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Y3 - Repro > Contraception > Flashcards

Contraception Flashcards

1
Q

What are the options for LARC?

A

Progestogen-only implant
Intrauterine system
Copper intrauterine device
Progestogen injection

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2
Q

What are the options for non-LARC?

A 
Vasectomy
Female sterilisation
Progestogen-only pills
Combined oral hormonal contraception
Combined hormonal transdermal patch
Combined hormonal vaginal ring
Female diaphragm
Male condom
Fertility awareness methods
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3
Q

What are the most effective methods of contraception?

A

Progestogen-only implant
Intrauterine system
Male and female sterilisation
Copper IUD

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4
Q

What are the risks of intrauterine methods of contraception?

A

Painful insertion

Risk of perforation, PID, malposition, expulsion

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5
Q

How do intrauterine contraceptions work?

A

Prevent fertilisation and implantation

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6
Q

Who are intrauterine contraceptions contraindicated for?

A

Patients with submucosal fibroids or uterine malformations

Pelvic inflammatory disease

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7
Q

How do intrauterine systems work?

A

Levonorgestrel (progesterone) releasing
Prevents endometrial proliferation, making the endometrium less favourable for implantation
Causes cervical mucous thickening, making it harder for sperm to reach the egg

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8
Q

How long does the intrauterine system take to work?

A

7 days after insertion

Immediate effect if in first 5 days of cycle, within 21 days postpartum or within 5 days of abortin or miscarriage

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9
Q

What are the advantages of intrauterine systems?

A 
LARC
May become amenorrhoeic (30-50%)
Intermittent light menses and less dysmenorrhea
Safe while breastfeeding and postpartum
Fewer side effects
Fertility returns immediately
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10
Q

What are the disadvantages of intrauterine systems?

A

Spotting for weeks-months after insertion - usually settles by 6 months
Increased relative risk of ectopic pregnancy
No protection against STIs

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11
Q

What is the most common form of intrauterine system?

A

Mirena IUS

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12
Q

How long does the Mirena IUS provide protection for?

A

Up to 5 years

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13
Q

What are the specific advantages of the Mirena IUS?

A

Can be used to treat menorrhagia, dysmenorhoea, endometriosis, hyperplasia

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14
Q

How does the copper IUD work?

A

Prevents fertilisation by decreasing sperm motility and survival

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15
Q

How long is the copper IUD effective?

A

5-10 years depending on device

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16
Q

How long does the copper IUD take to work?

A

Effective immediately after insertion

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17
Q

What are the advantages of the copper IUD?

A

Can be fitted at any point int he cycle
Can be fitted immediately after abortion or miscarriage
Fertility returns immediately after removal
Can be used as emergency contraception

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18
Q

What are the disadvantages of the copper IUD?

A

Periods can be heavier, longer and more painful in the first 3-6 months after IUD inserted
Spotting or bleeding can occur between periods
No protection against STIS

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19
Q

What is the subdermal implant also known as?

A

Nexplanon

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20
Q

What is the subdermal implant?

A 
Thin rod inserted under the skin of the upper arm
Releases progesterone (etonogestrel)
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21
Q

How does the subdermal implant work?

A

Inhibits ovulation and thickens cervical mucus

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22
Q

How long does the subdermal implant take to work?

A

Immediate if fitted within the first 5 days of cycle
If any other day - 7 days
Immediate if on or before 21 days post-partum - if after, 7 days
At the time of medical or surgical abortion - immediate

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23
Q

What are the advantages of the subdermal implant?

A 
LARC
Non-user dependent
Can be used if unable to take oestrogen
Safe in beastfeeding and postpartum
Can help reduce menorrhagia
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24
Q

What are the disadvantages of the subdermal implant?

A

Can cause irregular bleeding
Hormonal side effects - headache, nausea, breast pain, skin changes
Efficacy can be reduced by enzyme-inducing drugs (anti-epileptics, rifampicin)
No protection against STIs

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25
Q

What are the contraindications for the subdermal implant?

A

Current breast cancer

Active/severe liver disease

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26
Q

What are the different names of the injective contraception, and what is the difference?

A

Depo Provera - IM injection, requires administration by healthcare provider
Sayana press - SC injection, can be done by yourself at home, not available everywhere

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27
Q

How does injective contraception work?

A

Lowers oestradiol and suppresses FSH

This inhibits ovulation and thickens cervical mucus

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28
Q

What are contraindications for injective contraception?

A

Breast cancer
Significant liver disease
History of thromboembolism

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29
Q

How long does injective contraception take to work?

A

If given in first 5 days of cycle - immediate protection
If any other time - 7 days
If started before 21 days postpartum - immediate
If over 21 days postpartum - 7 days
Before 5 days after abortion or miscarriage - immediate
After 5 days - 7 days

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30
Q

Can injective contraception be used when breastfeeding?

A

Yes safe to do so
Can be started any time post-partum if not breastfeeding
If breastfeeding usually given after 6 weeks

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31
Q

What are the advantages of injective contraception?

A

LARC
Not user-dependent
Useful if you find it difficult to take a pill at same time every day
Not affected by enzyme-inducing drugs so can be used in epileptic women
Can cause amenorrhoea
Can be used to treat heavy menstrual bleeding, dysmenorrhoea, endometriosis

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32
Q

What are the disadvantages of injective contraception?

A

Can’t be reversed - once it’s in its in for the duration fo the injection
Delayed return to fertility (up to 1 year)
Irregular bleeding
Potential for weight gain - especially adolescents with BMI >30
Increased risk of osteoporosis
No protection against STIs
Hormonal side effects - nausea, spots, headaches
Efficacy reduced by delay in getting injection

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33
Q

How often is injective contraception given?

A

Every 8 or 13 weeks

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34
Q

What is the fertility awareness method?

A

Paying attention to physiological indicators of ovulation to identify when a women is most fertile in her cycle, and avoid unprotected intercourse in this time
Sex should be avoided 7 days before ovulation and at least 2 days after

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35
Q

What are the advantages of fertility awareness?

A

No side effects
Acceptable in all faiths and cultures
Can be used both to avoid pregnancy or to get pregnant

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36
Q

What are the disadvantages of fertility awareness?

A

Less effective
Very user-dependent
Restricts timing of intercourse
Can be affected by stress, illness, travel, lifestyle, regularity of cycle, post-partum

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37
Q

What are the advantages of condoms?

A

Avoids hormones

Protects against STIs

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38
Q

What are the disadvantages of condoms?

A

Typical use failure rate is high

Can break or irritate skin

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39
Q

How are female condoms used?

A

Worn inside the vagina before contact to prevent semen from entering the cervical canal

40
Q

How are diaphragms/caps used?

A

Reusable circular dome made of thin, soft, silicone which is inserted into the vagina before sex
Always used with spermicide
Left in place for at least 6 hours after sex

41
Q

What are the disadvantages of diaphragms/caps?

A 
Lack of spontaneity
User-dependent
No protection against STIs
Increased risk of cystitis
Latex and spermicide can cause irritation
42
Q

How does the COCP work?

A

Oestrogen and progesterone inhibit ovulation and thicken mucus

43
Q

What are the options for regimens of the COCP?

A

Taken every day for 21 days and stopped for 7 days where a withdrawal bleed occurs
3 cycles in a row, then a 7 day withdrawal bleed
Taken continually then when a bleed starts stop the pill for 4 days, then start again

44
Q

How long does the COCP take to work?

A

If started within the first 5 days of the menstrual cycle - immediate
After day 5 - 7 days
If started by day 21 post-partum - immediate
If started after day 21 post-partum - 7 days
Up to 5 days after miscarriage or abortion - immediate

45
Q

What is done if 1 COCP pill is missed?

A

Take the last pill, even if 2 pills taken in 1 day

No additional contraception needed

46
Q

What is done if 2 COCP pills are missed?

A

Take the past pill, even if 2 taken in 1 day, omit any earlier missed pills
Use additional contraception until the pill has been taken 7 days in a row
If missed in week 1 - consider emergency contraception if unprotected sex in the pill-free interval or week 1
If missed in week 2 - no emergency contraception needed if the pill was taken for 7 consecutive days before missed pill
If missed in week 3 - finish current pack and start the next pack right after, omitting the pill-free interval

47
Q

What are the advantages of the COCP?

A

Treats menorrhagia, dysmenorrhea, endometriosis and pre-menstrual syndrome
Reversible on stopping

48
Q

What does the COCP reduce the risk of?

A 
Ovarian cancer
Endometrial cancer
Colorectal cancer
Ovarian cysts
Benign breast disease
Acne vulgaris
49
Q

What are the disadvantages of the COCP?

A

Need to take at the same time every day (within 24 hours)
Medications such as enzyme inducing drugs and rifampicin can reduce effectiveness
No protection against STIs
Hormonal side effects - headache, nausea, breast tenderness, mood changes, low libido
Irregular bleeding

50
Q

What can the COCP increase the risk of?

A

Cervical cancer
Breast cancer
Venous thromboembolism
Stroke and ischaemic heart disease

51
Q

What are the relative contraindications of the COCP (disadvantages outweigh benefits)?

A

> 35 years old and smoking <15 cigarettes a day
BMI >35
Family history of thromboembolic disease in 1st degree relatives <45 years
Controlled hypertension
Immobility
Gene mutations associated with breast cancer e.g. BRACA 1 or 2
Ongoing gallbladder or liver disease
Complicated diabetes

52
Q

What are the absolute contraindications of the COCP?

A

> 35 years old and smoking >15 cigarettes a day
Migraine with aura
History of thromboembolic disease or thrombogenic mutation
History of stroke or ischaemic heart disease
Uncontrolled hypertension
Current breast cancer
Major surgery with prolonged immobilisation

53
Q

What is the combined transdermal patch and how is it used?

A

Daily dose of oestrogen and progesterone through the skin into the blood
Worn for 7 days and changed on day 8
Worn for 3 weeks then patch free on week 4 for a withdrawal bleed

54
Q

How does the combined transdermal patch work?

A

Prevents ovulation and thickens cervical mucus

55
Q

How long does the combined transdermal patch take to work?

A

If started before day 5 - immediate

If after day 5 - 7 days

56
Q

What is done if the patch is removed?

A

If removed for <48 hours - stick it back asap or use new patch, no additional contraception needed if patch used correctly for the past 7 days
If >48 hours - use new patch immediately and use additional contraception for next 7 days

57
Q

What is the combined vaginal ring also known as?

A

Nuvaring

58
Q

What is the combined vaginal ring?

A

Soft plastic ring placed in the vagina that releases oestrogen and progesterone

59
Q

How does the combined vaginal ring work?

A

Release of oestrogen and progesterone inhibits obulation

60
Q

How is the combined vaginal ring used?

A

Place ring in vagina for 21 days then remove for 7 days to allow withdrawal bleed

61
Q

How long does the combined vaginal ring take to work?

A

If inserted in first 5 days of cycle - immediate
If after that - 7 days
If inserted on or before day 21 postpartum - immediate
If after that - 7 days

62
Q

What is done if the combined vaginal ring is removed?

A

If >3 hours - protection is reduced

  • if week 1 or 2 - use additional protection for next 7 days
  • if week 3 - insert new ring to start new cycle or allow withdrawal bleed during which time you’re protected and insert new ring no later than 7 days after ring expelled
63
Q

What is done if the insertion of a new combined vaginal ring is delayed?

A

Contraceptive protection is lost - insert new ring asap and use additional protection for 7 days

64
Q

What is done if the removal of the combined vaginal ring is delayed?

A

If up to 1 weeks - no additional contraception needed

Start 7 days ring free interval and insert new ring after

65
Q

What is the name of the progesterone only pill (POP)?

A

Desogestrel

66
Q

How does the POP work?

A

Release of progesterone prevents ovulation and thickens cervical mucus

67
Q

How is the POP taken?

A

Taken at same time every day without a pill free break

68
Q

How long does the POP take to be effective?

A

If started up to day 5 - immediate effect
After day 5 - use additional contraception for the first 2 days
If switching from COCP - immediate protection if continues directly from the end of a pill packet (from day 21)

69
Q

What is done if a dose of the POP is missed?

A

If taken <12 hours after usual time - take pill as normal
If taken >12 hours after usual time - take missed pill asap and use additional protection until pill has been taken for 48 hours
For older traditional pills (non-desogestrel) the window is 3 hours not 12

70
Q

What are the advantages of the POP?

A

Few contraindications - can be taken if combined contraception contraindicated
Reversible immediately on stopping

71
Q

What are the disadvantages of the POP?

A

Irregular bleeding
Diarrhoea and vomiting interfere with absorption - assume missed pill
Liver enzyme inducers may reduce effectiveness
No protection against STIs

72
Q

What are the contraindications for the POP?

A

Severe or active liver disease

Current breast cancer

73
Q

What is a vasectomy?

A

Procedure to cut or seal the vas deferens, to permanently prevent pregnancy
This blocks the transport of semen from the testes to the urethra during ejaculation

74
Q

How long does a vasectomy take to work?

A

Alternative contraception needed until semen samples confirmed negative - take at 12 and 16 weeks

75
Q

What are the disadvantages of a vasectomy?

A

Permanent - should be considered irreversible reversal procedures not always successful and unavailable on NHS
Procedural-related risks, e.g. scrotal pain, swelling or bruising, infection, haematoma
Risk of chronic scrotal pain (<15%)
Does not protect against STIs

76
Q

What is female sterilisation?

A

Prevention of pregnancy by blocking/sealing the fallopian tubes to prevent egg from reaching the sperm, preventing fertilisation

77
Q

What are the methods of female sterilisation?

A

Applying clips or rings over the fallopian tubes
Cutting and removing a small piece of the tubes
Salpingectomy - removal of fallopian tubes

78
Q

How long does female sterilisation take to work?

A

Additional contraception necessary until next period after surgery

79
Q

What are the disadvantages of female sterilisation?

A

Procedural-related risks - bleeding, infection, injury to other organs
Operation may not be 100% successful - failure rate is 1 in 200
Relative increased risk of ectopic pregnancy
Considered irreversible - reversal procedures less successful than for vasectomy, IVF often required if pregnancy desired
No protection against STIs

80
Q

What is emergency contraception?

A

Used in the event of unprotected sex or failure of regular contraception

81
Q

What are the methods of emergency contraception?

A

2 types of oral emergency contraception

Copper IUD

82
Q

Which method of emergency contraception is the most effective?

A

Copper IUD

83
Q

When are oral emergency contraceptives effective?

A

First half of cycle - little to no effect after ovulation (2nd half)

84
Q

What are the options for oral emergency contraception?

A 
Levonorgestrel (Levonelle)
Ulipristal acetate (EllaOne)
85
Q

What is Levonelle?

A

Single dose of levonorgestrel (progesterone)

86
Q

What is the action of Levonelle?

A

Delays/prevents ovulation, and reduces implantation

87
Q

When must Levonelle be taken?

A

Within 72 hours of unprotected sex

88
Q

Can Levonelle be taken more than once in a menstrual cycle?

A

Yes

89
Q

When can hormonal contraception be taken after taking Levonelle?

A

Immediately

90
Q

What are the disadvantages of Levonelle?

A

Disturbance of menstrual cycle - menses may be earlier or later than expected in
the cycle
Nausea and vomiting - dose should be repeated if it occurs within 3h of taking the
pill
Side effects - dizziness, Diarrhoea, Breast tenderness

91
Q

What is Ellaone?

A

A progesterone receptor modulator

92
Q

How does Ellaone work?

A

Delays/inhibits ovulation by stopping LH surge

93
Q

Can Ellaone be taken more than once in one cycle?

A

Yes (but not particularly recommended)

94
Q

When must Ellaone be taken?

A

Within 5 days of unprotected sex

95
Q

When is Ellaone avoided?

A

Severe asthma

Regular antacid use

96
Q

What are the disadvantages of Ellaone

A

May reduce effectiveness of hormonal contraception - restart 5 days after taking Ellaone
Menstrual cycle irregularities
Nausea and vomiting can impair absorption - dose should be repeated if it occurs within 3h of taking the pill
Side effects - headache, dizziness, breast tenderness

97
Q

When is the copper IUD effective as an emergency contraceptive?

A

If inserted within 5 days of unprotected sexual intercourse

OR up to 5 days after expected day of ovulation in regular cycle

Y3 - Repro (13 decks)

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