2 - Contraception Flashcards by Rachel Barlow-Evans

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

Two days prior to ovulation

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How long can sperm survive within the female genital tract?

5-7 days

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After ovulation in what timeframe can fertilisation occur?

Up to 12 hours

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Average conception rate for midcycle intercourse

30%

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Postvasectomy how long is another method of contraception required for?

90 days and two negative semen analyses

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What is the most common form of contraception used worldwide?

Sterilisation

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What percentage of women in the UK are sterilised

10%

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

Inhibit ovulation

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

Yes

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What are the three methods of emergency contraception?

Levonorgestrel
ellaOne (ulipristal acetate)
Copper IUD

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What type of medication is ellaone

Selective progesterone receptor modulator

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How many hours is a ellaone licensed for

120 hours

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Hormonal component of nexplanon

68 mg etonogestrel

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Serum level of etonogestrel required to inhibit ovulation

90 pg/ml

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Serum level of etonogestrel within one day of Nexplanon insertion

266 pg/Ml

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What does etonogestrel find two in plasma

Serum proteins, predominantly albumin, and SHBG

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Time to return of fertility after implant removal

Serum levels of etonogestrel undetectable in 1-10 days.

Return of ovulation within three weeks

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Mechanism of action of implant

Prevents ovulation- inhibiting LH surge

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What affect does the implant have on FSH levels

No effect.

Remain normal range

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

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

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

After at least five days with seven days extra precaution

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

Breast cancer

Advantages of implant

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

Disadvantages to the implant

``` 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 ```

Reported side-effects of implant

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

What medication may reduce the efficacy of the implant

Enzyme induces: | Carbamazepine, modafinil, phenytoin, rifabutin, ritonavir, rifampicin, primidone, St John's wort

How to manage women on enzyme induces with an implant

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

What precautions are required when changing the implant

No additional precautions

Assessment of bleeding problems on the implant

``` Full medical and sexual history STI screen Palpate implant UPT Investigate for gynaecological pathology ```

Management of bleeding problems with the implant when pathology excluded

Con commitment COC for three months - continuous or cyclic

Things to check prior to insertion of implant

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

Advice to woman after implant insertion

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

Required history if impalpable implant

``` 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 ```

Management of impalpable implant

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

Examination in impalpable implant

Palpate both arms | Check at site of insertion and 2 cm above and below

How many fertilised eggs are lost before implantation?

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

Duration of sperm survival

7 days

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

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

Oestrogen effects on cervical mucus

Clear, wet, slippery, elastic

Progesterone effects on cervical mucus

Decreased volume, opaque, sticky / tacky

Second infertile phase in relation to peak cervical mucus

4th day after peak cervical mucus

Factors which confound cervical mucus assessment

Sexual arousal Sexual intercourse - semen Spermicide Thrush / vaginal infection

For what period is Levonorgestrel licenced for in emergency contraception

72 hours

For what period is ulipristal acetate licenced for in emergency contraception

120 hours

For what period is an IUD licenced for in emergency contraception

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

Efficacy of levonorgestrel emergency contraception within first 24 hours

98%

Efficacy of levonorgestrel emergency contraception at 49-72 hours

58%

Advantages of natural family planning

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

Disadvantages of natural family planning

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

Efficacy of natural family planning with multiple indicators

If abstinence (not condoms) 96%

Requirements for lactation amenorrhoea as contraceptive

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

Effectiveness of lactation amenorrhoea

98%

Following LNG EC how long are additional precautions required when quick starting - CHC - POP - qlaira

- CHC - 7/7 - POP - 2/7 - qlaira - 9/7

Following UPA EC how long are additional precautions required when quick starting - CHC - POP - qlaira

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