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MFSRH > 2 - Contraception > Flashcards

2 - Contraception Flashcards

1
Q

Intercourse at what time in the cycle has the highest rate of conception occur?

A

Two days prior to ovulation

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2
Q

How long can sperm survive within the female genital tract?

A

5-7 days

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3
Q

After ovulation in what timeframe can fertilisation occur?

A

Up to 12 hours

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4
Q

Average conception rate for midcycle intercourse

A

30%

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5
Q

Postvasectomy how long is another method of contraception required for?

A

90 days and two negative semen analyses

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6
Q

What is the most common form of contraception used worldwide?

A

Sterilisation

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7
Q

What percentage of women in the UK are sterilised

A

10%

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8
Q

What is the major mechanism of action of depomedroxyprogesterone acetate (DMPA)

A

Inhibit ovulation

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9
Q

Do progesterone implants have a higher failure rate with BMI >40

A

Yes

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10
Q

What are the three methods of emergency contraception?

A

Levonorgestrel
ellaOne (ulipristal acetate)
Copper IUD

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11
Q

What type of medication is ellaone

A

Selective progesterone receptor modulator

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12
Q

How many hours is a ellaone licensed for

A

120 hours

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13
Q

Hormonal component of nexplanon

A

68 mg etonogestrel

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14
Q

Serum level of etonogestrel required to inhibit ovulation

A

90 pg/ml

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15
Q

Serum level of etonogestrel within one day of Nexplanon insertion

A

266 pg/Ml

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16
Q

What does etonogestrel find two in plasma

A

Serum proteins, predominantly albumin, and SHBG

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17
Q

Time to return of fertility after implant removal

A

Serum levels of etonogestrel undetectable in 1-10 days.

Return of ovulation within three weeks

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18
Q

Mechanism of action of implant

A

Prevents ovulation- inhibiting LH surge

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19
Q

What affect does the implant have on FSH levels

A

No effect.

Remain normal range

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20
Q

When starting the implant in what circumstances is additional contraception not required

A

Day 1-5 of the menstrual cycle
On or before day 21 postpartum
Up to and including five days post TOP
Switching from CHC immediately (No pill free break)
Switching from injection within 14 weeks
Switching from copper coil in day 1-5 of menstrual cycle

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21
Q

When starting the implant in what circumstances is additional contraception required and for how long

A

Seven days if:
After day five of menstrual cycle
After day 21 postpartum
After administration of Levonorgestrel EC
After a seven day pill free interval from CHC
Switching from injection if 14 weeks +
Switching from POP
Switching from copper coil or mirena (or leave it in situ for seven days)

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22
Q

When can and implant be fitted after ulipristal acetate (EllaOne)

A

After at least five days with seven days extra precaution

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23
Q

What is the only medical condition that is UKMEC 4 for implant

A

Breast cancer

24
Q

Advantages of implant

A 
How are you affective
Long acting
Quickly reversible
Independent of sexual intercourse
Easy to insert
No user failure 
Oestrogen free
No affect on metabolism
No follow-up
Few contraindications
Cost-effective
25
Q

Disadvantages to the implant

A 
No STI protection
Irregular bleeding
Procedure required to fit and remove
Removal requires Dr
May be difficult to remove
Rare-skin atrophy
risk of damage to deep structures in arm
26
Q

Reported side-effects of implant

A

Acne. (May improve or worsen)
Headache (no evidence)
Weight gain (No evidence)

27
Q

What medication may reduce the efficacy of the implant

A

Enzyme induces:

Carbamazepine, modafinil, phenytoin, rifabutin, ritonavir, rifampicin, primidone, St John’s wort

28
Q

How to manage women on enzyme induces with an implant

A

If short-term use use additional contraception during use and for for 28 days after enzyme inducer have stopped

29
Q

What precautions are required when changing the implant

A

No additional precautions

30
Q

Assessment of bleeding problems on the implant

A 
Full medical and sexual history
STI screen
Palpate implant
UPT
Investigate for gynaecological pathology
31
Q

Management of bleeding problems with the implant when pathology excluded

A

Con commitment COC for three months - continuous or cyclic

32
Q

Things to check prior to insertion of implant

A

Patient informed consent
UPT
Allergies/history/contraindications
Expiry date of LA and implant

33
Q

Advice to woman after implant insertion

A

Keep insertion area clean and dry for 24 hours
Give manufacturers leaflet.
Instructions if additional contraception required

34
Q

Required history if impalpable implant

A 
Length of time implant has been inserted
Change in menstrual cycle post insertion
Current menstrual pattern
History of insertion process including arm position
when was implant last palpable
35
Q

Management of impalpable implant

A

Additional precautions until presence confirmed
Refer for ultrasound
If not located to consider x-ray
If not located consider etonogestrel blood levels

36
Q

Examination in impalpable implant

A

Palpate both arms

Check at site of insertion and 2 cm above and below

37
Q

How many fertilised eggs are lost before implantation?

A

40-50%
Most due to chromosome abnormalities.
Or endometrium receptivity issues

38
Q

Duration of sperm survival

A

7 days

39
Q

In Natural family planning what are the patient identifiable factors of fertility?

A

Altered cervical mucus - thin, fluid
Cervical changes - higher, softer, dilated to fingertip
Altered basal body temp - 3rd higher temp indicates 2nd infertile phase

40
Q

Oestrogen effects on cervical mucus

A

Clear, wet, slippery, elastic

41
Q

Progesterone effects on cervical mucus

A

Decreased volume, opaque, sticky / tacky

42
Q

Second infertile phase in relation to peak cervical mucus

A

4th day after peak cervical mucus

43
Q

Factors which confound cervical mucus assessment

A

Sexual arousal
Sexual intercourse - semen
Spermicide
Thrush / vaginal infection

44
Q

For what period is Levonorgestrel licenced for in emergency contraception

A

72 hours

45
Q

For what period is ulipristal acetate licenced for in emergency contraception

A

120 hours

46
Q

For what period is an IUD licenced for in emergency contraception

A

120 hours after sexual intercourse or within five days of earliest ovulation

47
Q

Efficacy of levonorgestrel emergency contraception within first 24 hours

A

98%

48
Q

Efficacy of levonorgestrel emergency contraception at 49-72 hours

A

58%

49
Q

Advantages of natural family planning

A 
Free
No SE
Acceprable to most cultures / religions
Personal control 
Can be used with barrier methods 
Can help with trying to conceive in future
50
Q

Disadvantages of natural family planning

A 
Abstinence required
Requires daily monitoring and recording
Intercourse / arousal can confuse mucus assessment 
Vaginal infections can change mucus
Requires high motivation
51
Q

Efficacy of natural family planning with multiple indicators

A

If abstinence (not condoms) 96%

52
Q

Requirements for lactation amenorrhoea as contraceptive

A

Fully breastfeeding
Baby not yet 6m
Amenorrhoeic
Breastfeeding every 3-4hours

53
Q

Effectiveness of lactation amenorrhoea

A

98%

54
Q

Following LNG EC how long are additional precautions required when quick starting

  • CHC
  • POP
  • qlaira
A
  • CHC - 7/7
  • POP - 2/7
  • qlaira - 9/7
55
Q

Following UPA EC how long are additional precautions required when quick starting

  • CHC
  • POP
  • qlaira
A
  • CHC - 14/7
  • POP - 9/7
  • qlaira - 16/7

MFSRH (18 decks)

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