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Phase 3a- flashcards I forget > 3a- contraceptives and HRT > Flashcards

3a- contraceptives and HRT Flashcards

1
Q

what contraceptives increase the risk of breast cancer?

A

anything hormonal

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2
Q

if a patient is concerned about breast cancer/ has a significant family history, what contraceptive choice is safest?

A

copper coil/ barrier methods

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3
Q

which contraceptive choice increases the risk of cervical or endometrial cancer?

A

intrauterine system (IUS- Mirena coil)

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4
Q

what contraceptive is contraindicated if the patient has Wilsons?

A

copper coil

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5
Q

what risk factors, if present, can contraindicate the COCP?

A
  • HTN
  • migraine w/aura
  • VTE
  • age >35 AND smoking >15 a day (together, not as separate risks)
  • major surgery
  • vascular disease/stroke
  • IHD, CM, AF
  • liver cirrhosis
  • SLE
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6
Q

Up to what age can the COCP be used?

A

50

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7
Q

what contraceptive must be stopped before the age of 50 and why?

A

progesterone injection (Depo-Provera)= risk of osteoporosis

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8
Q

contraceptive options after giving birth

A
  • fertility is low for 21 days after birth anyway
  • lactational amenorrhoea (physiological)
  • progesterone-only pill and implant (can be started anytime)
  • copper coil/ IUS fine
  • MUST NOT USE COCP IF BREASTFEEDING
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9
Q

what is the action of the COCP?

A
  • prevents ovulation
  • progesterone thickens cervical mucus
  • progesterone inhibits proliferation of endometrium (decreases chance of successful implantation)
  • suppression of GnRH, FSH, LH
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10
Q

side effects of COCP

A
  • abnormal bleeding for 3 months
  • breast pain/ tenderness
  • mood changes
  • headaches
  • HTN
  • VTE
  • increased risk of breast and cervical cancer (returns to normal after 10 years of stopping pill)
  • increased MI and stroke risk
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11
Q

benefits of the COCP

A
  • contraception
  • fertility returns quickly once stopped
  • improves premenstrual sx, menorrhagia and dysmennorhoea
  • reduced risk of endometrial, ovarian and colon cancer
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12
Q

what is the only UKMEC4 criteria for the progesterone only-pill?

A

active breast cancer

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13
Q

after how many hours is the :

  • COCP
  • POP

considered late?

A

COCP= 24

POP=3

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14
Q

how does the progesterone only pill work?

A

thickens cervical mucus

reduces ciliary action of fallopian tubes

makes endometrium less acceptable for implantation

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15
Q

for the COCP and the POP, when is contraception provided if the pill is started:

  • on day 1-5 of menstrual cycle
  • after day 5
A

COCP

  • days 1-5= immediately
  • after day 5= 7 days

POP:

  • days 1-5= immediately
  • after day 5= 48 hours

(so inbetween, barrier contraception is required)

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16
Q

possible SE’s of the POP

A
  • abnormal bleeding (amenorrhoea etc)
  • breast tenderness
  • acne
  • headaches
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17
Q

how often is the Depo injection given and what type of contraceptive is it?

A

12-13 weeks, IM/SC

progesterone only

18
Q

give some contraindications for the progesterone-only injection

A

active breast cancer
IHD/stroke
unexplained vaginal bleed
severe liver cirrhosis/cancer

19
Q

what is the action of the progesterone injection

A
  • inhibits ovulation (inhibits FSH)

- thickens cervical mucus

20
Q

side effects of the progesterone injection

A
  • osteoporosis
  • WG
  • acne
  • reduced libido
  • headaches
  • flushes
  • alopecia
21
Q

where is the progesterone-only implant injected and how long does it last?

A

upper arm

3 years

22
Q

what is the only UKMEC4 criteria for the progesterone only-implant?

A

active breast cancer

23
Q

mechanism of action of the progesterone-only implant

A

Inhibiting ovulation
Thickening cervical mucus
Altering the endometrium and making it less accepting of implantation

24
Q

what are the 2 types of coil used?

A
  • copper coil (IUD)

- levonogestrel intrauterine system (IUS)

25
Q

Contraindications for IUD/IUS

A
  • PID
  • immunosuppression
  • pregnancy
  • unexplained bleeding
  • pelvic cancer
  • fibroids
26
Q

what should be done before inserting the coil?

A

STI screen

bimanual examination

27
Q

how long does the copper coil (IUD) last for?

A

5-10 years

28
Q

mechanism of action of the copper coil

A

Copper is toxic to the ovum and sperm. It also alters the endometrium and makes it less accepting of implantation

29
Q

benefits of using the copper coil

A

no hormones- so a lot safer in terms of cancer/ vascular risk

can be inserted at anytime during menstrual cycle and is effective immediately

30
Q

most common levonorgestrel coil seen

A

Mirena IUS

31
Q

other than contraception, what else can the Mirena IUS be used for?

A

menorrhagia

HRT

32
Q

Why can be Mirena coil be used for HRT?

A

contains levonorgestrel (progestogen)

33
Q

what are the 3 options for emergency contraception?

A
  • levonorgestrel (within 72h)
  • ulipristal (also known as EllaOne)- (120 hours)
  • copper coil (within 5 days)
34
Q

suitable contraceptives for a trasngender male (assigned female at birth) who currently has a vagina (i.e. undergoing transition)

A

barrier

copper coil (non-hormonal)

progesterone only options (as oestrogen can interact w/ testosterone)

35
Q

Indications for HRT

A
  • prematrue ovarian insufficiency
  • reducing vasomotor sx
  • imrpvoing sx- low mood, decreased libido
  • reduce osteoporosis risk in under 60’s
36
Q

risks of HRT

A
  • increased risk of breast cancer w/ combined HRT
  • increased risk of endometrial cancer
  • increased risk of venous thromboembolism
  • stroke and CAD
37
Q

when is there no risk of endometrial cancer in HRT?

A

if the woman has no uterus

38
Q

describe the 3 steps to deciding HRT

A

STEP 1:

  • local sx only= topical oestrogen cream
  • if systemic sx, go to step 2

STEP 2:
does the woman have a uterus?
- NO= use continuous oestrogen-only HRT
- YES= combined HRT and go to step 3

STEP 3:
have they had a period in the last 12 months?
- YES (so perimenopausal)- give cyclical combined HRT
- NO- so postmenopausal- give continuous combined HRT

39
Q

In HRT, what is the safest way to deliver oestrogen?

A

patches- reduced risk of venous thrombo-embolism

40
Q

in HRT, what is the best way of administering progesterone?

A

Mirena coil

41
Q

since HRT does not act as contraception, in perimenopausal woman what can be used as contraception?

A

mirena coil, progesterone-only pill (in addition to HRT)

Phase 3a- flashcards I forget (8 decks)

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