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Gynaecology > Contraception > Flashcards

Contraception Flashcards

1
Q

Prescribing COCP for a 14 y/o girl

What are key principles?

A
  • Confidentiality discussed
  • Gillick’s competence assessment
  • Encourage discussion with parents
  • HEADDSSS assessment
  • assess for sexual safety - consent, age of partner
  • STI prevention
  • History - medical/surgical/OGYN
  • Contraindications to COCP Qs
  • Gardasil vaccination considered
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2
Q

What information do you give about missing the COCP?

A
  • consider ECP if 2 (>72 hrs) or more missed pill in the 1st week after HFI (hormone free interval)
  • 1 missed pill is okay in 1st week after HFI as long as taken 7 days prior to HFI + 7 days afterward
  • > 2 missed pills okay in weeks 2 and 3 after HFI as long correct use for previous 7 days
  • Skip HFI if >2 missed pills in week 3
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3
Q

What general advice do you tell a young woman starting on COCP about how to take?

A

start first 5 days of cycle = protected
start any other time - use barrier contraception 7 days
does not protect from STI - always use a condom
can run packets together
return if headache or calf pain
return in 3/12 for BP check

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4
Q

What are 3 disadvantages of implanon (jadelle)

A
  • may increase acne
  • may cause irregular bleeding in first year
  • scar on arm
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5
Q

6 situations you would NOT prescribe COCP?

A
  • Age 35+ and smoker 15+/day
  • migraine with aura
  • SLE with +ve antiphospholipid syndrome
  • h/o DVT/PE
  • h/o breast cancer
  • h/o liver cancer/disease
  • cardiovascular risk factors high
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6
Q

What are 2 possible mechanisms that may link Yasmin (ethinylestradiol + drosperinon) and VTE?

A
  • weak diuretic/dehydration effect

- Less counteraction of the estrogen effect (relative to older progestins)

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7
Q
A
  • personal h/o unprovoked VTE
  • family h/o of 1st degree relative with unprovoked VTE
  • major surgery
  • immobilisation
  • age >35
  • smoker >15/day
  • High BMI
  • SMoker
  • known thrombophilia
  • recently postpartum
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8
Q

List 2 pharmacological effects unique to drosperinone?

A

Anti-androgen - reduced acne, hirsutism

Diuretic - reduced weight gain, reduced BP, less breast swelling/tenderness

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9
Q

List 4 contraceptive options if concerned about risk of VTE associated with contraception

A

POP
mirena
jadelle
depo provera

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10
Q

Outline the criteria for the lactation amenorrhoea method

A

<6 months postpartum
exclusively breast feeding
amenorrhoeic

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11
Q

What does exclusively breast feeding mean?

A

not providing food or other liquid

no more than 4-6 hours between feeds (4 during day, 6 at night)

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12
Q

What is the success rate of LAM when used correctly?

A

98%

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13
Q

What is the specific hormone compound and dose within the POP?

A

Levenorgestrel 30mcg

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14
Q

What is the specific hormone compound and dose of implanon (jadelle)

A

etonorgestrel

68mg

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15
Q

What is the specific hormone compound and dose in Mirena?

A

levonorgestrel 52mg (which equates to 0.02mg per day)

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16
Q

What is the hormone compound and dose of the depo provera?

A

DMPA

150mg

17
Q 
How long do women return to fertility after stopping
A) POP
B) Implanon
C) mirena
D) Depo provera
A

A) within 1 month
B) 7-14 days
C) as early as 1 month, 97% have menses by 3/12
D) Up to 6 months

18
Q

What is a disadvantage of the Depo provera?

A
  • side effect - bone density issues
19
Q

List 2 first and second generation progestins

A

levonorgestrel

norethisterone

20
Q

list a 3rd generation progestin

A

desogestrel

21
Q

Which progestin is in Ginet and why is this good for PCOS?

A

Cyproterone

Anti-androgen

22
Q

which progestin is in Yasmin and why is this good for fluid retention/bloating symptoms?

A

Drosperinone

- derived from spironolactone - therefore weak diuretic effect

23
Q

What are the two oral ECP methods available in NZ and Australia?

A
  • levonorgestrel 1.5mg

- ulipristal acetate 30mg- selective progesterone receptor modulator

24
Q

If used in the first 120 hours after intercourse what are the pregnancy rates for levonorgestrel vs ulipristal acetate?

A
  1. 2%
  2. 4% respectively
  • LNG only licensed for use within 72 hours of intercourse, UP licensed for up to 120 hours (5 days)
25
Q

What is the mechanism of action of Ulipristal acetate?

A

selective progesterone receptor modulator - acts by delaying ovulation for up to 5 days, until sperm from the UPSI are no longer viable

  • if taken at time of LH surge it can still delay ovulation a little
  • but risk of pregnancy if taken after start of LH surge)
    1. 4% pregnancy rate if taken within 5 days
26
Q

What is the mechanism of action of LNG for ECP?

A

if taken prior to the start of the LH surge it can delay ovulation by up to 5 days as it inhibits follicle rupture
in the late follicular phase the LNG is no longer effective

27
Q

What is the MOA of the Copper IUD?

A
  • toxic effect on sperm and ovum and prevents fertilisation
  • if fertilisation does occur, Cu IUD also has toxic effect on womb making it inhospitable for a pregnancy and prevents implantation
28
Q

How does BMI impact on the different ECP methods?

A
  • Does not effect Cu IUD
  • Might effect efficacy of UA (although unclear but higher BMI may equal higher risk of pregnancy)
  • Does effect efficacy of LNG (Obese women were 4 x higher risk of pregnancy than BMI <25 women), give UA, or 3mg LNG
29
Q

which medications interact with oral ECP methods?

A
  • inducers of CYP450 enzyme (BS CRAP GPS)
  • Ulipristal acetate efficacy can be reduced by use of progesterone or COCP
  • UPA has an antiglucocorticoid effect so if women have severe asthma and are taking glucocorticoid therapy this has to be considered
  • LNG and UPA not supposed to be taken with severe hepatic impairment however given risk of pregnancy on severe hepatic impairment??
30
Q

Breast feeding and ECP methods (all 3)

A
  • UPA is excreted in breast milk and not studied therefore advised to express and throwaway breast milk for 1/52 after use
  • limited evidence suggests LNG okay with breast feeding
  • increased risk of uterine perforation if breast feeding with Cu IUD (during involution)

Gynaecology (25 decks)

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