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Y5 O&G > Contraception > Flashcards

Contraception Flashcards

1
Q

What are the options for emergency contraception and when must they be taken?

A
  • Levonorgesterol = within 72 hours
  • Ulipristal = within 120 hours
  • Copper IUD = within 120 hours
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2
Q

Describe the levonorgesterol pill?

A
  • Mechanism = stops ovulation and inhibits implantation
  • Dose = 1.5mg stat (double dose if >26 BMI or >70kg)
  • 95% effective in <24 hours, 84% effective <72 hours
  • Safe and well-tolerated
    • Potential slight menstrual cycle disturbance
  • If vomiting within 2 hours of dose → repeat the dosage
  • Can be used >1 in each menstrual cycle
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3
Q

Describe the copper IUD?

A
  • Mechanism = selective progesterone receptor modulator → inhibits ovulation
  • Dose = 30mg statSTAT
  • 95% effective in <120 hours (5 days)
  • If on hormonal contraception, should restart 5 days after ulipristal
  • Use barrier for 5 days
  • If vomiting within 3 hours of dose → repeat the dosage
  • Unsure if safe if used >1 in each menstrual cycle
  • Contraindications = Levenorgesterol or Severe asthma
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4
Q

What are the side effects of emergency contraception pills?

A
  • N&V
  • Headache
  • Breast tenderness
  • Abnormal menstrual bleeding
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5
Q

What is the Pearl Index?

A

The number of pregnancies occurring per 100 woman-years

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6
Q

What is the mechanism of the COCP?

A

Prevents ovulation

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7
Q

What different ways can the COCP be taken?

A
  1. OD for 3 weeks → 1 week off = withdrawal bleed
  2. Tricycle = OD for 9 weeks → 1 week off = withdrawal bleed
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8
Q

What are the benefits of the COCP?

A
  • >99% effectiveness - if taken correctly
  • Reversible on stopping
  • Less pain, more regular, lighter periods - used in dysmenorrhoea
  • Reduced risk of ovarian, endometrial and bowel cancer
    • Ovarian cancer risk is associated to the greater number of ovulations
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9
Q

What are the side effects of the COCP?

A
  • Headache
  • N&V (if vomit <2hr since pill, take another)
  • Breast tenderness
  • Mood swings
  • Decreased libido
  • Bloating
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10
Q

What are the disadvantages of the COCP?

A
  • Easy to forget to take
  • May cause breakthrough bleeding and spotting at first
  • Does not reduce risk of STIs
  • Increased risk of VTE , breast cancer, cervical cancer
  • Has to be stopped 4w before surgery - can’t be restart until 2w after surgery
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11
Q

What are the contraindications to the COCP?

A
  • <6w postpartum and breastfeeding
  • Ischaemic or valvular HD
  • Diabetes with complications
  • ≥35yo and smoke >15/day
  • BP >160/100mmHg
  • VTE history
  • Breast cancer
  • Migraine with aura
  • Liver damage
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12
Q

What should a patient do if they miss doses of the COCP?

A
  • 1 pill missed = take last pill and current pill (even if 2 in 1 day) → no further action needed
  • 2 pills missed = take last pill and current pill (even if 2 in 1 day) → further action
    • Use condoms until pill has been taken correctly for 7 days in a row
    • 2 missed in week 1 → consider emergency contraception
    • 2 missed in week 2 → no need for emergency contraception
    • 2 missed in week 3 → finish current pack, start new pack immediately/no pill-free break
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13
Q

What is the mechanism of the POP?

A

Thickens cervical mucus

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14
Q

How is the POP taken?

A

OD at the same time every day → no pill-free week

  • If started if first 5 days of the cycle → offers immediate contraceptive protection
  • If starting at any other time → use additional measures for the first 2 days
  • If switching over from the COCP → provide immediate protection
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15
Q

What are the benefits of the POP?

A

It doesn’t have the same risks of oestrogen

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16
Q

What are the side effects of the POP?

A
  • Irregular bleeding
  • Acne
  • Constipation
  • Irritability
  • Breast tenderness
  • Mood changes
  • Headache
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17
Q

What are the disadvantages of the POP?

A
  • Very easy to forget to take
  • Initial irregular bleeding - this can continue = most common complaint
    • 20% = amenorrhoeic
    • 40% = bleed regularly
    • 40% = bleed irregularly
  • Osteoporosis
  • Ovarian cysts
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18
Q

What should a patient do if they miss doses of the traditional POP?

A
  • <3 hours late = continue as normal
  • 3+ hours late = take missed pill ASAP, continue with rest of pack + extra precautions/condoms until pill taking has been re-established for 48 hours
  • If missed 2 pills = take last missed pill and next pill, and use barrier methods until pill-taking has been re-established for 48 hours
  • Emergency contraception needed if UPSI during this interval
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19
Q

What should a patient do if they miss doses of the cerazette/desogestrol (POP)?

A
  • <12 hours late = continue as normal
  • >12 hours late = take missed pill ASAP, continue with rest of pack + extra precautions/condoms until pill taking has been re-established for 48 hours
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20
Q

What is the mechanism of the combined hormonal transdermal patch?

A

Thickens cervical mucus and prevents ovulation

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21
Q

What different ways can the combined hormonal transdermal patch be taken?

A
  • Applied and replaced weekly for 3 weeks → 1 week off = withdrawal bleed
  • Tricycle = Applied and replaced weekly for 9 weeks → 1 week off = withdrawal bleed
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22
Q

What are the benefits of the combined hormonal transdermal patch?

A

Harder to forget - done less frequently

23
Q

What are the disadvantages of the combined hormonal transdermal?

A

Skin sensitivity

24
Q

What are the contraindications to the combined hormonal transdermal?

A
  • <6w postpartum and breastfeeding
  • Ischaemic or valvular HD
  • Diabetes with complications
  • ≥35yo and smoke >15/day
  • BP >160/100mmHg
  • VTE history
  • Breast cancer
  • Migraine with aura
  • Liver damage
25
What should a patient do if they miss doses of the combined hormonal transdermal?
* Delayed change \<48 hours = change immediately with no further precautions * Delayed change \>48 hours in week 1 or 2 = change immediately and use barrier protection for 7 days * If UPSI \<5 days or during extended patch-free period, consider emergency contraception * Delayed removal \>48 hours in week 3 = remove immediately and apply next patch on the usual start date of the next cycle (no additional contraception is needed) * Delayed at the end of the patch-free week = use barrier contraception for 7 days
26
What is the mechanism of the combined hormonal ring?
Thickens cervical mucus and prevents ovulation
27
How is the combined hormonal ring taken?
Applied for 3 weeks → 1 week off = withdrawal bleed
28
What are the benefits of the POP?
Harder to forget - applied less frequently
29
What are the disadvantages of the combined hormonal ring?
* Skin sensitivity * Patch adherence
30
What are the contraindications to the combined hormonal ring?
* \<6w postpartum and breastfeeding * Ischaemic or valvular HD * Diabetes with complications * ≥35yo and smoke \>15/day * BP \>160/100mmHg * VTE history * Breast cancer * Migraine with aura * Liver damage
31
What are the types of long-acting methods of reversible contraception?
* Intrauterine system = progesterone coil * Intrauterine device = copper coil * Implantable contraceptives * Injectable contraceptives
32
What is the mechanism of the IUS/Mirena?
Prevents endometrial thickening and thickens cervical mucus
33
What are the benefits of the IUS/Mirena?
* 99% effective * Lasts for 3-5 years * Initially irregular bleeding → followed later by lighter menses or amenorrhoea
34
What are the disadvantages of the IUS/Mirena?
* Risk of expulsion * Infection * Perforation
35
What are the side effects of the IUS/Mirena?
* Irregular bleeding * Acne * Constipation * Irritability * Breast tenderness * Mood changes * Headache
36
What are the contraindications to the IUS/Mirena?
* Pregnancy * PID * Malignancy * Unknown bleeding
37
What are the indications for the IUS/Mirena?
* Heavy bleeding periods * PMS - good for mood symptoms
38
What are Jaydess and Kyleena?
* Jaydess * Smaller IUS used for contraception * Lasts for 3 years * Not indicated for menorrhagia * Kyleena * Smaller IUS used for contraception * Lasts for 5 years * Not indicated for menorrhagia
39
What is the mechanism of the IUD/Copper coil?
Decrease sperm motility and survival - causes sterile inflammation → implantation not possible
40
What are the benefits of the copper coil?
* Lasts up to 10 years * Works immediately
41
What are the disadvantages of the copper coil?
Can't be used in menorrhagia
42
What are the contraindications to the copper coil?
* Pregnancy * PID * Malignancy * Unknown bleeding
43
What are the side effects of the copper coil?
* Heavy and painful periods * Expulsion * Infection * Perforation
44
What is the mechanism of the implant?
Prevent ovulation and thickens cervical mucus
45
What are the benefits of the implant?
* Lasts up to 3 years * Fertility reversible immediately
46
What are the contraindications to the implant?
IHD
47
What are the side effects of the implant?
* Irregular bleeding * Acne * Constipation * Irritability * Breast tenderness * Mood changes * Headache
48
What are the side effects of the implant?
* Irregular bleeding * Acne * Constipation * Irritability * Breast tenderness * Mood changes * Headache
49
What is the mechanism of the depo-provera injection?
Prevent ovulation and thickens cervical mucus
50
What are the benefits of the depo-provera injection?
* Lasts 12-14 weeks and is hard to forget
51
What are the disadvantages of the depo-provera injection?
* Fertility can take 6-12 months to return following the last injection * Weight gain * Ectopic pregnancy
52
What counselling should be given to women around contraception?
* All LARCs take 1 week to start being effective - except copper IUD * Previous personal or family history of VTE, migraine, cancer, stroke and hypertension * Menstrual problems (e.g. heavy periods) * Explain that the contraception can be divided into long-acting and short-acting * Discuss the need for family planning before deciding on the contraceptive type
53
What contraception is offered post-partum?
No contraception required within 21 days postpartum * COCP * Not breastfeeding → can start from day 21, if starting \>21 days, use barrier for 7 days * Not \<6w post-partum + breastfeeding and a warning 6w-6m postpartum + breastfeeding * POP * Start anytime * Use barrier for 2 days if started after day 21 post-partum * IUD/IUS * Within 48 hours of childbirth or after 4 weeks * Lactational * 98% effective if: * Fully breastfeeding * Amenorrhoeic * \<6m postpartum
54
When is it it safe to stop/change contraception?
* Non-hormonal/Condoms * \<50 = stop ≥2 years amenorrhoea * \>50 = stop ≥1 years amenorrhoea * COCP * \<50 = continue to 50 then stop * \>50 = switch to non-hormonal or POP * Injection * \<50 = continue to 50 then stop * \>50 = switch to non-hormonal or POP * Implant * Continue beyond 50 years old

Y5 O&G (69 decks)

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