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Y3 repro > contraception > Flashcards

contraception Flashcards

1
Q

contraceptive methods available in UK

A

combined hormonal contraception (CHC), pill or patch - 25%
progesterone only pill (POP) - 5%
progesterone only implants/injection - 5%
intrauterine methods - 6%
sterilised (M/F) - 28%

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2
Q

what makes the ideal contraceptive

A 
100% reversible 
100% effective
unrelated to intercourse
free of adverse side effects
protective against STIs
non-contraceptive benefits
low maintenance, no ongoing medical input
male and female options
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3
Q

how can the effectiveness of contraceptive be descreibed

A

pearl index - number of pregnancies per 100 women within the first year of use
looks at the total mths/cycles of exposure from the initiation of the product to the end of the study

life table analysis provides the pregnancy rate over a specified time frame and can provide a cumulative failure rate for any specific length of exposure

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4
Q

LARC

A

long acting reversible contraception - less user input therefore minimises user failure rates
injection, implant, copper IUD, IUS

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5
Q

what is method failure

A

pregnancy despite correct use of method

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6
Q

what is user failure

A

pregnancy because method not used correctly

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7
Q

when can sex cause pregnancy

A

if 26-32 day cycle and no on hormonal Rx:
likely to ovulate day 12-18
egg survives 24hrs
most sperm survive <4days (5% up to 7days)
highest chance of pregnancy = sex on day 8-19

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8
Q

why can natural methods of contraception fail

A

sperm survival and ovulation timing after last period is variable
even w/ abstinence or barrier options on fertile days as predicted from usual cycle, natural methods can fail
use

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9
Q

what is within combined hormonal contraception

A 
ethinyl estradiol (EE)
synthetic progesterone
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10
Q

what does CHC do

A

stops ovulation

also affect cervical mucus and endometrium

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11
Q

standard regime for CHC

A

21 days w/ hormone free week

sex is safe in pill free week - must remember to start new pack

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12
Q

tailored regimes for CHC

A

tricycling/continuous use
no need for uncomfortable inconvenient withdrawal bleed
avoids forgetting to restart after break

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13
Q

types of CHC

A

pill
patch
vaginal ring

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14
Q

pill CHC

A

taken daily, anytime within 24hrs

not good if frequent GI upset - may not be absorbed properly

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15
Q

patch CHC - EVRA

A

changed weekly
applied to hairless skin, not breast area
<5% have skin reaction

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16
Q

ring CHC - nuvaring

A

changed every 3wks
can take out for 3hrs in 24
may prefer to take out for sex

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17
Q

non-contraceptive benefits of combined hormonal methods

A

regulate/reduce bleeding
stop ovulation - may help premenstrual syndrome
reduction in functional ovarian cysts
50% reduction in ovarian and endometrial cancer
improve acne/hirsutism
reduction in benign breast disease, rheumatoid arthritis, colon cancer and osteoporosis

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18
Q

side effects of CHC

A

breast tenderness
nausea
headache
irregular break thorugh bleeding in first 3mths
may effect mood - causal relationship or other life events?
weight gain - not causal

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19
Q

serious risks of CHC

A

increased risk venous thrombosis - DVT, PE
increased risk artherial thrombosis - MI, ischaemic stroke
increased risk cervical cancer - data predates HPV vaccine
increased risk breast cancer

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20
Q

who shouldn’t be using CHC

A

PE/DVT RISK: BMI>34, previous VTE, 1st degree relative VTE <45y/o, reduced mobility, thrombophilia (e.g. SLE)
MI/STROKE RISK: smokers >35 y/o, personal hx arterial thrombosis, focal migraine, >50y/o, HT >140/90

active gall bladder disease/prev liver tumour

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21
Q

breast cancer and CHC

A

back to normal after 10yrs off Rx, avoid if prev breast cancer

non BRCA FHx breast cancer not a CI

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22
Q

risk of VTE w/ CHC

A

risk increases from:
2/10 000 p/a in general pop
5-7/10 000 p/a w/ COC use (LNG and NET progesterone)
6-12/10 000 w/ patch/ring/COC other progesterone use
50/10 000 w/ pregnancy

pill increases risk 3x - overall risk is still small
need VTE prophylaxis if inpatient/surgery/immobile

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23
Q

progestogen only pill (POP) - how to take

A

same time every day w/o pill free interval

not good choice if frequent GI upset - poor absorption

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24
Q

types of POP

A

desogestrel pill

traditional LNG NET pills

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25
Q

desogestrel pill

A

12hr window period
nearly all cycles anovulant - also affect mucus
most users bleed free after 1st 4-6mths

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26
Q

traditional LNG NET pills

A

3hr window period
1/3 anovulant
2/3 rely on cervical mucus effect
1/3 bleed free, 1/3 irregular, 1/3 regular periods

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27
Q

CI for POP

A

oestrogen free so very few CI

personal Hx breast cancer (current) or liver tumour (past/present)

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28
Q

POP side effects

A 
appetite increase
hair loss/gain
mood change
bloating/fluid retention
headache
acne
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29
Q

risk of VTE/aterial thrombosis on POP

A

no increased risk with contraceptive doses of progestogen

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30
Q

injectable progestogen

A

medroxyprogesterone acetate

dose every 13wks

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31
Q

site of progestogen injection

A

1ml deep IM injection
upper outer quadrant of buttok - depoprovera
0.6ml SC injection abdo/thigh, possible self administration - Sayana press

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32
Q

how does the progestogen injection work

A

prevents ovulation
alters cervical mucus - hostile to sperm
endometrium unsuitable for implantation

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33
Q

benefits of progestogen injection

A

only need to remember every 12-14wks
70% amenorrhoeic after 3 doses
oestrogen free - few CI

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34
Q

disadvantages of progestogen injection

A

delay in return to fertility - ~9mths
reversible reduction in bone density - discuss other risks for osteoporosis
problematic bleeding - esp after 1st 2 doses
weight gain - 2/3 of women 2-3kg

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35
Q

what is the only contraceptive method with a causal effect on weight gain , delayed return of fertility and bone density

A

progestogen injection

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36
Q

subdermal implant - nexplanon - contents

A

small plastic rod, 4cm long
core - 68mg etonogestrel (ENG)
membrane - ethinyl vinyl acetate (EVA), rate controlling

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37
Q

progestogen implant effects

A

inhibition of ovulation

effect on cervical mucus

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38
Q

benefits of progestogen implant

A

can last 3 yrs, can be removed at any time
no user input needed
no causal effect on weight change
60% are almost bleed free

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39
Q

disadvantages of progestrogen implant

A

30% have prolonged/frequent bleeding

causes mood change more often than other progestogen only methods

40
Q

how long does intrauterine contraception last

A

5-10yrs

41
Q

benefits of intrauterine contraception

A

little user input after fitting, can check own threads
can be fitted for any age and any parity
effects/side effects immediately reversible when removed

42
Q

risks of intrauterine contraception

A

very small infection risk in first 3wks (<1:1000) - offer STI testing to all w/ new partner or <25y/o
1:1000 risk perforation
5:100 risk expulsion - check threads after every period
higher risk of ectopics, method is so effective that ectopic risk lower than for condoms

43
Q

who cannot have intrauterine contraception

A

untreated pelvic infection

distorted endometrial cavity e.g. submucous fibrouds/bicornuate/previous ablation

44
Q

mode of action of copper IUD

A

toxic to sperm
stop sperm reaching egg
may sometimes work by preventing implantation of fertilised egg

45
Q

advantages of copper IUD

A

hormone free
can last 5-10yrs depending on type
device fitted after 40y/o can work until menopause
not CI to MRI

46
Q

disadvantages of copper IUD

A

may make periods heavier/crampier

47
Q

levonorgestrel IUS effects

A

affects cervical mucus and endometrium
most women still ovulate
stops fertilisation of egg
may prevent implantation of fertilised egg

48
Q

release of progestogen in levonorgestrel IUS

A

slow release progestogen on stem

low circulating levels compared w/ pill/implant/injection

49
Q

effect of IUS on menstrual bleeding

A

reduce bleeding after up to 4mths initial irregular bleeding

50
Q

Mirena IUS - how long does it last

A

5yrs contraception (if fitted >45y/o effective till 55)

51
Q

Mirena IUS - effect on bleeding

A

85% almost bleed free by 12mths

52
Q

Mirena IUS - dose

A

equivalent systemic dose to 3 POP/wk

53
Q

other uses for Mirena IUS

A

licensed to treat heavy menstrual bleeding

can act as the progestogenic part of HRT for 5yrs

54
Q

Kyleena IUS - how long does it last

A

5yrs

55
Q

Jaydess IUS - how long does it last

A

3yrs

56
Q

benefits of Kyleena/Jaydess USS

A

less progestogen so even less chance of side effects BUT less likely to be bleed free
smaller frame and insertion tube

57
Q

what are the 3 types of emergency contraception

A 
most effective - copper IUD
levonorgestrel pill (Levonelle)
Ulipristal pill (Ellaone)
58
Q

Copper IUD emergency contraception

A

fit before implantation - within 120hrs of unprotected sex at any point of cycle OR by day 19 of 28 day cycle
can keep long term if working well
<1 pregnancy for 100 women using it

59
Q

levonorgestrel pill (Levonelle) emergency contraception

A

take within 72hrs

2-3 pregnancies for 100 women

60
Q

Ulipristal pill (Ellaone) emergency contraception

A

take within 120hrs
more CI e.g. breastfeeding/enzyme inducing drugs
1-2 pregnancies for 100 women

61
Q

when to start contraception

A

immediate cover if started in first 5days of cycle
can start at other points in cycle if no risk of pregnancy (need condoms/abstain for next 7 days AND do pregnancy test after 4wks)

62
Q

how soon after delivery can you become pregnanct

A

from 21days after delivery

5 days after miscarriage or abortion

63
Q

for how long is breastfeeding contraceptive

A

only for first 6mths AND feeding every 4hrs AND amenorrhoeic

a breastfeeding woman can use any type pof contraception - wait 6wks before CHC

64
Q

contraception and drug interactions

A

enzyme inducing drugs increase the metabolism of progestogen and oestrogen and reduce the effectiveness of combined pill, patch, ring and POP and the implant

progestogen injections and copper IUD/levonorgestrel IUS are not affected

65
Q

examples of enzyme inducing drugs

A

carbamazepine
topiramate
rifampicin
St John’s Wort

66
Q

how is female sterilisation normally carried out

A

laparoscopic
usually Filshie clips applied across tube to block tube lumen
metal/silicone
not CI for MRI

67
Q

effects of female sterilisation

A

risks of GA and laparoscopy
irreversible - risk regret
failure rate 1/200 in lifetime - could be ectopic

68
Q

does female sterilisation effect periods/hormones

A

no

69
Q

female sterilisation and ovarian cancer risk

A

reduces risk

even more reduction if salpingectomy but this is a more complex surgery

70
Q

when can a salpingectomy be carried out

A

at planned C section if baby seems well and discussed in advance

71
Q

what is a salpingectomy

A

surgical removal of one or both fallopian tubes

72
Q

vasectomy procedure

A

local anaesthetic, most done in 1y care
small incision midline scrotum
vas deference divided
ends cauterised

73
Q

how long does a vasectomy take to become effective

A

4-5mths
2 sperm samples sent in by post after 4 and 5 mths
failure rates 2/100 do not get clear samples

74
Q

failure rate of vasectomy

A

after 2x clear samples

1/2000

75
Q

is a vasectomy reversible

A

irreversible

anti-sperm antibodies even if vas reconnecte

76
Q

side effects of vasectomy

A

<1:100 risk long term testicular pain

77
Q

effects of vasectomy on other functions and cancer risk

A

no effects on testosterone or sexual function

no increased risk of testicular/prostate cancer

78
Q

stats for abortion

A 
1/3 women in UK
most common 20-24y/o
numbers falling, esp in 20s
90% under 12 wks
linked to deprivation
79
Q

types of contraception in use by women at TOP clinic

A

condoms - most common
unprotected sex (UPSI) - only 10% of these took emergency contraception
pills
LARC

80
Q

what is TOP

A

termination of pregnancy

81
Q

rights and responsibilities of clinicians regarding TOP

A

right to refuse participation in abortion because they have a conscientious objection to the procedure

obligation to ensure that the woman is still able to access abortion care

right to refuse participation as long as this doesn’t affect any duty to participate in treatment which is necessary to save the life/prevent grave permanent injury to the physical/mental health of a pregnant woman

82
Q

1967 abortion act

A

2 Drs sign

Continuing the pregnancy has grave risk to the life of the pregnant woman- greater than if pregnancy terminated

Termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman

Under 24 weeks and continuation of pregnancy involves risk greater than if the pregnancy were terminated of injury to the physical or mental health of the pregnant woman

Under 24 weeks and continuation of pregnancy involves risk greater than if the pregnancy were terminated of injury to the physical or mental health of the existing child (ren) of the pregnant

There is a substantial risk that if the child were born it would suffer physical or mental abnormalities as to be seriously handicapped

83
Q

TOP clinic consultation

A

medical Hx - risk VTE/bleeding/from GA/contraceptive eligibility
circumstances - reason for considering abortion, support see alone/language line, check no coercion
usually need scan to confirm gestation and viable IUP
discuss methods of abortion
risks
contraception for afterwards

84
Q

risks of abortion

A

infection <10%

blood transfusion <1:1000

85
Q

investigations before abortion

A

FBC/rhesus group >10wks or STOP +/- heamoglobinopathy
vaginal swab for chlamydia, gonorrhoea, TV
STI bloods offered - BBV, syphilis

86
Q

long term effects of abortion

A

safer than a full term delivery
no effect on future fertility unless infection/perforation
no effect on cancer risks
emotional effects - depend on reasons for abortion, pre-existing mental health issues

87
Q

when is surgical termination of pregnancy carried out

A

5-12wks

88
Q

procedure - surgical termination of pregnancy

A

cervical priming - misoprostol 3hrs preop, helps dilation, reduces risk of perforation/haemorrhage
GA/LA cervical block
transcervical - 6-10mm suction catheter
<10 mins

89
Q

complications of surgical termination of pregnancy

A

1-4:1000 perforation
<1:100 cervical injury
risks from GA

90
Q

when is medical termination of pregnancy carried out

A

5-23+5wks

91
Q

medical termination of pregnancy procedure

A

mifepristone - oral antiprogestogen tablet
36-48hrs later misoprostol initiates uterine contraction which opens cervix and expels pregnancy
avg 4-6hrs to pass pregnancy <12wks

92
Q

complications of medical termination of pregnancy

A

failure 1/100 <8wks, 8:100 >12wks

need surgery for incomplete abortion

93
Q

early medical abortion at home

A

legal to supply misoprostol for women to take away from clinic for home self administration
since COVID now also legal to supply mifepristone for home self administration

analgaesia supplied
phone advice 24/7

94
Q

who can have an early medical abortion at home

A

women <10wks gestation and prefer a home procedure and are healthy and have support

95
Q

follow up for early at home abortion

A

low sensitivity pregnancy test at 2wks or scan sooner if minimal bleeding

Y3 repro (47 decks)

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