Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OBGYN > Contraception > Flashcards

Contraception Flashcards

1
Q

How is efficacy of contraception measured?

A

Pearl index

Efficacy of contraception

The risk of pregnancy per 100 woman years of using the given contraceptive method
If PI is 3 – if 100 woman use it for 1year, 3 will become pregnant
Handout of PI’s for each method

Also depends on compliance
Perfect versus typical use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the pearl index for no contraception?

A

80-85

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what has a pearl index of 0?

A

Abstinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the top ranked contraceptives in the pearl index?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the classes of CIs to contraception?

A

Contra-indications – UK MEC categories
UK MEC 1: no restriction
UK MEC 2: advantages outweigh risks
UK MEC 3: risks outweigh advantages
(expert advice)
UK MEC 4: unacceptable health risk
Side-effects
Drug interactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the hormonal methods of contraception?

A

Combined (O + P)
-pill
-patch
-ring

Progestogen Only
-’mini’ pill
-Long-acting reversible
contraceptives (LARC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the non-hormonal options of contraception?

A

Copper IUCD
Male Vasectomy
Female Tubal Ligation
Male Condom
Female Diaphragm/condom
Natural methods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does the COCP work?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do you take the COCP?

A

Varies

Typically every day for 3weeks, then 7day break
Bleed in pill-free interval
Back-to-back

Newer pills – 28day packs, shorter break
Yaz, Qlaira, Zoely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the two hormones that are contained within traditional COCP?

A

Traditional –
synthetic oestrogen Ethinyloestradiol
Low-dose – 20mcg
Standard – 30mcg
Dianette – 35mcg
(can get up to 40mcg)

Progestogen:
1st generation: norethisterone, medroxyprogesterone
2nd generation: levonorgestrel
3rd generation: desogestrel, gestodene, norgestimate

Anti-androgens: cyproterone acetate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the features of the newer COCP which contain different types of estrogen?

A

Qlaira – natural oestrogen called oestradiol valerate (multiphasic – 4 phases). 26/2.

Zoely – natural oestrogen called oestradiol hemihydrate. 24/4.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the absolute CI of the COCP?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the common progestogenic s/e of the COCP that resolve within 2-3/12?

A

Acne
Weight gain
(no evidence of causal
relationship)
Vaginal dryness
Bleeding/amenorrhoea
Breast discomfort

PMS Sx
Mood changes
Reduced libido

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the common estrogenic s/e of the COCP that resolve within 2-3/12?

A

Nausea
Headaches
Fluid retention
HTN

Increased mucus
Breast discomfort and fullness
Bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the risks a/w/ the COCP?

A

MI/Ischaemic stroke/VTE
Cervical Cancer
Breast Cancer
Migraine
Hypertension
Liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the benefits of COCP?

A

Menstrual disorders: menorrhagia, dysmen
Endometriosis
PCOS: acne/hirsutism

Also of note:
PID

Also decreases benign breast cysts and ovarian cysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does the COCP impact the risk of cancer?

A

Increased risk: breast and cervical ca

Decreased risk: endometrial , ovarian, colorectal cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What drug interactions are seen with the COCP?

A

LIVER ENZYME-INDUCING DRUGS
Increases metabolism of COC

PCBRAS mnemonic

DECREASE ABSORPTON ??
- Antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is an example of the transdermal patch?

A

Evra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How is the patch given?

A

New patch applied every week for 3 weeks, then patch-free week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What drugs are in the patch?

A

Ethinyloestradiol 34mcg + Norelgestromin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the vaginal ring?

A

Nuvaring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What drugs are in the vaginal ring?

A

Ethinyloestradiol 15mcg + etonogestrel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How is the vaginal ring used?

A

Inserted into vagina and removed 3weeks later then ring-free week
Don’t remove during intercourse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is a benefit of the vaginal ring?

A

Less oestrogenic SEs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are some eg of progestogen only contraceptives?

A

“Mini-Pill”

Long-acting reversible contraception (LARC)
Depot
Implanon
Mirena IUCD

Similar CI’s and SE’s for all

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the 2 types of POP available in Ireland?

A

Desogestrel 75mcg (cerazette)
12hr window

Noriday (Norethisterone 350mcg)
Older, rarely used
3hr window ➔ less effective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the MOA of POP?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How do you take the POP?

A

Take every day with NO pill free break – same time

Can be given 12month supply

Can continue until age 55yrs

30
Q

What are the advantages of the POP? (3)

A

No increased risk of thrombosis (but stop if new MI/CVA/migraine with aura)
No problem with breast feeding
Not affected by antibiotics

31
Q

What are the disadvantages of POP? (4)

A

Daily timing-failure
Progestogenic s/e
Functional ovarian cysts
C/I related to breast ca (current UK MEC: 4, past> 5yrs: UKMEC 3)/liver(cirrhosis and liver tumours MEC 3)/Hepatic enzyme inducer MEC 3)

32
Q

What is the MOA of LARCs?

A
  • thicken cervical mucus
  • endometrial changes that inhibit implantation
  • inhibit ovulation (depot/implanon) so less risk of ovarian cysts.
33
Q

What are the progestogenic s/e of LARCs?

A

->Bleeding:
-Irregular bleeding – often initially but usually
followed by amenorrhoea

34
Q

What are some of the s/e specific to Depo? (3)

A

Decreased BMD (peaks 2-3yrs,regained after stopping)

Weight gain (up to 4kg per year)

Discontinuation
-Prolonged amenorrhoea up to 1yr
-Delay in return to fertility up to 1yr

35
Q

What drug is in the Depo-Provera injection?

A

Medroxyprogesterone acetate 150mg

36
Q

How is the depo injection given?

A

IM injection: Typical PI: 3

Every 12weeks

Late attenders – can be given up to 14weeks without need for additional precautions

37
Q

What drug is in the bar?

A

Nexplanon (etonogestrel)

38
Q

What is the bar?

A

Subcutaneous plastic rod 4cm X 2mm

39
Q

How effective is the bar?

A

Most effective contraception PI 0.05

40
Q

When in the cycle is the bar inserted?

A

Insert 1st 5 days of the cycle

41
Q

How long does the bar last?

A

3 years

42
Q

What are the side effects of the bar?

A

Irregular bleeding (1st yr)
Progestogenic SE’s

No drop in BMD
Nexplanon (insert, x-ray)

43
Q

What are hormonal IUS?

A

Plastic intra-uterine device

44
Q

What do hormonal IUS contain?

A

Contains progestogen levonorgestrel

45
Q

What are the 2 types of hormonal IUS?

A
46
Q

What is the MOA of Mirena?

A

Thicken cervical mucus
Endometrial changes preventing implantation
Inhibits ovulation in 20%

47
Q

What is the Mirenas impact on bleeding?

A

Reduces menstrual loss and pain ➔ 1st line treatment for menorrhagia

Irregular bleeding – reduces with time (months), often causing amenorrhoea

Systemic SE’s low

48
Q

What are some complications of the Mirena?

A

Pain
Cervical shock
Scarred uterus can make insertion more difficult (e.g. previous c-section)

Expulsion (1 in 20 most common 1st 3 months after insertion)
Perforation – approx < 1 in 200

Infection –10% (screen high risk pt’s for infection, practices vary)

Ectopic pregnancy (if pregnancy)
Failure (PI: 0.2): If pregnant remove before 12 weeks

49
Q

What are some CI to the Mirena IUS?

A

< 4 week post pregnancy. Most GPs wait 3 months.

Undiagnosed abnormal vaginal bleeding
Endometrial or cervical cancer
Ovarian Cancer (MEC 3)
Current breast cancer (past history MEC 3)
Active/recent pelvic infection
Pregnancy
Fibroids/Uterine Cavity Distortion (MEC 3)

50
Q

Case

A
51
Q

What are the non-hormonal methods of contraception?

A

Copper IUCD
Male Condom
Diaphragm / Female Condom
Tubal Ligation
Male Vasectomy
Natural Methods

52
Q

How long does the copper IUCD last?

A

3-10 years depending on device

53
Q

What else can the copper IUCD be used for?

A

Emergency contraception (5/7)

54
Q

How effective is the copper IUCD?

A

Slightly less effective than Mirena (typical PI: 0.8)

55
Q

What is the MOA of the copper IUCD?

A

Prevents fertilization – copper toxic to sperm

Block implantation – inflammatory response in endometrium

56
Q

What are the s/e of the copper IUCD?

A

Periods may become heavier, more painful and prolonged
(particularly in first 6 months)

Bloating

57
Q

What are the complications of the copper IUCD?

A

Same as Mirena

58
Q

What are the CI of the copper IUCD?

A

few

Undiagnosed abnormal vaginal bleeding
Endometrial/cervical cancer/ovarian cancer (MEC3)
Pregnancy
Active/recent PID
Fibroids distorting the uterine cavity

59
Q

What are the barrier methods?

A

Spermicides (nonoxynol-9) can be used in conjunction with any barrier methods

Male condom
Depends on proper use (1-2/15)
Best protection against STI’s

60
Q

What are the features of the female barrier method of diaphragms and caps?

A

Fitted before intercourse. In conjunction with sperimicide.
Must remain in situ for at least 6 hrs afterwards

Cervical cap fits over the cervix
Diaphragm held between pubic bone and sacral curve covering the cervix

Must be fitted by trained personnel
Less protection against STIs than male condoms

Female condom can protect against STIs

61
Q

What is the basis of tubal ligation?

A

Decreasing in popularity due to LARC
Basis: Interruption of fallopian tubes so sperm and egg don’t meet
Commonest technique – Filshie clips – laparoscopy
At time of c-section portion of each tube excised

Hysteroscopy and insert placement: fibrosis and occlusion confirmed with HSG 3 months later

62
Q

What are the surgical risks of tubal ligation?

A

Failure rate 0.5% - 1 in 200!
Counseling NB
Complications
Visceral damage
Co2 embolism
Need to convert to laparotomy
Pain/infection/bleeding
Risks of GA

Failure
Risk of ectopic if does become pregnant
Seldom reversible

63
Q

What are the features of the male vasectomy?

A

More effective – 1 in 2000 failure rate

Ligation and removal of small part of van deferens ➔ preventing release of sperm

Under LA

Can take up to 6months to achieve azoospermia – must be confirmed by 2 semen analyses ( usually 1 at 3/12, another 1/12 later)

64
Q

What are the complications of male vasectomy?

A

Failure
Haematomas and infection
Chronic pain (6-8% one year later)
Seldom reversible (antisperm abs)

65
Q

What are the natural methods of contraception?

A

Unreliable (typical PI: 25)
Only suitable if not bothered if get pregnant
Lactation – exclusive
‘Rhythm’ method – avoid fertile period around ovulation
‘Withdrawal’ method – removal of penis before ejaculation

66
Q

What is the emergency contraception?

A

Levonorgestrel (preferably within 24 hrs -up to 72 hrs. NB weight over 75kg)

Ulipristal (SPRM:’EllaOne’): up to 5 days (120 hrs)

IUD: up to 5 days

67
Q

What are 2 eg of 1st gen progestogen used in the COCP?

A
  • norethisterone
  • medroxyprogesterone
68
Q

What is an eg of a 2nd gen progestogen used in the COCP?

A

Levonorgestrel

69
Q

What are 3 eg of 3rd gen progestogens used in the COCP?

A
  • desogestrel
  • gestodene
  • norgestimate
70
Q

What are the relative (MEC 3) CI to the COCP?

A

OBGYN (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions