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Obs & Gynae > Contraception > Flashcards

Contraception Flashcards

1
Q

What are some absolute contraindications of the COCP?

A

Smoker ages 35+, <6 weeks post-partum, breast feeding, hypertension, current/past VTE history, migraine with aura, CVD, current breast cancer, liver cirrhosis

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2
Q

What are some relative contraindications of the COCP?

A

Adequately controlled hypertension, migraine and 35+, BMI over 35, enzyme-inducing medications

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3
Q

How does the COCP work?

A
  • Stops ovulation
  • Increases cervical mucus
  • Thins endometrium
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4
Q

How is the COCP taken?

A

Once daily-> 3 weeks on + 1 week off

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5
Q

What are the risks and side effects of the COCP?

A
  • Hormonal-> weight gain, acne, mood changes, headache
  • Blood clots
  • Increases breast + cervical cancer risk
  • Lighter periods
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6
Q

What are some positives about the COCP?

A
  • Can control periods, bleeding and pain

- Reduces risk of endometrial + cervical cancer

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7
Q

What should someone do if they miss one pill (COCP)?

A
  • Take ASAP even if means two at same time

- If next pill on time then should be fine

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8
Q

What should someone do if they miss two pills (COCP)?

A
  • Take 1 pill immediately
  • Use condoms for 7 days
  • Further management depends on week
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9
Q

What should someone do if they miss two pills (COCP) in the first week of their packet?

A

If had sex in pill-free interval or 1st week of packet-> will need emergency contraception

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10
Q

What should someone do if they miss two pills (COCP) in the second week of their packet?

A
  • Take 1 pill immediately
  • Use condoms for 7 days
  • No further action
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11
Q

What should someone do if they miss two pills (COCP) in the third week of their packet?

A
  • Take 1 pill immediately
  • Use condoms for 7 days
  • Omit the pill-free week
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12
Q

When should someone on the COCP use condoms for 7 days?

A
  • D+V
  • Enzyme inducing drugs
  • Usually when missed 2 or more pills
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13
Q

What are some absolute contraindications of the combined contraceptive patch?

A

Same as COCP-> smoker ages 35+, <6 weeks post-partum, breast feeding, hypertension, current/past VTE history, migraine with aura, CVD, current breast cancer, liver cirrhosis

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14
Q

What are some absolute contraindications of the combined contraceptive vaginal ring?

A

Same as COCP-> smoker ages 35+, <6 weeks post-partum, breast feeding, hypertension, current/past VTE history, migraine with aura, CVD, current breast cancer, liver cirrhosis

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15
Q

What are some relative contraindications of the combined contraceptive patch?

A

Same as COCP-> Adequately controlled hypertension, migraine and 35+, BMI over 35, enzyme-inducing medications

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16
Q

What are some relative contraindications of the combined contraceptive vaginal ring?

A

Same as COCP-> Adequately controlled hypertension, migraine and 35+, BMI over 35, enzyme-inducing medications

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17
Q

How does the combined contraceptive patch work?

A
  • Stops ovulation
  • Increases cervical mucus
  • Thins endometrium
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18
Q

How does the combined contraceptive vaginal ring work?

A
  • Stops ovulation
  • Increases cervical mucus
  • Thins endometrium
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19
Q

How is the combined contraceptive patch administered?

A

Change weekly with 1 patch-free week per month

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20
Q

What are some of the risks and side effects of the combined contraceptive patch?

A
  • Hormonal-> weight gain, acne, mood changes, headache
  • Blood clots
  • Increases breast + cervical cancer risk
  • Lighter periods
  • Local irritation
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21
Q

What are some positives about the combined contraceptive patch?

A
  • Can control periods, bleeding and pain
  • Reduced risk of endometrial + ovarian cancer
  • Don’t need to remember to take a pill every day
  • Effective when D+V etc
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22
Q

How is the combined contraceptive vaginal ring administered?

A

Leave in for 3 weeks then 1 ring-free week

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23
Q

What are some of the risks and side effects of the combined contraceptive vaginal ring?

A
  • Hormonal-> weight gain, acne, mood changes, headache
  • Blood clots
  • Increases breast + cervical cancer risk
  • Lighter periods
  • Pain from ring during intercourse-> can remove but only for 3 hours max
  • Can come out on its own
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24
Q

What are some of the positives of the combined contraceptive vaginal ring?

A
  • Can control periods, bleeding and pain
  • Reduced risk of endometrial + ovarian cancer
  • Don’t need to remember to take a pill every day
  • Effective when D+V etc
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25
Q

How effective if the COCP?

A
  • When used correctly-> 99%

- Typically-> 92%

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26
Q

How effective is the combined contraceptive patch?

A
  • When used correctly-> 99%

- Typically-> 92%

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27
Q

How effective is the combined contraceptive vaginal ring?

A
  • When used correctly-> 99%

- Typically-> 91%

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28
Q

How effective is the progesterone-only pill?

A
  • When used correctly-> 99%

- Typically-> 92%

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29
Q

What are the contraindications of the progesterone-only pill?

A

Forgetfulness, breast cancer, undiagnosed PV bleeding, liver disease

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30
Q

How does the progesterone-only pill work?

A
  • Increases cervical mucus

- Thins endothelium

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31
Q

How is the progesterone-only pill administered?

A

Once daily without a pill-free break

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32
Q

What are some risks and side effects of the progesterone-only pill?

A
  • Hormonal-> weight gain, acne, mood changes, headache
  • Periods-> can stop or be irregular, lighter or more frequent
  • Must take at same time each day-> window of effectiveness much narrower
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33
Q

What are the positives of the progesterone-only pill?

A
  • Not as many side effects as COCP

- Very effective when taken properly

34
Q

What should be done if someone misses one dose of the progesterone-only pill (within 3 hours)?

A

Take as soon as remember + no action needed

35
Q

What should be done if someone misses one dose of the progesterone-only pill (3 hours late or 12 hours late for Cerazette?)

A
  • Use condoms for 2 days

- Consider emergency contraception-> if had sex in 2-3 days before or since missed pill

36
Q

How effective is the copper coil (IUD)?

A

Over 99%

37
Q

What are the contraindications of the copper coil (IUD)?

A

Pelvic infection, PID <3 months ago, gynae cancer, small uterine cavity, undiagnosed PV bleeding, copper allergy

38
Q

How does the copper coil (IUD) work?

A

Acts as spermicide + causes intra-uterine inflammation

39
Q

How long does the copper coil (IUD) last?

A

-Usually 5 years

40
Q

What are the risks and side effects of the copper coil (IUD)?

A
  • Infection in 1st 3 weeks
  • Bleeding after procedure
  • Perforation (1/1000)
  • Expulsion (1/20)
  • Vasovagal (1/10)
  • Heavier periods
41
Q

What advice should be given to people getting the copper coil (IUD)?

A
  • Check strings monthly
  • STI check before insertion
  • If >40 can stay in place until menopause
42
Q

When can the copper coil (IUD) be fitted?

A
  • As emergency contraception (within 5 days of sex)
  • Any time if not had sex since period
  • Ideally within first 5 days of period
  • Should be effective immediately
43
Q

How effective is the intra-uterine coil (IUS)?

A

Most effective-> over 99%

44
Q

What are the contraindications of the intra-uterine coil (IUS)?

A

Pelvic infection, PID <3 months ago, gynae cancer, small uterine cavity, undiagnosed PV bleeding

45
Q

How does the intra-uterine coil (IUS) work?

A
  • Stops ovulation
  • Increases cervical mucus
  • Thins endometrium
46
Q

How long does the intra-uterine coil (IUS) last?

A
  • Usually 5 years

- Jaydess-> 3 years

47
Q

What are the risks and side effects of the intra-uterine coil (IUS)?

A
  • Infection in 1st 3 weeks
  • Bleeding after procedure
  • Perforation (1/1000)
  • Expulsion (1/20)
  • Vasovagal (1/10)
  • Some hormonal-> mood swings, breast tenderness, acne
  • Spotting for 6 months then light/absent periods
48
Q

What are the positives of the intra-uterine coil (IUS)?

A
  • Can forget about it

- Reduced dysmenorrhoea + menorrhagia

49
Q

What additional advice should be given to people getting the intra-uterine coil (IUS)?

A
  • Check strings monthly
  • STI check before insertion
  • If >45 can stay in place until menopause
50
Q

When should the intra-uterine coil (IUS) be fitted?

A
  • Ideally within first 7 days of period

- If not-> should use barrier contraception for 7 days after fitting

51
Q

What are the contraindications of the implant?

A

Liver/genital/breast cancer, liver disease, undiagnosed PV bleeds, on enzyme inducing medications

52
Q

How does the implant work?

A
  • Contains progesterone
  • Stops ovulation
  • Increases cervical mucus
  • Thins endometrium
53
Q

How long does the implant last?

A

3 years

54
Q

What are some of the side effects of the implant?

A
  • Some hormonal side effects-> weight gain, acne etc
  • Periods can stop, become irregular or get longer
  • Insertion risks-> bruising, infection, scarring, expulsion
55
Q

How is the implant inserted?

A
  • Under the skin of upper arm under local anaesthetic

- Can feel it

56
Q

When should the implant be inserted?

A
  • Ideally within first 7 days of period

- If not-> should use barrier contraception for 7 days after fitting

57
Q

How effective is the implant?

A

Over 99%

58
Q

How effective is the Depo injection?

A

97%

59
Q

What are the contraindications of the depo injection?

A

Liver/genital/breast cancer, liver disease, undiagnosed PV bleeds, on enzyme inducing medications

60
Q

How does the depo injection work?

A
  • Contains progesterone
  • Stops ovulation
  • Increases cervical mucus
  • Thins endometrium
61
Q

How long does the depo injection last?

A

3 months (13 weeks)

62
Q

What are the side effects of the Depo injection?

A
  • Some hormonal side effects-> weight gain, acne etc
  • Periods-> can stop, become irregular or longer
  • Takes time for fertility to return
  • Osteoporosis-> should consider stopping at 2 years and definitely at 5 years
  • Side effects can last 3 months as irreversible
63
Q

How effective are condoms?

A
  • When used properly-> 98%

- Typical use-> 85%

64
Q

What are the contraindications to condoms?

A

Latex allergy-> can get ones without

65
Q

How do condoms work?

A

Physical barrier to sperm

66
Q

What are the risks of condoms?

A
  • Small allergy risk
  • May slip off or break
  • Interrupts sex
67
Q

What are the benefits of condoms?

A

Only contraception with STI protection

68
Q

How effective is the diaphragm?

A

Around 84%

69
Q

How is the diaphragm used?

A
  • Inserted into vagina before sex to cover cervix
  • Needs spermicide
  • Leave in for 6 hours after
70
Q

What are the positives of using a diaphragm?

A
  • No hormonal side effects

- Reuseable after cleaning

71
Q

What are the risks of using a diaphragm?

A
  • Insertion can be difficult
  • Cystitis
  • Doesn’t protect from STIs
  • Don’t use during periods-> TSS risk
72
Q

How effective is tubal ligation?

A
  • Failure rate of 1/200

- So over 99% effective

73
Q

How is tubal ligation done?

A

Fallopian tubes clipped laproscopically under GA

74
Q

What are the risks of tubal ligation?

A
  • Failure-> 1 in 200
  • Anaesthetic risks
  • Bleeding, bruising, infection
  • Irreversible
75
Q

How effective is vasectomy?

A

-Very-> failure rate only 1 in 2000

76
Q

How is a vasectomy perfored?

A
  • Vas deference cut + tied with forceps through skin or scrotum
  • Local anaesthetic
  • Takes 20 minutes
77
Q

What are the risks of vasectomy?

A
  • Failure rate-> 1 in 2000
  • Bleeding, bruising, infection
  • Swollen scrotum for few days
  • Sperm granulomas if leaks
  • Chronic testicular pain
78
Q

What follow up and advice should be given after a vasectomy?

A
  • Can take 3 months for remaining sperm to be used up
  • Take sperm sample at 8 weeks then 2-4 weeks later-> both need to be negative
  • Can have sex with a condom whenever feel ready
79
Q

How effective is the fertility awareness method?

A

Around 73%

80
Q

How does the fertility awareness method work?

A
  • Monitor and record fertility signals during cycle-> temperature, cervical fluids
  • Use to work out when likely to get pregnant
81
Q

What are the benefits of the fertility awareness method?

A
  • No side effects

- Normal fertility instantly if decide to plan pregnancy

82
Q

What are the risks of the fertility awareness method?

A
  • Least effective method
  • Can be a lot of effort
  • Measurements can be affected by stress or illness

Obs & Gynae (5 decks)

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