cOGText: Family Planning Flashcards
What is the most commonly performed Gynaecological procedure in the UK?
abortion
T/F: access to contraception is associated with a reduction in maternal mortality
true - unplanned pregnancy is associated with poorer outcomes both for mother and baby
A short inter-pregnancy interval of <12 months is associated with an increased risk of which feotal complications?
- preterm labour
- foetal growth restriction
- stillbirth
- increase in neonatal mortality.
Adolescents who get pregnant have a higher risk of what complications?
preterm birth or have low birth-weight babies > more predisposed to neonatal mortality
(children born to adolescent mothers are more likely to get pregnant as adolescents themselves)
LARC methods of contraception? (from most to least effective)
- Progestogen-only implant
- Levonorgestrel-releasing intrauterine system
- Copper intrauterine device
- Progestogen-only injectables
Other methods of family planning? (i.e. non-LARC)
from most > least effective
- Vasectomy
- Female sterilisation
- Progestogen-only pills
- Combined hormonal contraception
- Female diaphragm
- Male condom
- Fertility awareness methods
- What is ‘natural family planning’?
- There are a number of different indicators which can be used in combination to increase accuracy - what are these known as?
- For women with a regular menstrual cycle, ovulation usually occurs ___ days before the start of the next cycle. The egg can generally survive up to ___ hours after ovulation unless it is fertilised, meaning that the sperm has to reach the egg within this time frame for fertilisation to occur.
- Length of menstrual cycle can vary and should be measured for at least __ consecutive months.
- How should sex be restricted around ovulation and why?
- Name some FAM of contraception?
- Relies on physiological indictors of ovulation to identify when a woman is most fertile in her cycle and subsequently avoid otherwise unprotected intercourse.
- ‘Fertility Awareness-based Methods (FAM)’ of contraception
- 10-16, 24-48
- 3
- As sperm can live for up to 7 days in female genital tract, sex should be restricted 7 days before ovulation and at least 2 days after ovulation.
- Calendar method (as above). Temperature: ↑ temp 3 consecutive days could indicate that fertility has decreased. Billings method (cervical mucus): A rise in LH and oestrogen cause mucus to be moist, sticky, white and creamy, which indicates the start of the fertile period. Nearer ovulation the mucus becomes more watery and clearer, indicating peak fertility period.
- pros of natural family planning?
- cons?
- no side effects, acceptable to all faiths and cultures, avoids hormones, increased awareness of own body and cycle
- Less effective, high failure rate, user-dependent, lack of spontaneity in intercourse, menstrual cycle length can be irregular/ change over time (esp around menopause/ menarche), requires constant monitoring, fertility signs may be disrupted by stress, illness, travel, hormonal treatment, certain meds, no STI protection, not effective immediately post-pregnancy (regular cycles don’t resume for at least 3 months),
- name 3 barrier methods of contraception
- discuss the pros and cons of each
- .
- .
- Describe how the diaphragm is used
- T/F: Condoms may also be used with spermicide for additional protection
- How should a female condom be worn?
- male condom, female condom, diaphragm/ cap
- Male condom. Pros: protects against STIs, avoids use of hormones. Cons: typical use failure rate if high (18%), highly user-dependent
- Female condom. Pros: as above. Cons: as above, also less widely available and harder to use than male condoms and slightly higher failure rate
- Diaphragm. Cons: lack of spontaneity around sexual activity, highly user-dependent, no protection against STIs, increased risk of cystitis, requires new diaphragm to be fitted if >3kg weight lost/gained, baby delivered, or a miscarriage or abortion occurs, latex and spermicide can cause irritation
- Should always be used with spermicide. Can be inserted any time before sex, but more spermicide is needed if it has been inserted for >3hrs or having sex again (don’t remove diaphragm to reapply spermicide). Needs to be left in place for at least 6 hours after sex (overnight if easier - max 30h)
- False - can promote condom breakage and irritant to skin which can increase risk of STI transmission. Should also not be used with oil-based lubricants
- Worn inside the vagina, before contact with penis, to prevent semen from entering the cervical canal
Combined Oral Contraceptive Pill (COC)
- Describe its mechanism of action
- Describe how it is taken
- Faiulre rate with typical pill use?
- When in the cycle would it be necessary to take contraception at the same time
- What about in the post-partum period?
- Pill can be started up to __ days after miscarriage or abortion without additional contraceptive precautions
- Oral pill containing oestrogen and progesterone, which inhibits ovulation and thickens mucus
- Traditionally taken every day for 21 days and stopped for 7 days (withdrawal bleed occurs). Many women now have tailored regimens which doesn’t increase side effects and allows better bleeding control, with higher rates of amenorrhoea.
- 9% have unintended pregnancy in the first year
- If the pill is started within the first 5 days of the menstrual cycle, contraceptive effect starts immediately. After day 5, additional contraception is needed for 7 days after starting the pill.
- If started by day 21 post-partum it is immediately effective. If started after day 21, condoms should be used for the next 7 days.
- 5
- what to do if 1 COC pill is missed?
- what about if 2 pills are missed?
- what about if the pill has been missed in week 1 and unprotected sex has occurred in the pill free interval?
- what about if the pill is missed in week 2?
- week 3?
- Take the last pill, even if 2 pills are taken in 1 day - No additional contraceptive protection needed
- Take the last pill even if 2 pills are taken in 1 day and omit any earlier missed pills. Use condoms or abstain from sex until pill has been taken 7 days in a row -
- consider emergency contraception
- no emergency contraception needed if pill was taken 7 consecutive days before missing the pill.
- pills in current pack should be finished and new packed started the next day, omitting the pill free interval
- Advantages of COC?
- Disadvantages?
- Treatment for menorrhagia, dysmenorrhea, endometriosis and premenstrual syndrome, reversible contraceptive, reduced risk of ovarian, endometrial and colorectal cancer, may protect against PID, may reduce occurrence of ovarian cysts, benign breast disease, acne vulgaris
- no protection against STIs; Should be taken around the same time every day (within 24 hours of last pill); can interact with other meds- liver enzyme-inducing drugs e.g. anti-epileptics; increased risk of cervical and breast cancer, VTE, stroke and ischaemic heart disease (in women with other risk factors); hormonal side effects e.g. HA, nausea, breast tenderness, mood changes, low libido; irregular bleeding – most common in 1st 3/12 us
relative contraindications to COCP?
PMH
- Controlled hypertension
- Ongoing gallbladder or liver disease
- Complicated diabetes
- Gene mutations assoc with breast cancer eg BRACA1/2
FH
- FH of thromboembolic disease in 1st degree relatives <45 years
SH
- >35 years old and smoking <15cig /day
- BMI>35kg/m2
- Immobility
Absolute contraindications to COCP?
Should be avoided = UKMEC 4
PMH
- Migraine with aura
- Hx of thromboembolic disease, thrombogenic mutation, stroke or ischaemic heart disease
- Uncontrolled HTN
- Current breast cancer
- Major surgery with prolonged immobilisation
SH
- >35 y/o and smoking >15 cigarettes/day
Combined Transdermal Patch (CTP)
- Mechanism of action?
- How is it used?
- If patch is started before day __ of the menstrual cycle, contraceptive effect is immediate.
- What to do if the patch falls off?
- Pros and cons?
- Relases oestrogen and progesterone through the skin into the blood to prevent ovulation. Also thickens cervical mucus.
- Wear 7 days, change on day 8. Continue for 3 weeks, week 4 patch-free to allow withdrawal bleed.
- 5 (>day 5, condoms should be used for the first 7 days)
- If off for <48hrs, stick it back as soon as possible or use a new patch. Protection against pregnancy remains as long as patch was used correctly for 7 days before it was removed. If removed for >48hrs, a new patch should be started immediately, and additional contraception used for the next 7 days.
- as per COCP (may have slightly higher risk of VTE). Contraindications also as per COCP.
Combined Vaginal Ring (CVR)
- mechanism of action?
- How is it used?
- T/F: Sex can continue as normal with the ring in place
- If the ring is expelled for __ __, contraceptive protection may be reduced.
- What to do if this occurs during week 1 or 2 of the menstrual cycle?
- If expulsion occurs during week 3?
- T/F: No additional contraception is needed if removal of the ring is delayed up to 1 week (4 weeks of continuous use).
- Ring can be inserted on day __ post-partum for immediate contraception.
- T/F: Ring can be used immediately after a miscarriage or abortion
- pros and cons?
- Continuous release of oestrogen and progesterone into the bloodstream, preventing ovulation.
- Soft, plastic ring that is placed inside the vagina. Should be in for 21 days, removed for 7 to allow withdrawal bleed
- true
- 3 hours
- Additional protection should be used for the next 7 days after the ring is re-inserted.
- Insert new ring to start a new cycle, or allow a withdrawal bleed. New ring should be inserted no later than 7 days after the ring was expelled. If insertion of new ring is delayed at the start of a cycle, contraceptive protection is lost, and a new ring should be inserted as soon as possible while using condoms for the first 7 days.
- true - 7 day ring-free interval should be started after this and ring re-inserted after this interval.
- 21 (After 21 days, condoms should be used for 7 days after insertion)
- as per COCP (may have a better bleeding profile. Contraindications also the same.