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Reproduction and Sexual Health > Contraception (1 and 2) > Flashcards

Contraception (1 and 2) Flashcards

1
Q

In general, the poorly educated have less money and less access to contraception. This leads to an _________ birth rate!

A

INCREASED

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2
Q

What is the most used contraception worldwide?

A

Withdrawal

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3
Q

When does ovulation occur?

A

14 days before menstruation

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4
Q

What hormones peak in ovulation?

A

LH and FSH

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5
Q

How can contraceptions work?

A
  • Can stop ovulation.
  • Can block the fallopian tubes, or slow the transport of the ovum down the tube so that it is dead by the time it gets to the uterus.
  • Prevent the endometrium from becoming thick enough for implantation.
  • Block at the cervix.
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6
Q

How long does sperm live in the female genital tract?

A

5 days

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7
Q

How long does a ovum survive in the female genital tract?

A

24 hours (17-24 hours)

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8
Q

What is used to express contraceptive failure rates?

A

Pearl index

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9
Q

What does the Pearl Index represent?

A

The number of contraceptive failures per 100 women users per year.

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10
Q

How is the pearl index calculated?

A

No. of accidental pregnancies x 1200 / total number of months of exposure.

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11
Q

What are the 5 main areas of natural family planning?

A

1) Basal body temperature
2) Cervical mucous
3) Cervical position
4) “Standard” days
5) Breast feeding

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12
Q

When should basal body temperature be taken?

A

In the morning, before rising !!

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13
Q

A sudden increase in basal body temperature by > 0.2oC suggests what?

A

That ovulation has taken place

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14
Q

For how long should this raised basal body temperature be sustained for to be indicative of ovulation? After what?

A

Sustained for 3 days after at least 6 days of lower temperature

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15
Q

Around ovulation, what is cervical mucous like?

A

Thin and watery. (to allow sperm to swim)

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16
Q

After ovulation, what is cervical mucous like?

A

Thick and sticky

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17
Q

Before you can quite safely say that a woman is not fertile anymore, what is required? (in terms of cervical mucous)

A

There must be thick and sticky post-ovulation mucous for at least 3 days after thinner, watery, ‘stretchy’ mucous.

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18
Q

When fertile, what is the cervix like?

A

High in the vagina, soft and

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19
Q

When less fertile, what is the cervix like?

A

Low in the vagina, firm and closed

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20
Q

What does the standard days method do?

A

Identifies the most fertile days in a female’s 28 day cycle

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21
Q

On what days are women most fertile?

A

Days 8 to 18.

ovulation usually happens at day 14, and sperm can survive for 5 days, while the ovum can survive 1 day

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22
Q

What is the criteria for lactational amenorrhoea?

A
  1. Exclusively breast feeding.
  2. Less than 6/12 post-natal.
  3. Amenorrhoeic.
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23
Q

What does the combined pill do?

A

Inhibits ovulation

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24
Q

What 2 things does the combined pill have an effect on?

A
  • Cervical mucous.

* Endometrium.

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25
Q

What is the failure rate of the combined pill?

A

Pearl index – 0.3%.

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26
Q

What is Desogestel?

A

Progesterone only pill

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27
Q

What is the mode of action of the POP?

A

Inhibit ovulation

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28
Q

What does the POP have an effect on?

A
  • Cervical mucous
  • Fallopian tube transport
  • Endometrium
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29
Q

What do older POP’s have an effect on?

A
  • Cervical mucous
  • Fallopian tube transport
  • Endometrium
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30
Q

What is the failure rate of the POP?

A

pearl index – 0.3%.

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31
Q

How long is the implant left in for?

A

3 years

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32
Q

Why is the implant more reliable than the pill?

A

It is not user dependant

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33
Q

What is the primary mode of action of the implant?

A

Inhibition of ovulation

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34
Q

Apart from inhibition of ovulation, what are the other actions of the implant?

A
  • Effect on endometrium.

* Effect on cervical mucous.

35
Q

What is the failure rate of the implant?

A

Pearl index 0.05%.

36
Q

What is the primary mode of action of the depot injection?

A

Inhibits ovulation

37
Q

How often is the depot injection given? How long does it last?

A

Given every 13 weeks.

Will last 14 weeks.

38
Q

What are the other functions of the depot injection?

A
  • Effect on cervical mucous.

* Effect on endometrium.

39
Q

What is the failure rate of the depot injection?

A

Pearl index – 0.2%.

40
Q

What is the primary mode of action of the IUS?

A

Effect on implantation - endometrium is rendered unfavourable for implantation

41
Q

What other effects does the IUS have?

A

Impact cervical mucous – makes it thick and sticky.

Also has other pre-fertilisation effects.

42
Q

What is the failure rate of the IUS?

A

Pearl index – 0.2% (approx. 1/500).

43
Q

How long does the IUS last?

44
Q

What is the primary mode of action of the IUD?

A

To prevent fertilisation.

toxic to an egg and sperm joining

45
Q

IUS releases ….?

A

Progesterone

46
Q

IUD releases ….?

47
Q

What kind of response does the IUD cause in the endometrium?

A

An inflammatory response

48
Q

How long is the IUD licenced for use?

A

5-10 years

49
Q

What is the failure rate of the IUD?

A

pearl index 0.6-0.8%. (1/200)

50
Q

What do barrier contraceptives do?

A

Block sperm from getting to the female genital tract

51
Q

What does female sterilisation do?

A

Blocks the fallopian tubes

52
Q

Via what 2 methods can female sterilisation be done?

A
  1. Filshie clips.

2. Essure (permanent coil springs put in fallopian tubes).

53
Q

What is ESSENTIAL to check before carrying out female sterilisation? Why?

A

That female isn’t at risk of pregnancy in the cycle where sterilisation is performed – could cause an ectopic pregnancy.

54
Q

Vasectomy is the division of ….

A

Vas deferens

55
Q

Female sterilisation has a higher failure rate than the coil

56
Q

What should always be recorded when prescribing someone a contraceptive?

A

BP and BMI

57
Q

What must you check before you put a coil in?

A

That someone isn’t already pregnant

58
Q

What is ‘Quick starting Contraception’?

A

Starting contraception when patient presents ie. not waiting until next period.

59
Q

What is ‘quick starting contraception possible with?’

A
  • Some CHC’s.
  • POP.
  • Implant.
  • (Depo).
60
Q

What is ‘quick starting contraception’ not possible with?

A

IUD, pills containing cyproterone acetate

61
Q

What should be done 2/3 weeks after starting ‘quick starting contraception’?

A

Pregnancy test

62
Q

What factors affect a persons choice of contraception?

A

Effectiveness.
Control.
Long/short term.
Non-contraceptive benefits.

63
Q

Give examples of non-contraceptive benefits of contraception.
(ie. factors which can be improved by contraception)

A 
Heavy menstrual bleeding
Painful periods
Acne
Irregular periods
Premenstrual symptoms
Endometriosis
Menstrual migraine (no aura)
64
Q

What is one of the most commonly used contraceptive methods in the UK (25%)?

A

Combined oral contraceptive (COC)

65
Q

There are now 3 types of CHC (pill, patch, ring) in the UK. What do all of these contain?

A

Ethinyl estradiol (EE) and a progesterone (various).

66
Q

Outline the 3 types of CHC, giving the amount of EE in each.

A
  • Combined oral contraceptive pill (COC) – 20-35μg EE.
  • Combined transdermal patch (CTP) - 33 μg EE.
  • Combined vaginal ring (CVR) - 15 μg EE.
67
Q

What is the failure rate of CHC with perfect use?

68
Q

What is the failure rate of CHC with typical use?

69
Q

The combined transdermal PATCH is affected by what?

A

Weight ≥ 90 kg  therefore, use something else

70
Q

Some COC’s are now marketed to be used continuously, or have pill-free internals of <7days

71
Q

Describe tri-cycling packs of the COC.

A

Tri-cycling – 3 ‘packs’ taken back to back then 4-7 days off

72
Q

What factors require consideration for safe prescribing of CHC?

A
  • Absorption.
  • Metabolism.
  • Metabolic effects.
73
Q

What factors may affect effectiveness of CHC?

A
  • Impaired absorption- ie. in GI conditions. (COC)
  • Increased metabolism - liver enzyme induction, drug interaction.
  • Forgetting.
74
Q

What are the 3 main risks to be aware of with CHC?

A
  • Venous thrombosis.
  • Arterial thrombosis.
  • Adverse effects on some cancers.
75
Q

The alteration in what, induced by EE, may be thrombogenic? What does this do?

A

Alteration in clotting factor levels  reduces levels of antithrombin III and protein S

76
Q

In who may EE also promote superimposed arterial thrombosis?

A

Patients with significant arterial wall disease.

77
Q

(In people who take COC’s) There is an increase in what activity? Who is this reversed in, however?

A

Fibrinolytic activity – but reversed in heavy smokers

78
Q

According to UKMEC, what are the risk factors for VTE?

A
  • Obesity.
  • Smoking.
  • Age.
  • Known thrombophilia.
  • VTE in first degree relative <45years.
  • Up to 6 weeks postnatal.
  • Trekking > 4,500 m for > 1 week
  • Long-haul flights
  • Reduced mobility
  • Antiphospholipid syndrome
79
Q

The risk of VTE in COC users is increased over non-users and varies according to what?

A

EE dose and progesterone type

80
Q

What is the VTE risk in pregnancy per 10000 women?

A

29/ 10,000

81
Q

And in the first weeks postnatally, per 10,000 women?

A

300-400/ 10,000

82
Q

What is - Co-cyprindiol - used in the treatment of?

A

Acne and hirsutism

83
Q

What are the components of Co-cyprindiol?

A

Ethinyl-estradiol 35μg/cyproterone acetate 2mg.

Reproduction and Sexual Health (51 decks)

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