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conntraception Flashcards

1
Q

what are the different modes of action of contraception ?

A

prevention of ovulation
prevention of fertilization
prevention of implantation
thickening of cervical mucus

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2
Q

what is the lactational amenorrhea method of contraception ?

A

allow women to safely rely on breastfeeding as a family planning method and this can be used as long as the woman is:
fully breast feeding ( baby fully dependent )
no periods
less than 6 months postpartum

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3
Q

what is the “safe period” method based upon ?

A

based on the assumption that :
the ovum life span os 24 hours post ovulation
spermatozoa are capable of fertilization for 4 days
ovulation occurs 12-16 days before the onset of the next menses
- safe period is not safe

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4
Q

what are the barrier methods of contraception ?

A

condom

diaphragm

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5
Q

how is the diaphragm used ?

A
  • before intercourse a spermicide gel is applied over the diaphragm and all around the ring , and is inserted in the vault
  • should be left for 8 hours after intercourse
  • diaphragm can be washed and reused
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6
Q

what chemical methods are available ?

A

spermicides

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7
Q

what is the active chemical in spermicides ?

A

nonoxynol-9 , used alone or usually with a barrier method

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8
Q

what important instruction must the female be aware of when using spermicides ?

A

no douching for 6 hours after intercourse

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9
Q

when should we avoid using spermicides ?

A

in young age
frequent intercourse
STDs

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10
Q

what are the hormonal methods of contraception?

A

combined OCPs
Hormone releasing vaginal rings
contraceptive patches
monthly combined injectables

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11
Q

what is the mode of action in combined hormonal contraception ?

A
  1. estrogen is given in certain doses and causes the inhibition of ovulation through suppression of the hypothalamo-pituitary-ovarian axis
  2. progesterone is given simultaneously to avoid the unopposed effect of oestrogen on the endometrium
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12
Q

how long are combined pills supposed to be taken ?

A

they are taken for 21 days then stopped for a week

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13
Q

when does withdrawal bleeding happen when using combined pills?

A

2-3 days after stoppage

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14
Q

when should the new course for OCPs be started ?

A

5th day of menstruation

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15
Q

what is the mode of action of OCPs ?

A

inhibition of ovulation
interference with fertilization
effect on the endometrium ( edema of the stroma and atrophy of the glands)

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16
Q

what is used to delay menstruation ?

A

progesterones more than OCPs

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17
Q

what are the side effects of OCPs?

A

thrombo-embolic disorders
slight transient liver impairment
decreased milk production
menstrual disturbances ( spotting , breakthrough bleeding, hypomenorrhea, amenorrhea)

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18
Q

when is post pill amenorrhea diagnosed ?

A

after 3 months after stoppage of pills and is related to prolonged suppression of the hypothalamus

19
Q

how do you manage in a case of break through bleeding with a patient on OCP?

A

increase the dose of OCP on the 5th day of menstruation

20
Q

inn what conditions are OCPs contraindicated ?

A 
In CVD 
inn VTE 
breast cancers 
liver cancers 
migranes with auras 
immobilization 
breast feeding 
above 35 y/o and a smoker 
above 35 BMI 
SLE 
APS ( anti-phospholipid)
21
Q

what is a vaginal contraceptive ring ?

A

ring that releases progesterone and oestrogen and has a similar effect to OCP but bypasses the first pass metabolism by the liver

22
Q

how is a vaginal contraceptive ring used ?

A

to be left inn for 21 days and may be removed during intercourse

23
Q

what is a contraceptive patch ?

A

same idea as vaginal rings, avoid the first pass metabolism by the liver

24
Q

how is a contraceptive patch used ?

A

replaced every 3 weeks with a one week interval

25
Q

what are the two types of progesterone only pills ?

A

traditional

desogestrel- containing

26
Q

what is the mechanism of action of POP ?

A

makes the cervical mucus impenetrable for sperm

27
Q

what are the disadvantages of POP ?

A

menstrual irregularities

must continuously take pill no pill free week

28
Q

what are the advantages of POP ?

A

avoids the side effects of oestrogen

no inhibition of lactation

29
Q

If a patient forgets to take her POP pill what must she be instructed ?

A

to take it as soon as she remembers and to take thew next one as well

30
Q

what instruction must be given regarding sexual intercourse if the POP pill was missed ?

A

a condom must be used for 2 days after a missed POP

31
Q

when would EC be needed in the case of a missed POP pull ?

A

if unprotected sex has happened within two days of a missed POP

32
Q

what emergency contraception can be used if required when a POP pill is missed ?

A

levonorgestrel IUD offered up to 72 hours

UPA offered up to 120 hours

33
Q

what are the two types of progesterone only injection ?

A 
depo-provera ( intra muscular injection)
sayana press ( subcutaneous)
34
Q

what other type of progesterone only methods are available ?

A

subdermal implants ( same effect as the injectables)

35
Q

what are the types of IUDs ?

A

copper intrauterine device (IUD)

progesterone intrauterine system (IUS)

36
Q

what are the types of progesterone intrauterine system ?

A

MIrena ( 5 years)

Jaydess ( 3 years)

37
Q

when should intrauterine contraception be inserted ?

A

post-menstrual

after pregnancy within the first 48 hours after delivery or 4 weeks after delivery

38
Q

what are the risk of intrauterine contraception ?

A

ectopic pregnancy
expulsion
infection

39
Q

what are the contraindications to using intrauterine contraception ?

A

Pelvic inflammatory disease
pregnancy
abnormal shape of uterine cavity

40
Q

what are the medical indications of sterilization ?

A

failure of other methods of contraception with a complete family
medical or surgical condition that may threaten the patient’s life if pregnancy occurs

41
Q

how is male sterilization done ?

A

bilateral ligation and excision of a segment of the vas

42
Q

what investigation should be done for follow up after male sterilization ?

A

a semen analysis needs to be done after 6 months to confirm success of the operation

43
Q

how is female sterilization done

A

bilateral ligation of the tubes

WH (68 decks)

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