Contraception Flashcards
1
Q
What are the 2 most common methods of barrier contraception?
A
- condoms
- diaphragms and cervical caps
2
Q
What is the efficacy of male condoms?
A
perfect use - 98%
typical use 80%
3
Q
What is the efficacy of female condoms?
A
perfect use - 95%
typical use - 80%
4
Q
What should not be used with latex condoms?
A
oil based lubricants
5
Q
What material should be use if you are allergic to latex in regards to condoms?
A
polyurethane condoms
6
Q
What is the only combine contraceptive patch licensed for use in the UK?
A
Evra patch
7
Q
What is the patch cycle of the Evra Patch?
A
4 weeks
8
Q
How is the Evra patch worn for the first 3 out of 4 weeks?
A
- worn everyday for 3 weeks
9
Q
When should you change the Evra patch?
A
- every week
10
Q
What should you do with the evra patch during the 4th week?
A
do not wear
allow withdrawal bleed
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
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
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
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
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
16
Q
What are the advantages of the COCP? (x8)
A
- highly effective
- does not interfere with sex
- reversible upon stopping
- regular periods, lighter, less painful
- reduced risk of ovarian and endometrial cancers
- reduced risk of colon cancer
- protects against pid
- may reduce ovarian cysts, benign breast disease and acne
17
Q
What are the disadvantages of the COCP?
A
- forget to take
- no protection against STIs
- VTE risk
- Breast and cervical ca risk increased
- increased risk of stroke and IHD (especially in smokers)
- side effects: headache, nausea, breast tenderness
18
Q
Is there a causal relationship between COCP and weight gain?
A
No
19
Q
What are the UKMEC 3 conditions that are contraindications to starting the COCP? (x7)
A
- > 35 years old and smoking less than 15 cigarettes a day
- BMI > 35kg/m^2
- FH of thromboembolic disease in first degree relatives< 45 years
- Controlled HTN
- immobility
- carrier of known gene mutations associated with breast cancers e.g. BRCA1/BRCA2
- current gallbladder disease
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)
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
22
Q
In regards to COCP what is the UKMEC for breast feeding 6 weeks-6 months postpartum?
A
UKMEC 2
23
Q
Is additional contraception required if the COCP is started with in the first 5 days of the cycle?
A
No
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
25
At what time should one take the the cOCP?
same time each day
26
How is the cOCP conventionally taken? (in terms of days in the cycle)
21 days
stopped for 7 days
27
What is tricycling in terms of COCP?
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
28
Is there an option to never have a pill free interval in regards to COCP?
yes - no evidence that there is benefit of withdrawal bleeding
29
When is intercourse safe during pill free period?
if the next pack is started on time
30
What may effect the efficacy of cocp?
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)
31
What dose of ethinylestradiol does the COCP contain?
30-35 mcg
32
What advise is given if 1 pill is missed at any time in the cycle of COCP?
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
33
What advise is given if 2 pills is missed of the cOCP?
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'
34
If 2 or more pills are missed in week 1 in regards to COCP what advise is given?
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
35
if 2 or more pils are missed in week 2 in regards to cocp what advise is given?
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*
36
if 2 or more cocp pills are missed in week 3 what advise is given?
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
37
What method f contraception is advised against in women >40 years?
None by age alone
38
How could the COCP benefit a women >40 years?
in perimenopausal women can hep maintain bone mineral density
may help reduced menopausal symptoms
39
How long of a delay in fertility can the depo-provera cause in women >40 years?
delay in fertility of over a 1 year
40
Which contraception is associated with a small loss in bone mineral density and when is this recovered?
1. depo provera
2. after disocntinuation
41
When can women < 50 years stop non-hormonal contraceptives?
after 2 years of amenorrhea
42
When can women > 50 years stop non-hormonal contraception?
after 1 year of amenorrhoea
43
When can women < 50 years continue COCP?
up until 50 years
44
What advise is given in regards to COCP and women > 50 years who are on it?
switch the non hormonal or progesterone only method
45
Up to watch age can the depo prover be used up to in women < 50 years?
up until they are 50 years
46
What advice is given to women in regards to depo provera and women > 50 years if they are already on depo provera?
switch to non hormonal
stop after 2years of ammehnorhea
or switch the progesterone only method
47
What age can the implant, pop and its be used up untiL?
beyond 50 years
48
What advice is given to women > 50 years who use implant, pop and IUS and can they continue etc?
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
49
What contraception is advised to be used alongside HRT?
POP as long as HRT has a progesterone component
50
What are the methods of action condoms?
physical barrier
51
What other diseases do condoms protect you against?
stis
52
How does the cOCP work?
inhibits ovulation
53
How to the POP work?
thickens cervical muscus
54
What is the main side effect of POP?
Irregular bleeding
55
How does the injectable contraceptive medroxyprogesterone acetate?
inhibits ovlations
thickens cervical muscus
56
how long does the medroxyprogesterone acetate last?
12 weeks
57
How does the implantable contraceptive etonogestrel for?
inhibit ovulation
thickens cervical mucus
58
how long does the implantable contraceptive etonogestrel last for?
3 years
59
What is a common side effect of the implantable contraceptive etongestrel?
irregular bleeding
60
How does intrauterine contraceptive device work?
deceased sperm motility and survival
61
how does a intrauterine system e.g. levonorgestrel work and what is a common side effect?
prevents endometrial proliferation and thickens cervical mucus
irregular bleeding
62
What is desogestrel?
type of POP which also inhibits ovulation
63
how does levonorgestrel work?
inhibits ovulation
64
how does ulipristal work?
inhibits ovulation
65
How does intrauterine contraceptive device work?
toxic to sperm and ovum
inhibits implantation
66
When should young people be advised to have STI tests after an incident of unprotected sex (UPSIs)
2 and 12 weeks after UPSI
67
What choice of contraception is best for young people?
LARC such as progesterone only implant (Nexplanon)
68
What types of emergency contraception are available?
1. levonorgestrel
2. Ullipristal
3. IUD
69
What is the MOA of levonorgestrel?
1. not fully understood
2. stops ovulation
3. inhibits implantation
70
Why should levonorgestrel be taken asap?
efficacy decreases with time
71
When should levonorgestrel be taking?
with in 72 hours of UPSI
72
What is levonorgestrel?
an emergency contraceptive pill
a progesterone
73
When is the dose of levonorgestrel doubled (1.5mg)?
those with BMIs . 26 or weight over 70 kg
74
In percentage, how effective is levongestrel if used with in 72 hours of UPSI?
84%
75
What should you do if vomiting occurs with in the first 3hurs of taking levongestrel?
dose should be repeated
76
Can levongestrel be used more than once in the menstrual cycle ?
yes
77
When can hormonal contraception e started after using levogenstrel (levonelle)?
immediately after
78
What is ullipristal?
emergency contraceptive
selective progesterone receptor modulator marketed as EllaOne
79
What is the MOA of Ullipristal?
inhibits ovulation
80
When do you take Ullipristal and what dose and no later than what?
30mg
ASAP
no later than 120 hours after inetrcourse
81
Can you use ullipristal and levongetsrel together?
No
82
When should long term contraception be used with ullipristal and what should be used during these days ?
after 5 days
barrier methods should be used during these 5 days
83
What affect does ullipristal have on hormonal contraception?
reduced effectiveness of hormonal contraception
84
Which patients should ullipristal be used with caution?
severe asthma
85
When can you breastfeed with Ullipristal?
after 1 week of taking ulipristal
86
Wen can you breast feed with levongestrel?
whenever
87
is repeat dosing with in the same menstrual cycle recommended in ulipristal?
yeah (used to be no)
88
What is the most effective emergency contraception?
copper iud
89
when should a copper iud be inserted in relation to when the UPSI occurred?
within 5 days of UPSI
90
If a woman presents after 5 more days when can a IUD be fitted?
up to 5 days after the ;likely ovulation date
91
How does a copper iud work?
inhibit fertilisation or implantation
92
When may prophylactic antibiotics be given in regards to a IUD?
if the patient is considered high risk for STI
93
What is the efficacy of copper IUD?
99%
94
How long can a copper IUD be kept in for?
long term
or if the patient does not want it up until next period
95
What is the advice in regards to other use of contraception and ocndoms for patient's with epilepsy?
consistent use fo condoms in addition to other forms of contraception
96
What types of contraceptives are advised for use for epilepsy patients taking phenytoin, crabamazepine, barbiturates, primidone, topiramate and oxcarbazepine?
depo-porvera
iud
ius
implant
97
What types of contraceptives are not advised for use for epilepsy patients taking phenytoin, crabamazepine, barbiturates, primidone, topiramate and oxcarbazepine?
COCP
POP
98
What types of contraceptives are advised for use for epilepsy patients taking lamotrigine?
POP, implant, Depo-Provera, IUD, IUS
99
What types of contraceptives are not advised for use for epilepsy patients taking lamotrigine?
COCP
100
What is the implantable contraceptive used in the UK?
nexplanon
101
What are the 2 main differences between nexplanon and implanon?
applicator redesigned to prevent deep insertions
radioopaque so easier to locate
102
How does the nexplanon implant work?
slow releases progesterone hormone etonogestrel
prevents ovulation
thickening cervical muscus
103
how and when is nexplanon inserted?
inserted in the proximal non-dominant arm overlying the tricep
104
What is the efficacy of nexplanon?
highly effective failure rate 0.07/100 women
105
how long doe snexplanon last for?
3 years
106
Ca nexplanon be used in people with history of thromboemmoolism, migraine etc?
yes does not contain oestrogen
107
Following a termination of pregnancy when can nexplanon be inserted?
immediately following a termination of pregnancy
108
Disadvantages of nexplanon
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
What re the adverse effetcs of nexplanon?
irregular/heavy bleeding
110
What interactions are there with nexplanon?
enzyme inducing drugs reduce efficacy of nexplanon
111
What are the contrainidcation of nexplnon?
IHD/Stroke
unexpained or suspicious vaginal bleeding
past breast ca
severe ievr crihossis
liver canacer
MAJOR NO: breast ca current
112
What is the main injectable contraceptive used in the UK?
Depo Provera
113
What doe depo provera contain?
medroxyprogesterone acetate 150 mg
114
How is depo provera given and how often?
IM injection every 12 weeks
115
how does depo provera work?
inhibits ovulation
cervical muscus thickening
endometrial tickenin g
116
what are the adverse effects of depo provera?
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
what are the contraindications to depo provera?
current or past breast ca
118
What does intrauterine contraceptive devices compromise of?
1. Copper Intrauterine device
2. Levongesterel releasing intrauterine systems (IUS, Mirena)
119
Other than contraception what else can IUS be used in managing?
Menorrhagia
120
How effective are Iuds and IUS?
More than 90%
121
What is the MOA of IUD?
prevent fertilisation by causing decreased sperm motilty and survival
122
What is the MOA of IUS?
levongestrel prevents endometrial proliferation and causes cervical mucous thickening
123
When can IUD start working?
immediately
124
How long can a IUD be kept in for?
Cu on stem only: 5 years
Cu on stem and arm: 10 years
125
When does a IUS start working?
7 days
126
How long can IUS (Mirena) be kept in for?
5 years
127
How long are they licensed for women using IUS for oestrogen only hormone replacement therapy protection?
4 years
128
What are the problems with IUDs?
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
what are the problems with IUS?
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
After giving birth after how many days is a women required contraception?
21 days
131
When can a postpartum woman start POP?
anytime postpartum
132
Is POP contraindicated in breast feeding?
No
133
When is COCP contraindicated in post part women?
if they are breast feeding <6 weeks post party
134
Why should COCP not be used in first 21 days post partum?
Increased risk of thromboembolism
135
When can COCP be used post partum?
after day 21
for 7 days use additional contraception
136
When can a IUD or IUS be inserted post partum?
48 hours of childbirth
after 4 weeks
137
How effective is the lactational amenorrhoea method (LAM)?
98% provided the woman is fully breast feeding, amenorrhoeic and < 6months post partum
138
What is an inter-pregnancy interval of less than 12 months associated with?
increased risk of preterm birth
low birth weight
small for gestational age babies
139
What are the pros of POP?
highly effective failure rate 1 per 100 woman
does not inteerefere with sex
reversible upon stopping
can breast feed whilst using
140
What are the cons of POP?
irregular periods
no STI protection
increased incidence of functional ovarian cysts
141
what are the common side effects of pop?
breast tenderness
weight gain
acne
headaches
142
After how long do the pop side effects subside?
first few months
143
If POP is started up to and including day 5 of the cycle when does protection commence?
Immediately
144
If POP starts after day 5 of the cycle what advise is given in terms of protection?
Additional contraceptive methods should be used for 2 days
145
When should pop be taken in the day?
same time everyday without a pill free break
146
Do you require a pill free break with POP?
No
147
If you are < 3 hours late with POP when should you take it?
continue as normal
148
If you are > than 3 hours late with POP when should you continue?
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
What should you do if you are vomiting or have diarrhoea and are on the pOP?
consider those doses as missed and see missed pills regime
150
Do antibiotics have an effect onPOP?
No
151
Do liver enzymes have an effect on POP?
yes. reduce effectiveness
152
How may hours period is allow for cerazette if you miss it ?
12 hours
153
Types of progesterone pills?
second generation
third generation - new generation e.g. desogestrel
