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Reproduction Week 2 2018/19 > 1: Contraception > Flashcards

1: Contraception Flashcards

1
Q

What do contraceptives do?

A

Prevent pregnancy

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2
Q

Why do women choose to use contraceptives?

A

Family planning - no. of children and timing; to avoid unplanned pregnancy

For non-contraceptive reasons

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3
Q

How many babies are born every two seconds?

A

Six babies every two seconds

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4
Q

The prevalence of contraceptive use is higher in (high / low) income countries.

A

high income countries

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5
Q

What are some non-contraceptive reasons for using contraception?

A

Heavy, irregular or painful periods

Premenstrual syndrome (abdo pain, bloating, cravings…)

Endometriosis

Menstrual migraine

Acne

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6
Q

Contraceptive use is described in terms of perfect use and typical use.

What’s the difference between these two?

A

Perfect use - 100% compliance, never forgetting

Typical use - allows for occasional omission

Obviously effectiveness is less for typical use, but it’s more realistic

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7
Q

How long can sperm live in the female reproductive tract for?

A

5 days

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8
Q

How long does an egg survive in the female reproductive tract once released from the ovaries?

A

12 - 24 hours

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9
Q

For the greatest chance of conceiving, when in the menstrual cycle should a woman have sex?

A

Days preceding and following ovulation

Ovulation occurs at roughly Day 14, so Days 8 - 18 ish

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10
Q

What measurement is used to describe the effectiveness of contraceptive methods?

A

Pearl index

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11
Q

What does the Pearl index describe?

A

No. of contraceptive failures per 100 women per year

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12
Q

How is the Pearl index calculated?

A

(Number of accidental pregnancies) x 1200 / Total number of months using contraceptive

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13
Q

How long do

a) sperm
b) eggs

survive in the female reproductive tract?

A

a) 5 days

b) 12 - 24 hours

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14
Q

The Pearl index describes the number of ___ pregnancies experienced per ___ women per year.

A

accidental pregnancies per 100 women per year

It’s a measure of how effective a contraceptive method is

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15
Q

How does body temperature change around the time of ovulation?

A

Basal body temperature increases by around 1 degree Celsius

From 36 to 37 degrees Celsius, supports the sperm and eggs

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16
Q

How does the position of the cervix change around ovulation?

A

Cervix rises up into vagina and the internal + external os open up

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17
Q

What are the properties of cervical mucus around the time of ovulation?

A

Thin and slippery

So the sperm can swim through it easier

Sorry for the imagery

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18
Q

What are two natural methods of contraception?

A

Withdrawal method - man pulls out before he ejaculates

Lactational amenorrhoea - post-natal state that lasts for up to 6 months

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19
Q

What is the Pearl index for no contraception use in a sexually active woman?

A

85

i.e 85 out of 100 sexually active women would fall pregnant each year if they didn’t use contraception

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20
Q

What is the Pearl index for the withdrawal method?

Why?

A

22 i.e 22 out of 100 women will fall pregnant each year if the man uses the withdrawal method

Because there’s no barrier to sperm entry and it all relies on the man’s reflexes, plus a large proportion of sperm are contained in the initial ejaculate so he has to be quick

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21
Q

What are the three criteria for lactational amenorrhoea to be an effective state of natural contraception?

A

1. Woman is exclusively breastfeeding

2. Less than 6 months post-birth

3. Woman isn’t have periods

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22
Q

What is the most commonly used contraceptive method in the UK?

A

Combined hormonal contraception (CHC)

i.e the oestrogen/progrestrogen contraceptive pill

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23
Q

The CHC stops ___.

A

stops ovulation

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24
Q

The CHC is (short / long)-acting.

A

short acting

has to be taken daily

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25
Q

What is the Pearl index of the CHC?

A

0.2

i.e 0.2 per 100 women getting pregnant per year, very effective

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26
Q

Apart from the CHC, which other hormonal tablet is used for contraception?

A

Progesterone only pill / Desogestel / “Mini pill”

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27
Q

The mini pill contains a progesterone precursor called ___.

A

desogestel

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28
Q

Apart from tablets, what are other medical methods of contraception?

A

Barriers - male and female condoms, diaphragms and caps

Contraceptive implant

Contraceptive injection

Intrauterine system (IUS)

Intrauterine device (IUD)

Male and female sterilisation

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29
Q

What are three adaptations the female reproductive tract makes around the time of ovulation to increase the likelihood of pregnancy?

A

Basal body temperature increases

Cervical mucus becomes thin and “slippery”

Cervix rises and internal + external os open

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30
Q

For how long does the average contraceptive implant last?

A

3 years

31
Q

What is the mode of Depo-Povera contraception?

A

Injection

32
Q

What does the contraceptive injection contain?

A

Progesterone

Stops ovulation

33
Q

How often must the contraceptive injection be given?

A

Every 13 weeks

Because it lasts for 14 weeks

34
Q

What is the difference between an intrauterine system and intrauterine device?

A

System - releases progestrogen, rendering endometrium poor for implantation of fertilised egg

Device - releases copper, which acts as a spermicide and inflames the endometrium, stopping implantation

35
Q

How long are

a) intrauterine devices
b) intrauterine systems

effective for?

A

a) 5 - 10 years

b) 3 - 5 years

36
Q

Which substances actually cause the contraception in

a) intrauterine devices
b) intrauterine systems?

A

a) Copper

b) Progestrogen

37
Q

What short-acting method of contraception is easy to use and provides some protection against STIs?

A

Barriers

i.e condoms for men

internal condoms, diaphragms and caps for women

38
Q

What is a diaphragm / cap?

A

Barrier method of contraception which covers the os (entrance to the cervix), preventing fertilisation

39
Q

Diaphragms or caps should be used alongside ___.

A

spermicide

to ensure sperm aren’t getting past it to fertilise an egg

40
Q

What are the permanent methods of contraception for

a) men
b) women?

A

a) Vasectomy

b) Tubal occlusion

41
Q

Which structures are cut, blocked or tied off in

a) female
b) male

sterilisation?

A

a) Fallopian tubes

b) Vas deferens

bilaterally

42
Q

Does sterilisation have 100% effectiveness in preventing pregnancy?

A

No, small chance tubes could reform so Pearl index isn’t 0

43
Q

Contraception should be used when the ___ outweigh the ___.

A

advantages outweight the risks

44
Q

Which document tells you whether or not certain forms of contraception are contraindicated in certain patients?

A

UKMEC

Scale goes from 1 (fine to use) to 4 (contraindicated)

45
Q

Which measurements and examinations should be carried out on a patient before prescribing them contraception?

A

BP

BMI

PV exam

bare minimum

46
Q

To exclude pregnancy, when should contraception be started?

A

Menstruation

47
Q

What exists in case a woman forgets to use contraception or her contraception fails?

A

Emergency contraception

48
Q

WHEN should emergency contraception be used?

A

Within 5 days of unprotected sexual intercourse

Within 5 days of expected ovulation

49
Q

What are the two forms of emergency contraception?

A

Copper intrauterine device

Emergency contraceptive pill

50
Q

What is the most effective form of emergency contraception?

A

Copper intrauterine device

51
Q

What are the two forms of emergency contraceptive pill?

A

Levonorgestrel

Ulipristal acetate

52
Q

Which emergency contraceptive pill is effective within

a) 72h
b) 120h

of unprotected sexual intercourse?

A

a) Levonorgestrel

b) Ulipristal acetate

53
Q

In relation to the LH surge which triggers ovulation, when is

a) levonorgestrel
b) ulipristal acetate

effective?

A

a) Before the LH surge
b) Before and during the LH surge

54
Q

Do emergency contraceptive tablets work after ovulation?

A

No

55
Q

Do emergency contraceptives cause abortion?

A

No

Stop sperm passage, fertilisation and implantation

So they’re looked upon as “family planning” by the Catholic church, not abortion

56
Q

Ulipristal acetate is contraindicated in which patients?

A

Asthmatics

Exacerbates severe asthma

57
Q

What are some non-contraceptive reasons for using contraception?

A

Heavy, irregular or painful periods

Abdominal pain assoc. with premenstrual syndrome, endometriosis

Menstrual migraine

Acne

58
Q

How does contraception affect menstrual bleeding?

A

Affects menstruation and so bleeding becomes INFREQUENT and/or LIGHTER

Except for the IUD - inflammation causes menorrhagia

59
Q

To be fully protected, when ideally should you start the combined contraceptive pill?

A

Menstruation or thereabouts

60
Q

If you start oral contraception outwith five days of your period, what should you do for the next week to be fully protected?

A

Abstain or use barrier protection

61
Q

How is the combined oral contraceptive pill taken?

A

21 days on, 7 days off (to let withdrawal bleed occur)

62
Q

Which co-existing medical conditions can affect the absorption of contraceptive tablets?

A

Malabsorption - IBD, short bowel, gastroenteritis

Liver disease

63
Q

Problems with which organ can affect the metabolism of contraceptive drugs?

A

Liver

64
Q

Which type of drug can affect the metabolism of contraceptive drugs?

A

Enzyme inducers

anti-epileptics, anti-retrovirals, St John’s Wart, rifampicin

65
Q

Which enzyme family is induced by antiepileptics, anti-retrovirals etc. and can affect the metabolism of contraceptive drugs?

A

Cytochrome P450

66
Q

What may patients do which affects the effectiveness of contraceptive drugs?

A

Forget to take them

67
Q

The combined oral contraceptive is known to increase your chances of which cardiovascular disease?

A

Venous thromboembolism

usually DVT leading to PE, MI, stroke

68
Q

The combined contraceptive pill comes with a (large / small) increase in a patient’s DVT risk.

A

small

risk while on oral contraceptives is far less than risk due to being pregnant and immobile regardless

69
Q

Which genetic condition can present with recurrent miscarriages?

A

Anti phospholipid syndrome

70
Q

Apart from increased risk of VTE (venous thromboembolsim), what other cardiovascular condition is linked to oral contraceptives?

A

Systemic hypertension

71
Q

The combined contraceptive pill is contraindicated in patients who have migraine with aura.

Why?

A

Study showed link between contraceptive use, these patients and ischaemic stroke

72
Q

Which cancers are linked to the combined contraceptive pill?

A

Breast cancer

Cervical cancer

73
Q

Which cancers are protected against by the combined contraceptive pill?

A

Ovarian and endometrial cancer

74
Q

The risks for which cancers are

a) increased
b) reduced

affected by the combined contraceptive pill?

A

a) Breast and cervical cancers

b) Ovarian and endometrial cancers

Reproduction Week 2 2018/19 (9 decks)

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