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Year Three - Reproductive System > Contraception > Flashcards

Contraception Flashcards

1
Q

What is contraception?

A

The intentional prevention of pregnancy as a consequence of sexual intercourse

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2
Q

When are women most fertile during a 28 day cycle?

A

10-17 days

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3
Q

What is the combined oral contraceptive pill?

A

A pill containing a combination of oestrogen and progesterone

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4
Q

How effective is the combined oral contraceptive pill with perfect use and typical use?

A

Perfect Use - 99%

Typical Use - 91%

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5
Q

In what three ways does the combined oral contraceptive pill prevent conception?

A

Ovulation prevention

Cervical mucus thickening

Endometrium thinning

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6
Q

What is the primary mechanism in which the combined oral contraceptive pill prevents conception?

A

Ovulation prevention

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7
Q

How does the combined oral contraceptive pill prevent ovulation?

A

This is due to the fact that oestrogen and progesterone have a negative feedback effect on the hypothalamus and anterior pituitary and therefore they suppress the release of GnRH, LH and FSH

When LH and FSH are absent, ovulation doesn’t occur

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8
Q

How does cervical mucus thickening prevent conception?

A

This prevents sperm from reaching and thus fertilising the egg

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9
Q

How does a thinned endometrium prevent conception?

A

This reduces the chance of successful implantation of a fertilised egg

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10
Q

What are the two types of combined oral contraceptive pills?

A

Monophasic

Multiphasic

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11
Q

What are monophasic combined oral contraceptive pills?

A

They contain the same amount of hormone in each pill

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12
Q

What are multiphasic combined oral contraceptive pills?

A

They contain varying amounts of the hormones to match the normal cyclical hormonal changes more closely

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13
Q

What are the two dosing regimes for the combined oral contraceptive pill?

A

Standard

Continuous dosing

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14
Q

What is the standard combined oral contraceptive pill regimen?

A

It involves individuals taking the combined pill for 21 days with a hormone free week

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15
Q

Describe the mechanism behind the standard combined oral contraceptive pill regimen

A

The lining of the endometrium is maintained in a stable state while taking the contraceptive pill

When the pill is stopped the lining of the uterus breaks down and sheds

This leads to a withdrawal bleed

This is not classed as a menstrual period as it is not part of the natural menstrual cycle

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16
Q

What is the continuous dosing combined oral contraceptive pill regimen?

A

It involves individuals taking the combined pill for 63 days (three packs) with a hormone free week

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17
Q

What are the two advantages of the continuous dosing combined oral contraceptive pill regimen?

A

This avoids the inconvenient withdrawal bleed

It avoids individuals forgetting to restart their pill after the break

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18
Q

Is it safe for individuals to have sexual intercourse during the hormone free week of the combined oral contraceptive pill?

A

Yes - as long as they remember to start their new packet

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19
Q

What two investigations should be conducted prior to individuals starting the combined contraceptive pill?

A

Blood pressure

BMI

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20
Q

When do individuals start the combined oral contraceptive pill?

A

First day of the menstrual cycle

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21
Q

How long does the combined oral contraceptive pill take to offer protection?

A

7 days

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22
Q

When would additional contraception be required when starting the combined oral contraceptive pill? How long for?

A

If it is started after day five of the menstrual cycle

Individuals will need to take extra contraception for the first seven days of consistent pill use before they are protected from pregnancy

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23
Q

What advice is given to individuals when they are switching between different types of the combined oral contraceptive pill?

A

We advise them to finish one pack then immediately start the new pack without the pill-free period

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24
Q

What advice is given to individuals when switching from the progesterone only pill to the combined oral contraceptive pill?

A

They can switch at any time, but seven days of extra contraception is required

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25
Q

How often should individuals take the combined oral contraceptive pill?

A

Daily, with 24 hours ideally between each dose

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26
Q

What is regarded as a missed combined oral contraceptive pill dose?

A

If an individual takes the pill more than 24 hours late, which therefore means that it has been 48 hours since the last pill was taken

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27
Q

What advice do we give if an individual has a missed the combined oral contraceptive pill by less than 72 hours?

A

They should take the missed pill as soon as possible even if this means taking two pills on the same day

They are not required to use extra contraception protection if other pills before and after are taken correctly

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28
Q

What advice do we give if an individual has a missed the combined oral contraceptive pill by more than 72 hours?

A

They should take the most recent missed pill as soon as possible even if this means taking two pills on the same day

They are required to use extra contraception protection until they have taken the pill regularly for seven days straight

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29
Q

What advice do we give if an individual has a missed the combined oral contraceptive pill by more than 72 hours (during day one to seven of the packet)?

A

They are required to take emergency contraception if they have had unprotected sex

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30
Q

What advice do we give if an individual has a missed the combined oral contraceptive pill by more than 72 hours (during day eight to fourteen of the packet)?

A

They are not required to take emergency contraception if they have had unprotected sex

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31
Q

What advice do we give if an individual has a missed the combined oral contraceptive pill by more than 72 hours (during day fifteen to twenty one of the packet)?

A

They are required to take emergency contraception if they have had unprotected sex

These individuals should also miss their pill-free period

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32
Q

What are the five non-contraceptive benefits of the combined oral contraceptive pill?

A

Dysmenorrhea Relief

Premenstrual Syndrome Relief

Menorrhagia Relief

Decreased Risk of Ovarian Cysts & Cancers

Acne Treatment

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33
Q

Which three cancers does the combined oral contraceptive pill decrease the risk of?

A

Ovarian

Endometrial

Colon

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34
Q

What are the seven side effects of combined oral contraceptive pill?

A

Irregular Bleeding

Breast Tenderness

Cholestasis

Headaches

Nausea

Hypertension

Depression & Mood Changes

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35
Q

How long does irregular bleeding persist with the combined oral contraceptive pill? What makes this side effect more common?

A

The first three months

Continuous dosing or extended cycle pills

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36
Q

What are the five risk factors associated with the combined oral contraceptive pill?

A

Venous Thrombosis (DVT & PE)

Arterial Thrombosis (MI & ischaemic stroke)

Breast & Cervical Cancer

Liver Disorders

Gallbladder Disease

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37
Q

Due to the risk of VTE, what advice is given to patients in regards to the combined oral contraceptive pill and upcoming surgery?

A

They should stop the pill 4 weeks before surgery

They should restart it 2 weeks after surgery

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38
Q

How long after stopping the combined oral contraceptive pill does the risk of breast and cervical cancer return to normal?

A

10 years

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39
Q

What are the seven relative contraindications associated with the combined oral contraceptive pill?

A

Controlled Hypertension

Smoking, in individuals who are > 35 years old and smoke less than 15 cigarettes/day

BMI > 35

Thromboembolic Disease FH History, which involves first degree relatives < 45 years old

Prolonged Immobility, which is normally due to a major surgery or disability

Breast Cancer History, which can be a personal history or family history associated with the BRCA gene

Current Gallbladder Disease

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40
Q

What are the seven absolute contraindications associated with the combined oral contraceptive pill?

A

Uncontrolled Hypertension

Smoker, in individuals > 35 years old and more than 15 cigarettes/day

Migraine With Aura

Thromboembolic Disease History

Ischaemic Disease History

Breast Feeding < 6 Weeks Postpartum

Current Breast Cancer

Major Surgery, with prolonged immobilisation

Positive Antiphospholipid Antibodies (SLE)

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41
Q

What are the two other forms of combined oral contraception, apart from the pill?

A

Patch

Vaginal ring

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42
Q

What combined contraceptive patch is usually prescribed? How often is this changed?

A

EVRA

Weekly

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43
Q

How long does the contraceptive patch take to offer protection?

A

7 days

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44
Q

What advice should be given if patients delay in changing their patch at the end of week one or two (within 48 hours)?

A

It should be changed immediately, with no further precautions

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45
Q

What advice should be given if patients delay in changing their patch at the end of week one or two (greater than 48 hours)?

A

It should be changed immediately and a barrier method of contraception should be used for the next 7 days

In cases where the patient has had sexual intercourse in the last 5 days, then emergency contraception should be considered

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46
Q

What advice should be given if patients delay in changing their patch at the end of week three?

A

It should be removed as soon as possible and the new patch should be applied on the usual cycle start day for the next cycle

No additional contraception is needed

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47
Q

What advice should be given if patients delay in changing their patch at the end of a patch free week?

A

A barrier contraception method should be used for 7 days following any delay at the start of a new patch cycle

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48
Q

What combined vaginal ring is usually prescribed? How often is this changed?

A

NuvaRing

Every three weeks

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49
Q

How long does the combined vaginal ring take to offer protection?

A

7 days

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50
Q

Can individuals take the vaginal ring out during sexual intercourse?

A

The ring can be taken out for three hours every twenty-four hours for sex

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51
Q

What is the progesterone only pill?

A

A type of contraceptive pill that only contains the hormone progesteron

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52
Q

How effective is the progesterone only pill with perfect use and typical use?

A

Perfect Use - 99%

Typical Use - 91%

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53
Q

What are the two types of progesterone only pills?

A

Traditional Progesterone-Only Pill

Desogesterol-Only Pills

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54
Q

When is the traditional progesterone only pill classified as missed?

A

If it is delayed by more than three hours

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55
Q

When is the traditional desogesterol only pill classified as missed?

A

If it is delayed by more than twelve hours

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56
Q

What are the four mechanisms in which the traditional progesterone only pill prevents conception?

A

Cervical Mucus Thickening

Endometrium Thinning

Ciliary Action Reduction

Ovulation Inhibition

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57
Q

What is the primary mechanism in which the progestogen-only pill (excluding desogestrel) prevents conception?

A

Cervical Mucus Thickening

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58
Q

What are the three mechanisms in which the traditional desogesterol only pill prevents conception?

A

Endometrium Thinning

Ciliary Action Reduction

Ovulation Inhibition

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59
Q

How does reduced ciliary action prevent conception?

A

It prevents movement of the egg through the fallopian tube

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60
Q

How is the progesterone only pill taken?

A

It is taken continuously, unlike the cyclical combined pills

It is therefore taken at the same time every day without a pill-free interval

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61
Q

How is the progesterone only pill started?

A

It is started between the first and fifth day of the menstrual cycle

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62
Q

How long does the progesterone only pill take to offer protection?

A

2 days

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63
Q

Can the progesterone only pill be started at other times of the menstrual cycle?

A

Yes

However, in this instance, additional contraception is required for 48 hours

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64
Q

What advice is given if individuals miss a progesterone only pill?

A

Patients are advised to take a pill as soon as possible and continue with the next pill at the usual time even if this means taking two in 24 hours

These patients are also advised to use extra contraception for the next 48 hours of regular use

Emergency contraception is required if they have had sex since missing the pill or within 48 hours of restarting the regular pills

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65
Q

What happens if individuals experience episodes of vomiting or diarrhoea whilst on the progesterone only pill?

A

These patients are advised to treat this as a missed pill.

These patients are also advised to use extra contraception until 48 hours after the vomiting and diarrhoea settle

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66
Q

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

A

Irregular Bleeding

Decreased Libido

Mood Changes

Headache

Breast Tenderness

Acne

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67
Q

How long does irregular bleeding persist with the progesterone only pill?

A

Three months

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68
Q

What are the three risk factors associated with the progesterone only pill?

A

Breast Cancer

Ovarian Cysts

Ectopic Pregnancy

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69
Q

How long after stopping the progesterone only pill does the risk of breast cancer return to normal?

A

10 years

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70
Q

Why does the progesterone only pill increase the risk of an ectopic pregnancy?

A

It reduces ciliary action in the fallopian tubes

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71
Q

What is the advantage of the progesterone only pill compared to the combined oral contraceptive pill?

A

There are fewer contraindications

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72
Q

What are the three contraindications of the progesterone only pill?

A

Breast Cancer, however, this does not include a family history just personal history.

Liver Cancer

Enzyme Inducing Drugs, such as carbamazepine, topiramate and rifampicin increase the metabolism of progesterone and oestrogen. They therefore reduce the effectiveness of the combined oral contraceptive pill.

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73
Q

Do antibiotics have an effect on the progesterone only pill?

A

No

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74
Q

What is another name for the progesterone-only injection?

A

Depot medroxyprogesterone acetate (DMPA)

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75
Q

What is the dosage of the progesterone-only injection?

A

It is given at three-month (13 weeks) intervals

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76
Q

What are the two forms in which the progesterone-only injection can be given?

A

Intramuscular

Subcutaneous

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77
Q

What is contained in the progesterone-only injection?

A

Medroxyprogesterone acetate – which is a form of progesterone

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78
Q

How effective is the progesterone-only injection with perfect use and typical use?

A

Perfect Use - 99%

Typical Use - 94%

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79
Q

What is the typical use of the progesterone-only injection?

A

Women may forget to book in for an injection every three months

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80
Q

What are the three ways in which the progesterone-only injection prevents conception?

A

Ovulation Prevention

Cervical Mucus Thickening

Endometrium Thinning

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81
Q

What is the primary mechanism in which the progesterone-only injection prevents conception?

A

It inhibits ovulation + thickens cervical mucus

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82
Q

What are the two types of the progesterone-only injection?

A

Depo-Provera Injection

Sayana-Press Injection

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83
Q

How is the depo-provera injection given?

A

Intramuscular into the upper outer quadrant of the buttock

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84
Q

What dose of the depo-injection is given?

A

1ml

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85
Q

How is the sayana-press injection given?

A

Subcutaneous into the abdomen or thigh

These patients are able to administer themselves this injection at home

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86
Q

What dose of the sayana-pressinjection is given?

A

1ml

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87
Q

How is the progesterone only injection started?

A

It is started between the first and fifth day of the menstrual cycle

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88
Q

How long does the progesterone only injection take to offer protection?

A

7 days

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89
Q

Can the progesterone only injection be started after day five of the menstrual cycle?

A

Yes

However, in this instance, additional contraception is required for 7 days

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90
Q

What are the four non-contraceptive benefits of the progesterone only injection?

A

Dysmenorrhea Relief

Endometriosis Symptom Relief

Decreased Risk of Ovarian & Endometrial Cancers

Decreased Sickle Cell Crisis Severity

91
Q

What are the eight side effects of the progesterone only injection?

A

Irregular Bleeding

Fertility Effects

Osteoporosis

Weight Gain

Decreased Libido

Mood Changes

Skin Reactions

Acne

92
Q

What type of irregular bleeding is experienced with the progesterone only injection?

A

These patients often experience more irregular, heavier, and longer lasting periods

This is usually temporary and after a year of regular use, most women experience amenorrhoea

93
Q

How do we try to help control irregular bleeding experienced by those on the progesterone-only injection?

A

We prescribe the combined oral contraceptive pill in addition to the injection for three months to help settle the bleeding

94
Q

Which contraception method is proven to be associated with weight gain?

A

Depo Provera injection

95
Q

Why does the progesterone only injection affect fertility?

A

This is due to the fact that it can take 12 months before individuals begin ovulating again

This makes it less suitable for women who may wish to get pregnant in the near term

96
Q

Why is osteoporosis an effect of the progesterone only injection?

A

This is due to the fact that oestrogen maintains bone mineral density in women and is mainly produced by the follicles in the ovaries.

The progesterone-only injection suppresses the development of follicles and therefore reduces the amount of oestrogen produced

97
Q

What are the two unique side effects of the progesterone only injection?

A

Osteoporosis

Weight gain

98
Q

How much weight can individuals gain with the progesterone only injection?

A

2-3kg

99
Q

What are the three contraindications of the progesterone only injection? Due to the side effect of osteoporosis what else should we consider?

A

Breast Cancer, however only in those who have active cancer

Ischaemic Heart Disease & Stroke

Liver Disorders, such as liver cirrhosis and liver cancer

We should also be cautious about prescribing it to women over 50 and those on steroids

100
Q

What is the progesterone only implant?

A

A small flexible plastic rod that is placed in the upper arm

It slowly releases progesterone into the systemic circulation

101
Q

How deep in the upper arm do we place the progesterone only implant?

A

It is placed beneath the skin and above the subcutaneous fat

102
Q

How long is the implant? How wide is the implant?

A

4cm long

2mm wide

103
Q

How often is the implant changed?

A

Three years

104
Q

How effective is the implant with perfect use and typical use?

A

It is 99% effective with perfect and typical use

Once in place, there is no room for user error

105
Q

What is the most effective form of contraception (excluding abstinence)?

A

Progesterone implant

106
Q

What brand of the implant is most commonly given?

A

Nexplanon

107
Q

What is contained in the Nexplanon implant?

A

68mg of progesterone etonigestrel in its core

The rod is then covered in a rate controlling membrane made from ethinyl vinyl acetate

108
Q

What are the three mechanisms in which the implant prevents conception?

A

Ovulation Prevention

Cervical Mucus Thickening

Endometrium Thinning

109
Q

What is the primary mechanism in which the implant prevents conception?

A

It inhibits ovulation + thickens cervical mucus

110
Q

How is the implant inserted?

A

It is inserted between the first and fifth day of the menstrual cycle

111
Q

How long does the implant take to offer protection?

A

7 days

112
Q

Can the implant be started after day five of the menstrual cycle?

A

Yes

However, additional contraception is required for 7 days.

113
Q

Where in the arm is the implant inserted?

A

It is placed a third the way up the upper arm and on the medial side

114
Q

What type of anaesthetic is used when inserting the implant?

A

Local

Lidocaine

115
Q

What are the two non-contraceptive benefits of the implant?

A

Dysmenorrhea Relief

Menorrhagia Relief

116
Q

What are the five side effects of the implant?

A

Irregular Bleeding

Mood Changes

Decreased Libido

Headaches

Breast Tenderness

117
Q

How do we control irregular bleeding with the implant?

A

We prescribe the combined oral contraceptive pill in addition to the implant for three months to help settle the bleeding

118
Q

What side effect is more common with the implant compared to other progesterone only methods?

A

Mood changes

119
Q

Should the implant be palpable after insertion? What should be done if this is not the case?

A

Yes

Extra contraception is required until it is located

120
Q

Which two scans can be used to locate the implant?

A

US

X-ray

121
Q

What is added to Nexplanon to make is radio-opaque on x-rays?

A

Barium sulphate

122
Q

What is a rare complication of the implant?

A

There are reports of devices entering blood vessels and migrating through the body, including to the lungs

If the implant cannot be located even after an ultrasound scan, a chest x-ray may be considered to identify an implant in a pulmonary artery

123
Q

What is the one contraindication of the implant?

A

Enzyme Inducing Drugs, such as carbamazepine, topiramate and rifampicin increase the metabolism of progesterone and oestrogen. They therefore reduce the effectiveness of the combined oral contraceptive pill.

124
Q

What are coils?

A

They are devices inserted into the uterus that provide contraception

125
Q

How often do coils need to be changed?

A

Every 5 to 10 years

126
Q

How effective are coils?

A

99%

127
Q

What are the two types of coils?

A

Copper Intrauterine Device (IUD)

Levonorgestrel Intrauterine System (IUS)

128
Q

What is the IUD composed of?

A

Copper

129
Q

What is the IUS composed of?

A

Progesterone

130
Q

What is another name for the IUS?

A

Mirena coil

131
Q

Why is the levonorgestrel considered as a system?

A

It contains hormones

132
Q

When do we conduct extra tests before inserting the coil?

A

When patients are at an increased risk of sexually transmitted infections

We screen for chlamydia and gonorrhoea

133
Q

What tests do we conduct in all patients before insertion of the coil?

A

A bimanual examination is performed to check the position and size of the uterus

The blood pressure and heart rate measurements are recorded before and after insertion

134
Q

What two tools are used to insert the coil?

A

Speculum

Forceps

135
Q

What do we prescribe patients after insertion of the coil? Why?

A

NSAIDs

Individuals may experience temporary crampy, period-like pain

136
Q

How long after insertion of the coil do we check it again?

A

These patients then have their threads checked around three to six weeks after insertion

After this they should be taught to feel the strings after each period to ensure the coil remains in place

137
Q

How long should women abstain from sex or use condoms before the coil is removed? Why?

A

7 days

There is a risk of pregnancy

138
Q

When can the IUD be used as an emergency contraception method?

A

When inserted up to five days after an episode of unprotected intercourse

When inserted by day 19 of a 28 day cycle

139
Q

How long does the IUS take to offer protection?

A

7 days

140
Q

How long does the IUD take to offer protection?

A

Immediately

141
Q

When can the IUD be inserted?

A

At any time during the menstrual cycle

142
Q

In what two ways does the IUD prevent conception?

A

The copper within the coil is toxic to the ovum and sperm.

It can also alter the endometrium and makes it less accepting of implantation of a fertilised egg

143
Q

What is the primary mechanism in which the copper coil prevents conception?

A

It decreases sperm motility and survival

144
Q

What are the three side effects of IUD’s?

A

Irregular Bleeding

Pelvic Pain

Ectopic Pregnancies

145
Q

When is the IUD contraindicated?

A

Wilson’s disease

This is a condition where there is excessive accumulation of copper in the body and tissues

146
Q

In breast ccancer patients, which form of contraception is recommended?

A

IUD

147
Q

When should the IUS be inserted?

A

It is inserted up to day seven of the menstrual cycle without a need for additional contraception

148
Q

Can the IUS be started after the seventh day of the menstrual cycle?

A

Yes

However, in this instance, additional contraception is required for 7 day

149
Q

What are the four types of IUS’s?

A

Mirena

Levosert

Kyleena

Jaydess

150
Q

How long is the Mirena coil effective for?

A

5 years

151
Q

What two conditions can the Mirena coil also be prescribed for?

A

Menorrhagia

HRT

152
Q

What is the most commonly prescribed IUS type?

A

Mirena

153
Q

How long is the Levosert coil effective for?

A

5 years

154
Q

What condition can the Levosert coil also be prescribed for?

A

Menorrhagia

155
Q

How long is the Kyleena coil effective for?

A

5 years

156
Q

What is the advantage of the Kyleena coil?

A

It contains less progesterone than the Mirena and Levosert, thus preventing the chance of side effects.

157
Q

How long is the Jaydess coil effective for?

A

3 years

158
Q

What is the advantage of the Jaydess coil?

A

It contains less progesterone than the Mirena and Levosert, thus preventing the chance of side effects

159
Q

What are the two mechanisms in which the IUS prevents conception?

A

Cervical Mucus Thickening

Endometrium Thinning

160
Q

What is the primary mechanism in which IUS prevents conception?

A

It prevents thickening of the endometrium

161
Q

What are the three side effects of the IUS?

A

Irregular Bleeding

Pelvic Inflammatory Disease

Ectopic Pregnancies

162
Q

How long does irregular bleeding with the IUS coil persist for?

A

Six months

163
Q

How do we control irregular bleeding with the IUS?

A

We prescribe the combined oral contraceptive pill in addition to the coil for three months to help settle the bleeding.

164
Q

Which patients are at a high risk of pelvic inflammatory disease with the IUS coil? How do we manage this?

A

Those who are at a high risk of STIs

In these cases we can consider empirical treatment of pelvic infections.

165
Q

How effective are barrier methods?

A

88%

166
Q

What are the four types of barrier contraception methods?

A

Male condoms

Female condoms

Diaphragms

Cervical caps

167
Q

What only contraceptive method is effective in protecting against STI transmission? What three types of sex does this apply to?

A

Condoms

This applies to vaginal sex, oral sex and anal sex

168
Q

How effective are condoms with perfect use and typical use?

A

Perfect Use - 98%

Typical Use - 82%

169
Q

What is a male condom?

A

A thin sheath placed over the erect penis

170
Q

What is the main material which male condoms are made from?

A

Latex

171
Q

What advice is given to individuals using male condoms made from latex?

A

If individuals use oil-based lubricants, they can damage the latex and make it more likely that they will tear

172
Q

What condoms are used in males allergic to latex?

A

Polyurethane condoms

173
Q

What is a female condom?

A

A soft, loose-fitting pouch with a ring on each end

On insertion, one ring is placed into the vagina, to hold the condom in place, and the ring at the open end remains outside the vagina.

The outer ring helps keep the condom in place and is also used for removal

174
Q

What two types of sex can female condoms be used for?

A

Vaginal

Anal

175
Q

What are diaphragms and cervical caps?

A

They are silicone cups that fit over the cervix

176
Q

When do women insert diaphragms and cervical caps?

A

They fit them before having sex and leaves them in place for at least six hours after intercourse

177
Q

What should women use with diaphragms and cervical caps with to reduce the risk of pregnancy further?

A

Spermicide gel

178
Q

How effective are diaphragms and cervical caps with spermicide gel?

A

95%

179
Q

When should emergency contraception be used?

A

After episodes of unprotected sexual intercourse

This includes situations where the contraceptive method is not protective, such as damaged condoms or multiple missed pills

180
Q

What are the three types of emergency contraceptions?

A

Levonorgestrel Pill

Ulipristal Pill

Copper Coil

181
Q

What is contained in the levonorgestrel pill?

A

Progesterone

182
Q

When is levonorgestrel pill used for emergency contraception?

A

It can be used up to 72 hours post intercourse

183
Q

What dosage of levonorgestrel is given?

A

1.5mg one dose

However 3mg in those that have a BMI greater than 25

184
Q

What are the two side effects of the levonorgestrel pill?

A

Nausea

Vomiting

185
Q

What advice is given if women vomit within three hours of taking the levonorgestrel pill?

A

The dose should be repeated

186
Q

What advice is given to those breastfeeding with the levonorgestrel pill?

A

The pill is not known to be harmful breastfeeding

However, it is advised that breastfeeding is avoided for eight hours after taking the dose to reduce the exposure to the infant

187
Q

What is contained in the ulipristal pill?

A

A selective progesterone receptor modulator

188
Q

When can ulipristal pill be used an an emergency contraceptive?

A

It can be used up to five days post intercourse

189
Q

What is the most common brand of the ulipristal pill? What dose is usually prescribed?

A

EllaOne

30mg

190
Q

What is the most effective emergency contraceptive pill? How effective are they?

A

Ulipristal

60-80%

191
Q

What are the two side effects of the ulipristal pill?

A

Nausea

Vomiting

192
Q

What advice is given to individuals who vomit within three hours of taking the ulipristal pill?

A

The dose should be repeated

193
Q

What are the three contraindications of the ulipristal pill?

A

Breastfeeding

Severe Asthma

Enzyme Inducing Drugs

194
Q

What is the most effective emergency contraceptive? How effective are they?

A

Copper coil

99%

195
Q

What makes the copper coil the most effective emergency contraceptive?

A

This is due to the fact that it is not affected by BMI, enzyme inducing drugs or malabsorption – which can significantly reduce the effectiveness of oral methods

196
Q

How long should the copper coil be kept in for emergency contraception?

A

Until the next period, after which it can be removed

If individuals wish it can be left in long term as contraception

197
Q

What advice is given when the levonorgestrel pill has been used as an emergency contraceptive within the same menstrual cycle? (ulipristal pill)

A

It is advised that patients are not prescribed ulipristal within the next seven days

198
Q

What advice is given when the ulipristal pill has been used as an emergency contraceptive within the same menstrual cycle? (levonorgestrel pill)

A

It is advised that patients are not prescribed levonorgestrel within the next five days

199
Q

How long after taking the levonorgestrel pill can we prescribe hormonal contraception methods? Why?

A

Immediately

This is due to the fact that the levonorgestrel pill contains progesterone

200
Q

How long after taking the ulipristal pill can we prescribe hormonal contraception methods? Why?

A

It needs to be delayed for five days

This is due to the fact that the ulipristal pill contains progesterone receptor modulator

201
Q

At what age does a competence assessment need to be conducted before contraception can be prescribed?

A

Under 16

202
Q

What competence assessment test is used for prescribing contraception to under 16 year olds?

A

Fraser

203
Q

What guidelines are used to spot signs of child sexual exploitation?

A

Brook/BASHH guidelines

204
Q

At what age does sexual activity always result in a child protection referral?

A

13

205
Q

At what age does sexual activity with a partner of a two year age gap raise additional concerns?

A

16

206
Q

What after sterilisation procedures?

A

They are permanent surgical interventions to prevent concepti

207
Q

What is the female sterilisation procedure?

A

Tubal occlusion

208
Q

Describe tubal occlusion procedure

A

This is typically performed by laparoscopy under a general anaesthetic, with occlusion of the tubes using Filshie clips

In some cases, the fallopian tubes can be tied and cut, or removed altogether

This can be done as an elective procedure, or during a c-section

209
Q

How does tubal occlusion prevent conception?

A

The procedure works by preventing the ovum travelling from the ovary to the uterus along the fallopian tube

This means the ovum and sperm will not meet and pregnancy cannot occur

210
Q

Does tubal occlusion effect periods?

A

There is no effect

This is because the endometrium will still break down every month due to normal hormone production

211
Q

What is the male sterilisation procedure?

A

Vasectomy

212
Q

Describe the vasectomy procedure

A

This procedure involves cutting the vas deferens via a small incision midline of the scrotum

The procedure is performed under local anaesthetic, mostly in a primary care setting

213
Q

How does the vasectomy procedure prevent conception?

A

It prevents sperm travelling from the testes to join the ejaculated fluid

214
Q

Why is vasectomy preferred to tubal occlusion?

A

It is a less invasive procedure than female sterilisation

The failure rate is lower in males

215
Q

How long after vasectomy is alternative contraception required?

A

Two months

216
Q

How do confirm the success of a vasectomy procedure?

A

We then test the patient’s semen sample after 12 weeks to confirm the absence of sperm

The use of two sperm samples is usually recommended

217
Q

Do vasectomy procedures have an effect on sexual function? Why?

A

No

Due to normal hormone production of testosterone

218
Q

How long after childbirth can individuals become pregnant?

A

21 days

219
Q

How long after an abortion or miscarriage can individuals become pregnant?

A

5 days

220
Q

What is the lactational amenorrhea method (LAM)?

A

This is when breastfeeding delays the return of periods, therefore acting as a contraceptive

221
Q

How long can breastfeeding act as a contraceptive?

A

The first six months

222
Q

How often do individuals need to breastfeed for it to act as a contraceptive?

A

They nurse at least every 4 hours during the day and every 6 hours at night

223
Q

Does breastfeeding affect contraception use?

A

Breastfeeding patients can use any form of contraception

However, they must wait six weeks to use combined hormonal contraception

224
Q

What is the primary mechanism in which the copper coil prevents conception?

A

It decreases sperm motility and survival

Year Three - Reproductive System (52 decks)

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