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Year 3 Clinical > Contraception 1 > Flashcards

Contraception 1 Flashcards

1
Q

Why is contraception used?

A

To prevent pregnancy

Non-contraceptive benefits

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2
Q

Factors assoc. with higher birth rates of specific countries?

A

Western countries have lower birth rates

Higher birth rates are assoc. with lower educational attainment and reduced access to contraception

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3
Q

Ideal features of the perfect contraceptive?

A

100% effective and 100% safe

Free from side effects

Reversible

Simple and easy to use

Cheap (increases accessibility)

Non-contraceptive benefits

Acceptable to all

Not reliant on memory

Independent of medical professionals

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4
Q

Most common method of contraception used worldwide?

A

Withdrawal method

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5
Q

Describe the hypothalamic-pituitary-ovarian axis

A

Hypothalamus releases GnRH in a pulsatile manner, which stimulates LH and FSH release from the anterior pituitary

These hormones stimulate the ovaries to release oestrogen and progesterone

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6
Q

Describe the menstrual cycle

A

LH surge is prior to ovulation, which occurs at day 14

If fertilisation occurs, progesterone maintains the endometrium during the pregnancy

If fertilisation does not occur, the corpus luteum degenerates and menstruation occurs

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7
Q

Potential modes of action of contraception?

A
  1. Stop ovulation
  2. Block fallopian tubes
  3. Slow transport of ovum down the fallopian tubes, so that it dies
  4. Endometrium could be thinned, to prevent implantation
  5. Block entry via the cervix, with a diaphragm
  6. Block entry into the vagina, with a condom
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8
Q

How long do sperm live in the female genital tract?

A

5 days

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9
Q

How long do ova survive in the female genital tract?

A

17-24 hours

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10
Q

What is the Pearl index?

A

Failure rates of different types of contraception

It represents the no. of contraceptive failure per 100 women users/year

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11
Q

How is the failure rate calculated?

A

(No. of accidental pregnancies x 1200) divided by the total months of exposure

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12
Q

Methods of natural family planning?

A
  1. Basal body temperature
  2. Cervical mucous
  3. Cervical position
  4. Standard days
  5. Breastfeeding

NOTE - if being used as contraception, effectiveness increases if more than one is used; generally, they are not very effective

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13
Q

How are basal body temperature measurements used as contraception?

A

Basal body temp is taken before rising in the morning; an increased body temp by >0.2 degrees celsius

It is safe to have sex after the higher temp is sustained for 3 days, after at least 6 days of lower temp

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14
Q

How is cervical mucous used as contraception?

A

It is thick and sticky post-ovulation

Just before ovulation, mucous is thin, watery and “stretchy”; it is safe to have sex 3 days after

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15
Q

How is cervical position used as contraception?

A

When fertile, the cervix is high in the vagina and is soft & open

When less fertile, cervix is low in the vagina and is firm & closed

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16
Q

How is the standard days method used as contraception?

A

In a 28 days cycle, days 8-18 are most fertile (ovulation on day 14)

If sex is avoided on these days, less likely to fall pregnant

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17
Q

How is breastfeeding used as a method of contraception?

A

3 criteria for this to work:

  1. Patient must be exclusively breast-feeding
  2. Patient must be <6 months post-natal
  3. Patient must be amenorrhoeic
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18
Q

Types of contraception?

A

Combined Hormonal Contraception (CHC):
• Combined Oral Contraceptive pill (COC)
• Combined Transdermal Patch (CTP)
• Combined Vaginal Ring (CVR)

Progestogen only:
• Progestogen Only Pill (POP)
• Implant
• Depo injection

IUS (hormonal coil):
• Mirena
• Jaydess

Cu-IUD (copper coil)

Barrier methods:
• Male and female condoms
• Diaphragms

Natural methods

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19
Q

Mode of action of CHC?

A

Primarily inhibits ovulation

It also affects the cervical mucous and endometrium

20
Q

Failure rate of CHC?

A

Pearl Index 0.3%

21
Q

Mode of action of POP?

A

Newer POP (desogestel) mainly inhibits ovulation; it also affects cervical mucous, fallopian tube transport and the endometrium

Older POPs - affect cervical mucous, fallopian tube transport and the endometrium

22
Q

Factors to considers when prescribing CHC and POP?

A

Absorption - pill is absorbed from the jejunum, so as long as the small bowel is unaffected, it will likely be effective; examples of when absorption may be affected include Crohn’s, Bulimia, etc

Metabolism - be careful if patient is on enzyme inducers

23
Q

Mode of action of implants?

A

Primarily inhibit ovulation

Also affect the cervical mucous and endometrium

24
Q

Failure rate of implants?

A

Pearl Index 0.05%

25
Q

Mode of action of depo injection?

A

Primarily inhibit ovulation

Also affect cervical mucous and the endometrium

26
Q

Duration of depo injection effect?

A

Last 14 weeks and given every 13 weeks

27
Q

Failure rate of depo injection?

A

Pearl Index 0.2%

28
Q

Mode of action of IUS?

A

Primarily affect the endometrium, so that it is thin and unfavourable for implantation

Also affect cervical mucous and have pre-fertilisation effects

29
Q

Failure rate of IUS?

A

Pearl Index 0.2%

30
Q

Replacement of IUS?

A

Must be replaced every 5 years

31
Q

Mode of action of IUD?

A

Primarily prevent fertilisation by releasing copper and inducing an inflammatory response in the endometrium

32
Q

Replacement of IUD?

A

Lasts for 5-10 years

33
Q

Failure rate of IUD?

A

Pearl Index 0.6-0.8%

34
Q

Mode of action of barrier methods?

A

Block sperm from entering the female genital tract

35
Q

Mode of action of female sterilisation?

A

Blocks the fallopian tubes, with:
• Filshie clips
• Essure (not currently used due to incidence of pelvic pain)

36
Q

Cautions with female sterilisation?

A

Patient MUST NOT BE AT RISK OF PREGNANCY IN THE CYCLE where sterilisation is performed; this is due to the risk of ectopic pregnancy

i.e: must wait if the patient has had unprotected sex

37
Q

Mode of action of vasectomy?

A

Sperm are not ejaculated; eventually, they are reabsorbed

It is 100% effective but irreversible

38
Q

What are the methods of Long-Acting Reversible Contraception (LARC)?

A

Implants

Coils

Depo injections (partially LARC)

NOTE - these are non-patient reliant and so, with typical use, have a failure rate that is the same as the failure rate with perfect use

39
Q

What is the UKMEC?

A

UK Medical Eligibility Criteria - applies to hormonal contraception, intrauterine devices, emergency contraception and barrier methods

40
Q

Levels in UKMEC?

A
  1. No restriction for the use of the contraceptive method
  2. Where the advantages of using the method generally outweigh the theoretical/proven risks

3 A condition where the theoretical/proven risks generally outweigh the advantages of using the method; the provision of a method requires expert clinical judgement and/or referral to a specialist contraceptive provider, since use of the method is not usually recommended unless other more appropriate methods are not available or not acceptable

  1. A condition which represents an unacceptable risk if the contraceptive method is used
41
Q

History to consider before prescribing contraception?

A

PMH

FH

DH

Potential interactions

NOTE - must re-check annually

42
Q

Examination before prescribing contraception?

A

Depends upon method chosen:
• Record BP and BMI before the 1st prescription (dpo, CHC and POP methods)

Check smear status, if relevant in that patient

PV to check uterine size/position; this is relevant if the patient, e.g: wants a coil, which is difficult if the uterus is small, retroverted or if they have a congenital uterine septum

43
Q

Risk factors that are considered prior to prescribing contraception?

A

Osteoporosis

CV disease

Breast cancer

44
Q

How can a healthcare professional be reasonably certain that there is no risk of pregnancy before prescribing contraception?

A

If any one or more of the following are the case:

  1. No sex since last period
  2. Consistently use reliable contraception
  3. <7 days since last normal period
  4. <4 weeks post-partum for non-lactating/breastfeeding women
  5. Fully breastfeeding, amenorrhoeic and <6 months post-partum
  6. -ve pregnancy test and ≥3 weeks since UPSI (unprotected sexual intercourse)
45
Q

Define quick-starting contraception?

A

Starting contraception when the patient present, i.e: not waiting until their next period

In cases like this, it may not be possible to reliably exclude pregnancy (i.e: this is off-license)

46
Q

With which methods is quick-start contraception possible?

A
  1. Some CHCs
  2. POP
  3. Implant
  4. Depo

Not possible to quick-start with IUD or with pills containing cyproterone acetate

NOTE - low risk of teratogenicity with the pill, so can quick-start this and ask them to do a pregnancy test 3 weeks later to exclude pregnancy; if they are pregnant, stop the pill

47
Q

Use of pills containing cyproterone acetate?

A

Not licensed as a contraceptive; actually an acne treatment that has contraceptive actions

Year 3 Clinical (100 decks)

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