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1
Q

basal body temperature rise is due to?

A

high oestrogen levels?

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2
Q

how long is it sustained for?

A

3 days after ovulation

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3
Q

how much is the temperature raised by?

A

increase over 0.2 degrees

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4
Q

observing mucous, what is it like after ovulation?

A

thick

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5
Q

before ovulation?

A

thin and watery - egg white is ideal

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6
Q

cervix position when fertile?

A

high in vagina, soft and open?

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7
Q

when less fertile?

A

low and closed

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8
Q

in 28 day cycle - which days are most fertile?

A

8 -18

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9
Q

conditions for breast feeding - how effective is it? the three conditions?

A

98%. you are exclusively breastfeeding, baby is less than 6 months old. you are amenorrheic

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10
Q

UKMEC 1-4?

A

1 - no restriction, 2 advantages outweigh disadvantages, 3 risks outweigh advantages, 4 unacceptable risk

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11
Q

what is the pearl index?

A

number of failures out of 100 women users per year

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12
Q

LARC contraception?

A

depo provera

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13
Q

VLARC?

A

implant, IUD, IUS

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14
Q

how does depo proverb work?

A

inhibits ovulation

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15
Q

what does it have an effect on?

A

cervical mucus and endometrium

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16
Q

3 things you need to check before starting (going in)?

A

blood pressure, smear status, osteoporosis risk factors

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17
Q

underweight, steroid use, anorexia, excess alcohol, immobility, family history, smoking, low trauma fractures are risk factors, as well as hypothyroid, coeliac, RA, hyperparathyroidism, IBD, renal disease

A

ceoliac and IBD - not absorbing calcium

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18
Q

when can depo be started up to and including(which day of cycle?) without need for any more contraception?kev

A

day 5

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19
Q

beyond 5 days, can start the deep at any time, providing “relatively certain” she is not pregnant and?

A

use condoms/abstinence for 7 days

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20
Q

reasonably certain - what does this mean?

A

no sex since last period, reliable and consistent with last contraception, less than 7 days of normal period, less than 4 weeks post part, fully breastfeeing, amennorrheic and 6 months post partum. negative pregnancy test after 3 weeks after last episode of UPSI

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21
Q

if pregnancy can’t be excluded, what do you do?

A

do a pregnancy test after 3 weeks, then start depo

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22
Q

side effects?

A

weight gain - PROVEN, irregular bleeding, delay in return to fertility, risk of osteoperosis

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23
Q

IUD - when can it be fitted?

A

within the first 7 days of a period or ANYTIME providing reasonably certain not pregnant

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24
Q

can be fitted up to _____ days after UPSI or predicted date of ovulation

A

5

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25
Q

what does it contain?

A

copper and plastic

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26
Q

how dies it work? 2 things?

A

prevents ferTilisaTion, causes inflammatory response in endometrium

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27
Q

what can it cause?

A

endometritis

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28
Q

is it hormonal?

A

no

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29
Q

licesnsed for how long?

A

5-10 years IIIII

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30
Q

when can it be given in terms of childbirth/TOP?

A

within 48 hours of childbirth or after 4 weeks post partum or immediately after TOP

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31
Q

IUS - T shaped device with?

A

elastmorer core

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32
Q

______mg LNG IUS?

A

52 (sim, blackett)

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33
Q

how much is released daily?

A

20mcg

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34
Q

decreasing to _____mcg per day at 5 years?

A

10

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35
Q

has an effect on? 2 things

A

implantation and an effect on cerival mucus

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36
Q

renders endometrium?

A

unfavourable for implantation

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37
Q

failure rate?

A

0.2%

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38
Q

same as IUD, can be given in first 7 days, or anytime if reasonably certain not pregnant. can be given within 48hrs of giving birth or later 4 weeks post part, or immediately after TOP

A

y

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39
Q

contraindications to IUD/IUS?

A

current pelvis infection, pregnancy, infection, endometrial carcinoma, gestational trophoblastic disease (b hcg levels abnormal), abnormal uterine anatomy

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40
Q

side effects IUD?

A

pain, heavy prolonged menses, infection increased in first 20 days, perforation and expulsion

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41
Q

side effects of IUS?

A

lighter less frequent bleeding, pain and increased risk of infection, perforation and expulsion

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42
Q

implant ____mg ENG?

A

68

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43
Q

licensed for how long?

A

3 years

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44
Q

releases 60/70mg per day in weeks?

A

5-6, then 25-30/day by end of 3rd year use

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45
Q

how does it work?

A

inhibits ovulation

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46
Q

failure rate?

A

0.01%

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47
Q

when can it be fitted?

A

within first 5 days of cycle, up to day 5 post 1st/2nd trimester abortion, ON or BEFORE day 21 post partum

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48
Q

***there is need for additional precautions in the first 7 days

A

y

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49
Q

when is it immediately effective if fitted

A

after last active pill in pack taken, depo still within 14 weeks, or if in week 2-3 of COC, patch or ring

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50
Q

side effects of implant?

A

wight gain, acne, irregular bleeding

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51
Q

can cause nerve damage or vascular injury, if inserted too deep

A

y

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52
Q

risk of what 3 cardiovascular complications?

A

CV, MI, VTE

53
Q

when do you need additional precautions for first 7 days? when switching from?

A

Progesterone only pill or LNG IUS . POP LNG, switching from non hormonal method such as IUD

54
Q

what drugs does the implant have interactions with?

A

enzyme inducers

55
Q

3 types of short acting contraception?

A

CHC, POP and EHC

56
Q

advantages of combined hormonal contraceptive?

A

can fix heavy menstrual bleeding, painful periods, acne, irregular periods, pre menstrual symptoms, endometriosis, menstrual migraine

57
Q

short acting contraception all contain oestrogen in which form?

A

ethinyl estradiol

58
Q

combined pill has _______ugEE?

59
Q

vaginal ring?

60
Q

patch ?

61
Q

failure rate - typical? perfect?

62
Q

how does the CHC work?

A

inhibits ovulation via action on hypothalamic - pituitary ovarian axis to decrease LH and FSH

63
Q

what does it also do?

A

alters cervical mucus and renders endometrium unfavourable to implantation

64
Q

standard regime?

A

21days on, stop for 7 and get a bleed

65
Q

patch - how does it work with timings?

A

1 patch applied for 1 week to suppress ovulation, reapplied for 2 weeks. 4th week is patch free

66
Q

factors that effect effectiveness of CHC?

A

impaired absorption, GI conditions, increased metabolism, liver enzyme induction, drug interactions

67
Q

what does CHC reduce levels of which increases risk of thrombus?

A

anti thrombin 3 and protein s

68
Q

in patients with significant arterial wall disease, EE may also promote

A

superimposed arterial thrombosis

69
Q

risks in terms of arterial/venous/cancer?

A

risk of venous and arterial thrombosis and can have an adverse effect on some cancers

70
Q

cyproterone acetate, which patients would this be given to?

A

patients with acne/hirsutism

71
Q

name of the drug?

A

co-cyprindiol

72
Q

the risk of VTE varies between products, depends on type of ?

A

progesterone

73
Q

risk of MI in COC? particularly?

A

small increased risk, particularly in smokers

74
Q

hypertensives are at much higher risk of MI and stroke if using the COC

75
Q

increased risk of stroke when using the pill

76
Q

migraine with aura is contraindicated, why?

A

it increases the risk of having an ischaemic stroke

77
Q

being over 35 - what UKMEC is this?

78
Q

what does this mean?

A

benefits outweigh risks, but consider other risks

79
Q

breast cancer - what is the increased relative risk? how long does it take to return to normal after stopping?

A

1.24 x increased relative risk, 10 years

80
Q

UKMEC for family history of breast cancer?

A

UKMEC 1 (no restriction)

81
Q

personal history of breast cancer\?

A

contraindicated

82
Q

BRACA?

A

UKMEC 3 (risks outweigh benefits) (ladder)

83
Q

risk of cervical cancer?

A

small increased risk with long term use

84
Q

reduces to baseline?

A

10 years after stopping

85
Q

what do you have to discuss with these patients?

A

HPV/condom use/up tp date with cervical screening

86
Q

breastfeeding women less than 6 months post partum?

87
Q

benefits of CHC? cancers

A

protection against ovarian cancer and endometrial cancer

88
Q

all CHC show a beneficial effect on acne

A

decreased risk of cyst recurrence

89
Q

also very good for ?

A

PCOS and pre menstrual syndrome

90
Q

if bleeding (happens in up to 20%), when do you not change before?

91
Q

can cause mood changes, but no evidence….?

A

it causes depression

92
Q

other side effect?

A

weight gain

93
Q

side effects of patch?

A

more breast pain, nausea, painful periods

94
Q

ring?

A

less bleeding problems, acne. irritability and mood changes

95
Q

CHCs that contain (3), have lowest risk of VTEs?

A

nnl, levonngrestel, norehisterone or norgestimate

96
Q

when can you start CHC?

A

up to day 5, without need for further contraception

97
Q

OR?

A

any time after day 5, BUT, condoms or abstinence for 7 days

98
Q

after 7evonelle, need to abstain/use condoms for ?

99
Q

ullipristol acetate/ella one?

100
Q

if one pill missed >24 hours, but less than 48 hours, what needs to be done?

A

take pill as soon as remembered, remaining taken at normal time

101
Q

is EC required?

102
Q

more than 48 hours without pill?

A

take most recent pill, use condoms or abstain until 7** pills have been taken consecutively

103
Q

if its in the first week?

A

consider emergency contraception

104
Q

day 8-14?

A

no extra instructions

105
Q

day 15-21?

A

omit pill free interval

106
Q

patch can remain off up to 48 hours without efficacy being reduced. how long can the patch free period be extended up to?

107
Q

how long can the ring be left out the vagina without efficacy being reduced

108
Q

can be worn up to ____weeks without efficacy being reduced?

109
Q

ring free period can be extended to ___days?

110
Q

progesterone only pill…

A

levonorgestel, norethisterone LENOR

111
Q

primary mechanism?

A

thickens cervical mucus

112
Q

what is the newer POP called?

A

etonorgestrel - longer acting. eton, pack

113
Q

2y mechanism? frid

A

suppression of ovulation, decrease in receptor activity to blastocyst and reduction in cilia activity in fallopian tube

114
Q

current breast cancer is UKMEC?

115
Q

has interactions with?

A

liver enzyme inducers

116
Q

what pathway is involved?

117
Q

the effect continues for how long after stopping ?

118
Q

older pills and newer pills - when do they need to be taken?

A

older 24-27 hours, newer 24-36 hours

119
Q

one missed dose plus UPSI, what happens?

A

emergency contraception (plus 2 extra days protection)

120
Q

emergency contraception…

A

7evonelle, ella one, copper IUD

121
Q

when can 7evonelle be given?

A

72 hours after unprotected sex

122
Q

when can ella one be given?

A

120 hours post UPSI

123
Q

copper IUD?

A

up to 5 days

124
Q

which is more reliable? ella one or levonelle?

125
Q

what kind of drug is ella one?

126
Q

levonelle?

A

enzyme inducer

127
Q

what do they both do?

A

inhibit/delay ovulation

128
Q

side effect of 7evonelle?

A

increased BMI

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