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3a > Contraception > Flashcards

Contraception Flashcards

1
Q

what are the 3 mechanisms of action of the combined oral contraceptive pill (COCP)

A
  1. Prevents ovulation by suppressing LH and FSH
  2. Progesterone thickens cervical mucus
  3. Progesterone thins edometrium
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2
Q

give 4 SE of the COCP

A
  • Unscheduled bleeding = common in first 3 mnths
  • Breast pain and tenderness
  • Mood changes and depression
  • Headaches
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3
Q

What advice is given if one COCP is missed (less than 72 hrs since last pill)

A

-Take missed pill as soon as possible (even if 2 on same day)
-No extra protection required provided other pills before where taken correctly

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4
Q

what should be done if a COCP is missed and MORE than 72 hrs since last pill was taken

A

-Take most recent missed pill ASAP
-Additional contraception needed until pill has been taken for 7 days straight
-If this was missed on day 1-7 of the packet and they have had unprotected sex they will need emergency contraception

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5
Q

if started within first 5 days of menstrual cycle when does the COCP and POP work ?

A

immediately

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6
Q

If started after 5 days of menstrual cycle, how many days of extra protection is needed for the COCP and the POP

A

COCP : seven days
POP : 48 hrs

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7
Q

give 4 SE of the POP

A
  • Unscheduled bleeding
  • Breast tenderness
  • Headaches
  • Acne
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8
Q

what is classed as a ‘missed pill’ with the POP?

A

-Traditional POP : >3 hrs late (26 hrs from last pill)
-Desogestrel POP >12 hrs late (36 hrs from last pill

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9
Q

what is the advice for a missed POP

A
  • Take pill as soon as possible, taking next pill at usual time
  • Use extra contraception for 48 hrs
  • Emergency contraception is required if they have had sex since missing the pill or within 48 hrs of restarting the regular pills
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10
Q

what is the progestogen-only injection and when is it given

A

-Depot medroxyprogesterone acetate (DMPA)
-Given at 12 to 13 wk intervals as IM or Subcut injection

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11
Q

what is a CI to the progesterone only injection

A

Active breast cancer

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12
Q

how does the projesterone only injection work

A

Inhibits ovulation by inhibiting FSH secretion
Also thickens cervical mucus and alters endometrium

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13
Q

what are to SE unique to the progesterone only injection ?

A

weight gain
osteoporosis - oestrogen helps maintain bone mineral density and is produced by the follicles of the ovaries. Suppressing follicle development reduces oestrogen

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14
Q

give 6 CI to the coil

A

PID or infection
Immunosuppression
Pregnancy
Unexplained bleeding
Pelvic cancer
Uterine cavity distortion (e.g. fibroids)

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15
Q

how does the copper coil work (IUD) and what is a CI

A

-Copper is toxic to ovum and sperm, licensed for 5-10yrs after insertion
-Wilson’s disease

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16
Q

How does the IUS (mirena coil))work

A

-Releases levonorgesterel (progestogen) :

-Thicken cervical mucus
-Alter endometrium to make it less acceptive of implantation
-Inhibit ovulation in small no. of women

-Licensed for 5 yrs

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17
Q

what needs to be considered and met when giving contraception to someone under 16

A

Are they Gillick Competent
Do they meet the Frazer fuidelines

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18
Q

give 3 options for emergency contraception

A

-Levonorgestrel (take within 72 hrs)
-Ulipristal (within 120 hrs)
-Copper coil (inserted within 5 days of UPSI or within 5 days of estimated ovulation

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19
Q

If a womens cycle was 28 days, when can the IUD be inserted for emergency contracaption

A

-IUD can be inserted within 5 days after estimated ovulation date
-Estimated ovulation date would be 14 days
-Therefore can be inserted from day 14 to day 19

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20
Q

hoe long should the copper coil be kept in following emergency contraception and what is a complication ??

A

-Until at least the next period
-PID

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21
Q

how does levonorgestrel work as emergency contraception

A

-Type of progestogen -> prevents / delays ovulation
-1.5mg as a single dose or 3mg as a single dose in women >70kg or BMI >26

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22
Q

what are common SE of levonorgestrel

A

-N&V : if occurs within 3 hrs of the pill the dose should be repeated
-Avoid breastfeeding for 8 hrs after dose

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23
Q

What is ulipristal and how does it work as emegency contraception

A

-Selective prohesterone receptor modulator
-Delays ovulation
-Single 30mg dose
-Wait 5 days before starting combined OCP or progesterone only pill

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24
Q

when should ulipristal be avoided

A

-Severe asthma
-Breastfeeding should be avoiding for a week

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25
Q

how are the risks of different contraceptions classififed ?

A

UKMEC 1 : no restriction
UKMEC 2 : benefits generally outweigh risks
UKMEC 3 : risks outweigh benefits
UKMEC 4 : unacceptable risk (CI)

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26
Q

what contraception whould be given in breast cancer

A

-Copper coil or barrier methods
-Avoid hormonal contraception

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27
Q

what contraception shouldn’t be given in cervical or endometrial cancer

A

IUS (i.e mirena coil)

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28
Q

what RF would suggest avoiding combined OCP

A

Uncontrolled HTN
Migraine with aura
History of VTE
>35 y/o smoking >15 cigarettes a day
Major surgery with prolonged immobility
Vascular disease or stroke
IHD, cardiomyopathy or AF
Liver cirrhosis and liver tumours
SLE and antiphospholipid

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29
Q

How long is contraception required after the last period

A

<50 y/o = 2 yrs
>50 y/o = 1 year

30
Q

when should the progestogen injection be stopped ?

A

Before 50 yrs due to osteoporosis risk

31
Q

what age can the combined OCP be used up to

A

50
In older / perimenopausal women hormone therapy does no prevet pregnancy

32
Q

when should amenorrhoeic women taking progestogen-only contaception contunue until

A

EITHER
-FSH blood test is >30IU/L on two tests taken 6 weeks aprat (continue contraception for 1 more yr)
-55 y/o

33
Q

give 6 benefits of the combined OCP

A

-Effective contraception
-rapid return of fertility after stopping
-Improvement in premenstrual symptoms, menorrhagia and dysmenorrhoea
-Reduced risk of endometrial, ovarian and colon cancer
-Reduced risk of benign ovarian cysts

34
Q

give 3 cancers the combined OCP reduces the risk of

A

Endometrial
Ovarian
Colon

35
Q

explain the timing of when the combined OCP will provide protection

A

-If started on the first day of the cycle = protection straight away
-If starting after day 5 of the cycle, extra contraception is required for 7 days

36
Q

if switching from the combined OCP to the POP how many days of extra contraception are required

A

7
However if switching from desogestrel not additional contraception is required

37
Q

what should be done 4 wks before a major operation if taking the combined OCP

A

stop the pill to reduce the risk of VTE

38
Q

what is a complete CI of the POP

A

Active breast cancer

39
Q

what are the two types of POP

A

Traditional - cannot be delayed by more than 3 hrs
Desogestrel-only pil can be take up to 12 hrs late

40
Q

how does the traditional POP work

A

Thickens cervical mucus
Alters endometrium making is less accepting of implantation
Reduces ciliary action in fallopian tubes

41
Q

What does desogestrel work ?

A

INHIBITS ovulation
Thickens cervical mucus
Alters endometrium
Reduces ciliary action in the fallopian tubes

42
Q

How long can it take for fertility to return after stopping depot injections

A

12 mnths

43
Q

what are the CI to the depot injections

A

UKMEC 4 : active breast cancer
UKMEC 3 : IHD and stroke, unexplained vaginal bleeding, severe liver cirrhosisn and liver cnacer

44
Q

what cancers is the depot injection associated with a very small increased risk of

A

breast an cervical cancer

45
Q

explain the timing of the depot injection

A

Day 1-5 of cycle = immediate protection
After day 5 = 7 days of extra protection

46
Q

give 4 benefits of the depot injection

A

Improves dysmenorrhoea
Improves endometriosis related sx
Reduces risk of ovarian and endometrial cancer
Reduces severity of sick cell crisis in sickle cell pts

47
Q

How long does the progestogen-only implant last and how does it work

A

3 yrs
Inhibits ovulation, thickens cervical mucus and alters endometrium

48
Q

what is a complete CI to the implant

A

active breast cancer

49
Q

Explain the protection given by the implant

A

On day 1-5 of period = immediate
After day 5 =seven days of extra contraception

50
Q

what kind of hormonal contraception is mot associated with irregular bleeding

A

Progesterone only

51
Q

what can be given to help problematic bleeding with progesterone only contraception >

A

Taking the combined OCP for 3 mnths

52
Q

what kind of contraception of coil devices

A

long-acting reversible contraception

53
Q

give 6 CI to coils

A

-PID or infection
-Immunosuppression
-Pregnancy
-Unexplained bleeding
-Pelvic cancer
-Uterine cavity distortion (e.g. by fibroids)

54
Q

In a women <25 what is done before coil insertion ?

A

screening for chlamydia and gonorrhoea

55
Q

what 3 things to need to be excluded when coil threads cannot be seen or palpated

A

Expulsion, pregnancy and uterine perforation
USS = 1st line

56
Q

when does the copper coil become effective

A

immediately

57
Q

when does the mirena coil become effective

A

If inserted up to day 7 = immediately
If after day 7, contraception is required for 7 days

58
Q

what is a female form of sterilisation

A

Tubal occlusion
Filshie clips occlude the tubes

59
Q

what is the male sterilisation procedure

A

Vasectomy -> cutting of the vas deferns
Alternative contraception is require for 2 mnths
Testing of semen to confirm absence of sperm is done at 12 wks

60
Q

When on the POP, what is the only antibiotic that would require barrier contraception during and for 4 wks after cessation of treatment

A

Rifampicin

61
Q

What does the COCP contain and explain its effectiveness ?

A
  • Combination of oestrogen and progesterone
  • 99% effective with perfect use
  • 91% effective with typical use
62
Q

What 2 COCP do NICE recommend first line due to lower VTE risk ?

A
  • Levonorgestrel (Microgynon)
  • Norethisterone (Loestrin)
63
Q

What COCP is offered first line for PMS and why ?

A
  • Yasmin (contains drospirenone)
  • Has anti-mineralocorticoid and anti-androgen activity which helps with symptoms
64
Q

What are the 2 common regimes for taking the COCP?

A
  • 21 days on and 7 days off
  • 63 days on (three packs) and 7 days off (“tricycling“)
  • Continuous use without a pill-free period
65
Q

Give 4 risks of the COCP

A
  • HTN
  • VTE
  • Small increased risk of breast and cervical cancer (returns to normal 10 yrs after stopping).
  • Small increased risk of MI and stroke
66
Q

What is a UKMEC 3 for the COCP?

A

BMI above 35

67
Q

If started on the first day of the cycle (first day of menstrual period), when does the COCP offer protection ?

A

Straight away

68
Q

If the COCP is started after day 5 of the menstrual cycle, how long is barrier contraception required for ?

A

7 days

69
Q

When switching from a tradition progesterone only pill to a COCP, how many days of extra protection is required

A

7 days

70
Q

When switching from desogestrel to a COCP, how many days of additional contraception is required ?

A

NON

71
Q

When should the COCP be stopped prior to a major operation

A

4 weeks

72
Q
A

3a (45 decks)

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