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Contraception Flashcards

1
Q

When in the menstrual cycle is there the highest chance of pregnancy from sex?

A

Day 8-19 of a normal 26-32 day cycle. Egg survives 24 hrs. Most sperm survive less than 4 days.

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2
Q

What would be factors of an ideal contraception?

A

100% reversible. 100% effective (none). 100% unrelated to intercourse. 100% free of adverse side effects. 100% protective against STIs. Has non-contraceptive benefits. Low maintenance, no ongoing medical input. Male and female options.

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3
Q

What methods of contraception use a combination of hormones?

A

Combined oral contraceptive pill.
Patch
Vaginal ring

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4
Q

What hormones are used in combined hormonal contraceptive methods and what do these hormones cause?

A

Ethinyl estradiol and synthetic progesterone.
Stop ovulation. Affect cervical mucus and endometrium.
Standard regime: 21 days with a hormone free week.

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5
Q

How often is the combined hormonal patch (EVRA) changed?

A

Weekly

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6
Q

How often is the combined hormonal vaginal ring changed?

A

Every 3 weeks. (Can be taken out for 3hrs in every 24hrs so may prefer to take it out for sex)

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7
Q

What are the non-contraceptive benefits of combined hormonal methods of contraception?

A

Regulate/ reduce bleeding: helps heavy periods.
Stops ovulation: may help premenstrual syndrome.
Reduction in function of ovarian cysts.
50% reduction in ovarian and endometrial cancer.
Improves acne/ hirsutism
Reduction in benign breast disease, rheumatoid arthritis colon cancer and osteoporosis.

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8
Q

What are the possible side effects for combined hormonal methods of contraception?

A 
Breast tenderness.
Nausea 
Headache 
Irregular bleeding for first 3 months 
Weight gain: not causal
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9
Q

What are the serious risks of combined hormonal methods of contraception?

A 
Increased risk of:
- DVT,PE
- arterial thrombosis
Cervical cancer
Breast cancer
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10
Q

What type of contraception is the Desogestrel pill?

A

Progesterone only pill (mini-pill)

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11
Q

When should the progesterone only pill be taken?

A

Same time every day

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12
Q

What are the possible side effects of the progesterone only pill?

A 
Appetite increase
Hair loss/ gain 
Mood change
Bloating/ fluid retention 
Headache 
Acne
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13
Q

What does the injectable progesterone jag contain?

A

Solution of medroxyprogesteorne acetate.

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14
Q

How often is the progesterone jag administered?

A

Every 13 weeks

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15
Q

What is Depoprovera?

A

The progesterone jag

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16
Q

Where is Depoprovera administered?

A

1ml deep intramuscular injection into the upper outer quadrant of the buttock

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17
Q

Where is Sayana press injected?

A

0.6ml subcutaneous injection in abdomen/ thigh

18
Q

What is the role of the progesterone jag?

A
  1. Prevents ovulation
  2. Alters cervical mucus making it hostile to sperm
  3. Makes endometrium unsuitable for implantation
19
Q

What are the side effects of the progesterone jag.

A

Delay in return to fertility: average 9 months
Reversible reduction in bone density
Problematic bleeding especially first 2 doses
Weight gain: 2/3 of women gain 2-3 kg

20
Q

What is the subdermal progesterone implant comprised of?

A

Core: 68mg etonogestrel
Membrane: ethinyl vinyl acetate (EVA)

21
Q

What is Nexplanon?

A

The progesterone implant

22
Q

What is the role of the progesterone implant?

A

Inhibitor of ovulation and effect on cervical mucus

23
Q

How often must the progesterone implant be changed?

A

Every 3 years

24
Q

What type of contraception is the coil?

A

Long Acting Reversible Contraception

25
Q

What are the two types of coil?

A

Copper IUD

Mirena IUS

26
Q

What is the mode of action of the copper IUD?

A

Toxic to sperm: stops sperm reaching egg.
May sometimes work by preventing implantation of fertilised egg.
Hormone free.

27
Q

How long can a copper IUD last?

A

5-10 years depending on type

28
Q

What is the mode of action of the Mirena (Levonorgestrel) IUS?

A

Affects cervical mucus and endometrium
Stopes fertilisation of egg
May prevent implantation of fertilised egg.
Slow release progesterone on stem
85% of women almost bleed free by 12 months

29
Q

When does the Mirena IUD need to be changed?

A

Every 5 years

30
Q

What are the options of emergency contraception?

A

Copper IUD: most effective (fit before implantation, within 120 hrs)
Levonorgestrel pill: take within 72hrs
Ulipristal pill (Ellaone): take within 120hrs

31
Q

What drugs reduce the effectiveness of combined pill, patch, ring, POP and implant? Why is this?

A

Enzyme inducing drugs: carbamazepine, topiramate, rifampicin
These increase the metabolism of progesterone and oestrogen
Progesterone injections and Copper IUD or morning after pill are not affected.

32
Q

Describe the process of female sterilisation.

A

Laparoscopic. Filshie clips applied across tube to block lumen.
Irreversible
No effect on period/ hormones.
May do salpingectomy at planned Caesarean section if baby seems well and discussed in advance.

33
Q

Describe the process of a vasectomy.

A

Vas deferens divided and ends cauterised. Small incision midline of scrotum.
Local anaesthetic
Takes 4-5 months to be effective.

34
Q

What proportion of women in the UK will have an abortion?

A

1 in 3 women

35
Q

In what age group to abortions most commonly occur?

A

20-24 age group

36
Q

Describe the procedure for a surgical termination of pregnancy (STOP).

A

Cervical priming: misoprostol 3 hrs preop. Helps dilation and reduces risk of perforation/ haemorrhage.
Transcervical: 6-10mm suction catheter
<10 mins

37
Q

What is used in a medical termination of pregnancy (MTOP)?

A

Mifepristone oral antiprogesterone tablet.

36-48hrs later, uterine contraction which opens cervix and expels pregnancy

38
Q

What is a diaphragm?

A

Barrier method of contraception. Fits inside vagina and prevents sperm passing through the cervix.
Inserted before sex
Works better when used with a spermicide

39
Q

What is a cervical cap?

A

Barrier method of contraception. Fits over the cervix and blocks sperm from entering through os.

40
Q

What are the failure rates for perfect and typical use of condoms?

A

Perfect use: 3%

Typical use: 12%

Reproduction (13 decks)

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