 10
13
What are the adverse effects of POCP?
- Headaches
- Breast tenderness
- Skin changes
14
By how much does POCP increase risk of ovarian cysts?
30%
15
What are the contraindications to POCP?
- Current or past history of breast cancer
- Liver cirrhosis or tumours
- Stroke or coronary heart disease
16
In whom does the POCP have a lower efficacy?
Women over 70kg
17
What is the brand name for the progesterone only implant linseed for use in the UK?
Nexplanon
18
What is the progesterone only implant?
A small, flexible tube about 40mm long that is inserted into the upper arm
19
What does the progesterone only implant contain?
68mg steroidal progestin
20
How long does the progesterone only implant last?
3 years
21
What is the failure rate of the progesterone only implant with perfect use?
0.05%
22
What is the typical failure rate of the progesterone only implant?
0.05%
23
What is the main mechanism of action of the progesterone only implant?
Inhibition of ovulation
24
What are the additional mechanisms of action of the progesterone only implant?
- Causes thinking of cervical mucus, which inhibits the passage of sperm
- Causes thinning of endometrium, preventing implantation if the egg were fertilised
25
What are the advantages of the progesterone only implant?
- Extremely effective
- Can be used in some women for whom the COCP is contraindicated
- Users don't have to think about contraception for 3 years
- Can be used when breastfeeding
- Normal fertility returns as soon as implant is removed
- Effective in woman of all BMIs
- May reduce risk of endometrial cancer
26
What is recommended in women using the progesterone only implant with a high BMI?
Earlier replacement
27
What are the disadvantages of the progesterone only implant?
- About 50% of women experience changes in menstrual bleeding
- Fitting and removing the implant may cause pain, bruising, and irritation
- Small increased risk of breast cancer
- Implant can break or bend in situ
28
Are bleeding patterns likely to remain irregular if a woman with the progesterone only implant experiences changes in menstrual bleeding?
Yes
29
What are the contraindications to the progesterone only implant?
- Pregnancy
- Unexplained vaginal bleeding
- Liver cirrhosis or tumours
- History of breast cancer
- Stroke or transient ischaemic attacks whilst using implant
30
