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MSRA CONTRACEPTION > Contraception > Flashcards

Contraception Flashcards

1
Q

What are the 2 most common methods of barrier contraception?

A
  1. condoms
  2. diaphragms and cervical caps
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2
Q

What is the efficacy of male condoms?

A

perfect use - 98%

typical use 80%

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3
Q

What is the efficacy of female condoms?

A

perfect use - 95%

typical use - 80%

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4
Q

What should not be used with latex condoms?

A

oil based lubricants

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5
Q

What material should be use if you are allergic to latex in regards to condoms?

A

polyurethane condoms

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6
Q

What is the only combine contraceptive patch licensed for use in the UK?

A

Evra patch

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7
Q

What is the patch cycle of the Evra Patch?

A

4 weeks

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8
Q

How is the Evra patch worn for the first 3 out of 4 weeks?

A
  1. worn everyday for 3 weeks
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9
Q

When should you change the Evra patch?

A
  1. every week
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10
Q

What should you do with the evra patch during the 4th week?

A

do not wear

allow withdrawal bleed

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11
Q

What advise is given if the patch change is delayed at the end of week 1 or 2 and less than 48 hours ?

A

change the patch immediately

no further precautions are needed

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12
Q

What advise is given if the patch change is delayed at the end of week 1 and 2 and more than 48 hours?

A

changed immediately

barrier method of contraception up for next 7 days

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13
Q

What advise is given if the patch change is delayed at the end of week 1 and 2 and more than 48 hours and the woman has had sex during the extended patch free interval or if unprotected sex has occurred in the last 5 days?

A

emergency contraception needs to be considered

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14
Q

What advise is given if path removal is delayed at the end of week 3?

A

remove patch asap

put new patch on the usual cycle start day for the next cycle

this is even if withdrawal bleeding is occurring

no additional contraception’s required

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15
Q

What advise is given if patch application is delayed at the end of the patch free week?

A

additional barrier contraception should be used for 7 days following any delay at the start of a new patch cycle

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16
Q

What are the advantages of the COCP? (x8)

A
  1. highly effective
  2. does not interfere with sex
  3. reversible upon stopping
  4. regular periods, lighter, less painful
  5. reduced risk of ovarian and endometrial cancers
  6. reduced risk of colon cancer
  7. protects against pid
  8. may reduce ovarian cysts, benign breast disease and acne
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17
Q

What are the disadvantages of the COCP?

A
  1. forget to take
  2. no protection against STIs
  3. VTE risk
  4. Breast and cervical ca risk increased
  5. increased risk of stroke and IHD (especially in smokers)
  6. side effects: headache, nausea, breast tenderness
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18
Q

Is there a causal relationship between COCP and weight gain?

A

No

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19
Q

What are the UKMEC 3 conditions that are contraindications to starting the COCP? (x7)

A
  1. > 35 years old and smoking less than 15 cigarettes a day
  2. BMI > 35kg/m^2
  3. FH of thromboembolic disease in first degree relatives< 45 years
  4. Controlled HTN
  5. immobility
  6. carrier of known gene mutations associated with breast cancers e.g. BRCA1/BRCA2
  7. current gallbladder disease
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20
Q

What are the UKMEC 4 conditions contraindicating against COCP? (x11)

A

more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)

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21
Q

In regards to COCP what is diabetes mellitus diagnosed > 20 years ago classified as in regards to the UKMEC?

A

UKMEC 3 or 4 depending on severity

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22
Q

In regards to COCP what is the UKMEC for breast feeding 6 weeks-6 months postpartum?

A

UKMEC 2

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23
Q

Is additional contraception required if the COCP is started with in the first 5 days of the cycle?

A

No

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24
Q

Is additional contraception required if the COCP is started after the first 5 days of the cycle?

A

Yes - e.g. condoms for the first 7 days

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25
Q

At what time should one take the the cOCP?

A

same time each day

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26
Q

How is the cOCP conventionally taken? (in terms of days in the cycle)

A

21 days

stopped for 7 days

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27
Q

What is tricycling in terms of COCP?

A

in 2019 it was seen that there was no medical benefit from having withdrawal bleeds

tricycling is taking three 21 days packs bak to kick before having.a 4 or 7 day break

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28
Q

Is there an option to never have a pill free interval in regards to COCP?

A

yes - no evidence that there is benefit of withdrawal bleeding

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29
Q

When is intercourse safe during pill free period?

A

if the next pack is started on time

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30
Q

What may effect the efficacy of cocp?

A
  1. vomiting with in 2 hours o taking the pill
  2. medication that induce diarrhoea or vomiting
  3. liver enzyme inducing drugs
  4. antibiotics e.g. rifampicin - may interfere with the enetrohepatic circulation of oestrogen (extra precautions for 7 days)
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31
Q

What dose of ethinylestradiol does the COCP contain?

A

30-35 mcg

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32
Q

What advise is given if 1 pill is missed at any time in the cycle of COCP?

A

take the last pill even if it means taking two pills in one day and then continue taking pills daily, one each day

no additional contraceptive protection needed

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33
Q

What advise is given if 2 pills is missed of the cOCP?

A

take the last pill even if it means taking two pills in one day, leave any earlier missed pills and then continue taking pills daily, one each day

the women should use condoms or abstain from sex until she has taken pills for 7 days in a row.

FSRH: ‘This advice may be overcautious in the second and third weeks, but the advice is a backup in the event that further pills are missed’

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34
Q

If 2 or more pills are missed in week 1 in regards to COCP what advise is given?

A

if pills are missed in week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1

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35
Q

if 2 or more pils are missed in week 2 in regards to cocp what advise is given?

A

if pills are missed in week 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception*

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36
Q

if 2 or more cocp pills are missed in week 3 what advise is given?

A

if pills are missed in week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval

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37
Q

What method f contraception is advised against in women >40 years?

A

None by age alone

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38
Q

How could the COCP benefit a women >40 years?

A

in perimenopausal women can hep maintain bone mineral density

may help reduced menopausal symptoms

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39
Q

How long of a delay in fertility can the depo-provera cause in women >40 years?

A

delay in fertility of over a 1 year

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40
Q

Which contraception is associated with a small loss in bone mineral density and when is this recovered?

A
  1. depo provera
  2. after disocntinuation
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41
Q

When can women < 50 years stop non-hormonal contraceptives?

A

after 2 years of amenorrhea

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42
Q

When can women > 50 years stop non-hormonal contraception?

A

after 1 year of amenorrhoea

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43
Q

When can women < 50 years continue COCP?

A

up until 50 years

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44
Q

What advise is given in regards to COCP and women > 50 years who are on it?

A

switch the non hormonal or progesterone only method

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45
Q

Up to watch age can the depo prover be used up to in women < 50 years?

A

up until they are 50 years

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46
Q

What advice is given to women in regards to depo provera and women > 50 years if they are already on depo provera?

A

switch to non hormonal

stop after 2years of ammehnorhea

or switch the progesterone only method

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47
Q

What age can the implant, pop and its be used up untiL?

A

beyond 50 years

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48
Q

What advice is given to women > 50 years who use implant, pop and IUS and can they continue etc?

A

Yes they can continue

if ammehorhic check FSH and stop after 1 year if FSH >30 or stop at 55 years

if not amenorrhoeic consider investigating abnormal bleeding pattern

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49
Q

What contraception is advised to be used alongside HRT?

A

POP as long as HRT has a progesterone component

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50
Q

What are the methods of action condoms?

A

physical barrier

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51
Q

What other diseases do condoms protect you against?

A

stis

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52
Q

How does the cOCP work?

A

inhibits ovulation

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53
Q

How to the POP work?

A

thickens cervical muscus

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54
Q

What is the main side effect of POP?

A

Irregular bleeding

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55
Q

How does the injectable contraceptive medroxyprogesterone acetate?

A

inhibits ovlations

thickens cervical muscus

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56
Q

how long does the medroxyprogesterone acetate last?

A

12 weeks

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57
Q

How does the implantable contraceptive etonogestrel for?

A

inhibit ovulation

thickens cervical mucus

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58
Q

how long does the implantable contraceptive etonogestrel last for?

A

3 years

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59
Q

What is a common side effect of the implantable contraceptive etongestrel?

A

irregular bleeding

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60
Q

How does intrauterine contraceptive device work?

A

deceased sperm motility and survival

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61
Q

how does a intrauterine system e.g. levonorgestrel work and what is a common side effect?

A

prevents endometrial proliferation and thickens cervical mucus

irregular bleeding

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62
Q

What is desogestrel?

A

type of POP which also inhibits ovulation

63
Q

how does levonorgestrel work?

A

inhibits ovulation

64
Q

how does ulipristal work?

A

inhibits ovulation

65
Q

How does intrauterine contraceptive device work?

A

toxic to sperm and ovum

inhibits implantation

66
Q

When should young people be advised to have STI tests after an incident of unprotected sex (UPSIs)

A

2 and 12 weeks after UPSI

67
Q

What choice of contraception is best for young people?

A

LARC such as progesterone only implant (Nexplanon)

68
Q

What types of emergency contraception are available?

A
  1. levonorgestrel
  2. Ullipristal
  3. IUD
69
Q

What is the MOA of levonorgestrel?

A
  1. not fully understood
  2. stops ovulation
  3. inhibits implantation
70
Q

Why should levonorgestrel be taken asap?

A

efficacy decreases with time

71
Q

When should levonorgestrel be taking?

A

with in 72 hours of UPSI

72
Q

What is levonorgestrel?

A

an emergency contraceptive pill

a progesterone

73
Q

When is the dose of levonorgestrel doubled (1.5mg)?

A

those with BMIs . 26 or weight over 70 kg

74
Q

In percentage, how effective is levongestrel if used with in 72 hours of UPSI?

A

84%

75
Q

What should you do if vomiting occurs with in the first 3hurs of taking levongestrel?

A

dose should be repeated

76
Q

Can levongestrel be used more than once in the menstrual cycle ?

A

yes

77
Q

When can hormonal contraception e started after using levogenstrel (levonelle)?

A

immediately after

78
Q

What is ullipristal?

A

emergency contraceptive

selective progesterone receptor modulator marketed as EllaOne

79
Q

What is the MOA of Ullipristal?

A

inhibits ovulation

80
Q

When do you take Ullipristal and what dose and no later than what?

A

30mg

ASAP

no later than 120 hours after inetrcourse

81
Q

Can you use ullipristal and levongetsrel together?

A

No

82
Q

When should long term contraception be used with ullipristal and what should be used during these days ?

A

after 5 days

barrier methods should be used during these 5 days

83
Q

What affect does ullipristal have on hormonal contraception?

A

reduced effectiveness of hormonal contraception

84
Q

Which patients should ullipristal be used with caution?

A

severe asthma

85
Q

When can you breastfeed with Ullipristal?

A

after 1 week of taking ulipristal

86
Q

Wen can you breast feed with levongestrel?

A

whenever

87
Q

is repeat dosing with in the same menstrual cycle recommended in ulipristal?

A

yeah (used to be no)

88
Q

What is the most effective emergency contraception?

A

copper iud

89
Q

when should a copper iud be inserted in relation to when the UPSI occurred?

A

within 5 days of UPSI

90
Q

If a woman presents after 5 more days when can a IUD be fitted?

A

up to 5 days after the ;likely ovulation date

91
Q

How does a copper iud work?

A

inhibit fertilisation or implantation

92
Q

When may prophylactic antibiotics be given in regards to a IUD?

A

if the patient is considered high risk for STI

93
Q

What is the efficacy of copper IUD?

A

99%

94
Q

How long can a copper IUD be kept in for?

A

long term

or if the patient does not want it up until next period

95
Q

What is the advice in regards to other use of contraception and ocndoms for patient’s with epilepsy?

A

consistent use fo condoms in addition to other forms of contraception

96
Q

What types of contraceptives are advised for use for epilepsy patients taking phenytoin, crabamazepine, barbiturates, primidone, topiramate and oxcarbazepine?

A

depo-porvera
iud
ius
implant

97
Q

What types of contraceptives are not advised for use for epilepsy patients taking phenytoin, crabamazepine, barbiturates, primidone, topiramate and oxcarbazepine?

A

COCP

POP

98
Q

What types of contraceptives are advised for use for epilepsy patients taking lamotrigine?

A

POP, implant, Depo-Provera, IUD, IUS

99
Q

What types of contraceptives are not advised for use for epilepsy patients taking lamotrigine?

A

COCP

100
Q

What is the implantable contraceptive used in the UK?

A

nexplanon

101
Q

What are the 2 main differences between nexplanon and implanon?

A

applicator redesigned to prevent deep insertions

radioopaque so easier to locate

102
Q

How does the nexplanon implant work?

A

slow releases progesterone hormone etonogestrel

prevents ovulation

thickening cervical muscus

103
Q

how and when is nexplanon inserted?

A

inserted in the proximal non-dominant arm overlying the tricep

104
Q

What is the efficacy of nexplanon?

A

highly effective failure rate 0.07/100 women

105
Q

how long doe snexplanon last for?

A

3 years

106
Q

Ca nexplanon be used in people with history of thromboemmoolism, migraine etc?

A

yes does not contain oestrogen

107
Q

Following a termination of pregnancy when can nexplanon be inserted?

A

immediately following a termination of pregnancy

108
Q

Disadvantages of nexplanon

A

the need for a trained professional to insert and remove device

additional contraceptive methods are needed for the first 7 days if not inserted on day 1 to 5 of a woman’s menstrual cycle

109
Q

What re the adverse effetcs of nexplanon?

A

irregular/heavy bleeding

110
Q

What interactions are there with nexplanon?

A

enzyme inducing drugs reduce efficacy of nexplanon

111
Q

What are the contrainidcation of nexplnon?

A

IHD/Stroke

unexpained or suspicious vaginal bleeding

past breast ca

severe ievr crihossis

liver canacer
MAJOR NO: breast ca current

112
Q

What is the main injectable contraceptive used in the UK?

A

Depo Provera

113
Q

What doe depo provera contain?

A

medroxyprogesterone acetate 150 mg

114
Q

How is depo provera given and how often?

A

IM injection every 12 weeks

115
Q

how does depo provera work?

A

inhibits ovulation

cervical muscus thickening

endometrial tickenin g

116
Q

what are the adverse effects of depo provera?

A

irregular bleeding
weight gain
may potentially increased risk of osteoporosis: should only be used in adolescents if no other method of contraception is suitable
not quickly reversible and fertility may return after a varying time

117
Q

what are the contraindications to depo provera?

A

current or past breast ca

118
Q

What does intrauterine contraceptive devices compromise of?

A
  1. Copper Intrauterine device
  2. Levongesterel releasing intrauterine systems (IUS, Mirena)
119
Q

Other than contraception what else can IUS be used in managing?

A

Menorrhagia

120
Q

How effective are Iuds and IUS?

A

More than 90%

121
Q

What is the MOA of IUD?

A

prevent fertilisation by causing decreased sperm motilty and survival

122
Q

What is the MOA of IUS?

A

levongestrel prevents endometrial proliferation and causes cervical mucous thickening

123
Q

When can IUD start working?

A

immediately

124
Q

How long can a IUD be kept in for?

A

Cu on stem only: 5 years

Cu on stem and arm: 10 years

125
Q

When does a IUS start working?

A

7 days

126
Q

How long can IUS (Mirena) be kept in for?

A

5 years

127
Q

How long are they licensed for women using IUS for oestrogen only hormone replacement therapy protection?

A

4 years

128
Q

What are the problems with IUDs?

A

heavier, long and more painful periods

uterine perforation

ectopic pregnancies

infection first 20 days

expulsion in 1 in 20 people most likely in first 3 months

129
Q

what are the problems with IUS?

A

initial frequent uterine bleeding and spotting and later women have intermittent light menses with less dysmenorrhoea - some women even become amenorrhoeic

uterine perforation

ectopic pregnancies

infection first 20 days

expulsion in 1 in 20 people most likely in first 3 months

130
Q

After giving birth after how many days is a women required contraception?

A

21 days

131
Q

When can a postpartum woman start POP?

A

anytime postpartum

132
Q

Is POP contraindicated in breast feeding?

A

No

133
Q

When is COCP contraindicated in post part women?

A

if they are breast feeding <6 weeks post party

134
Q

Why should COCP not be used in first 21 days post partum?

A

Increased risk of thromboembolism

135
Q

When can COCP be used post partum?

A

after day 21

for 7 days use additional contraception

136
Q

When can a IUD or IUS be inserted post partum?

A

48 hours of childbirth

after 4 weeks

137
Q

How effective is the lactational amenorrhoea method (LAM)?

A

98% provided the woman is fully breast feeding, amenorrhoeic and < 6months post partum

138
Q

What is an inter-pregnancy interval of less than 12 months associated with?

A

increased risk of preterm birth

low birth weight

small for gestational age babies

139
Q

What are the pros of POP?

A

highly effective failure rate 1 per 100 woman

does not inteerefere with sex

reversible upon stopping

can breast feed whilst using

140
Q

What are the cons of POP?

A

irregular periods

no STI protection

increased incidence of functional ovarian cysts

141
Q

what are the common side effects of pop?

A

breast tenderness

weight gain

acne

headaches

142
Q

After how long do the pop side effects subside?

A

first few months

143
Q

If POP is started up to and including day 5 of the cycle when does protection commence?

A

Immediately

144
Q

If POP starts after day 5 of the cycle what advise is given in terms of protection?

A

Additional contraceptive methods should be used for 2 days

145
Q

When should pop be taken in the day?

A

same time everyday without a pill free break

146
Q

Do you require a pill free break with POP?

A

No

147
Q

If you are < 3 hours late with POP when should you take it?

A

continue as normal

148
Q

If you are > than 3 hours late with POP when should you continue?

A

take missed pill asap

continue rest of the pack

take extra precautions e.g. condoms

extra precaution should be used until pill taking has been re-established for 48 hours

149
Q

What should you do if you are vomiting or have diarrhoea and are on the pOP?

A

consider those doses as missed and see missed pills regime

150
Q

Do antibiotics have an effect onPOP?

A

No

151
Q

Do liver enzymes have an effect on POP?

A

yes. reduce effectiveness

152
Q

How may hours period is allow for cerazette if you miss it ?

A

12 hours

153
Q

Types of progesterone pills?

A

second generation

third generation - new generation e.g. desogestrel

MSRA CONTRACEPTION (1 decks)

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