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YR5 Obstetrics and Gynaecology > Contraception > Flashcards

Contraception Flashcards

1
Q

What are the three things which can be used as emergency contraception?

A

Levonorgestrel: up to 72h, can be given more than once per cycle

EllaOne: up to 120h, can be given more than once per cycle

Copper coil: up to 120h after UPSI or up to 5d after likely ovulation date

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2
Q

What is UKMEC 4? What are 9 UKMEC 4 conditions for the combined oral contraceptive?

A

Unacceptable health risk:

> 35y + smoking >15 cigarettes/day

Migraine with aura

Hx of VTE

Hx of stroke or IHD

Breast feeding < 6w post-partum

Uncontrolled HTN

Current breast cancer

Major surgery with prolonged immobilisation

+ve antiphospholipid antibodies (e.g. in SLE)

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3
Q

What is UKMEC 3? List 7 UKMEC 3 conditions for the COCP

A

Disadvantages generally outweigh advantages:
>35y + smoking <15 cigarettes/day

BMI > 35 kg/m^2*

FH thromboembolic disease in 1st degree relatives < 45y

Controlled HTN

Immobility e.g. wheel chair use

Carrier of known gene mutations a/w breast cancer (e.g. BRCA1/BRCA2)

Current gallbladder disease

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4
Q

Give 3 advantages of the COCP

A

Effects reversible upon stopping

Makes periods regular, lighter + less painful

Reduced risk of ovarian + endometrial cancer- this effect may last for several decades after cessation

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5
Q

Give 4 disadvantages of the COCP

A

May forget to take it

Increased risk of VTE

Increased risk of breast + cervical cancer

Increased risk of stroke + IHD (esp. in smokers)

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6
Q

When is additional contraception needed when starting the COCP?

A

If start COCP in first 5 days of cycle: Not needed
If start COCP at any other point, need condoms for 7 days

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7
Q

What happens if you miss pills on the oral contraceptive?

A

1 missed pill: Take next pill ASAP, no contraception needed

2 missed pills: Take last missed pill ASAP, no more than 2 in one day, consider additional contraception for 7 days

If missed pills in week 1 of pack + UPSI during pill free interval/ 1st week: Emergency contraception

If missed pills in week 2 of pack + UPSI: no emergency contraception needed

If missed pills in week 3 of pack + UPSI: Finish current pack + start next pack (omit pill free interval)

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8
Q

What is the MOA of the COCP?

A

Inhibits ovulation

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9
Q

Give 3 side effects of the COCP

A

Headaches
Nausea
Breast tenderness

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10
Q

What is the MOA of the POP? (excluding desogestrel)

A

Thickens mucus

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11
Q

When is additional protection needed when starting the POP?

A

If start POP in first 5 days of cycle: provides immediate protection

Otherwise condoms should be used for the first 2 days

If switching from COCP: gives immediate protection if continued directly from the end of a pill packet (i.e. Day 21)

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12
Q

How should the POP be taken?

A

At the same time every day, without a pill-free break

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13
Q

What action is required if a patient misses the POP?

A

Take missed pill ASAP
if < 3h late: continue as normal
if > 3h: continue with the rest of the pack, condoms should be used until pill taking has been re-established for 48h

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14
Q

Which progesterone only pill has a 12h window within which the pill can be taken without extra precautions needed?

A

Cerazette (Desogestrel)

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15
Q

Give 3 side effects of the POP

A

Irregular bleeding
Mood swings
Acne

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16
Q

What is the MOA of desogestrel, medroxyprogesterone acetate (Injection) and etonogestrel (Implant)?

A

Primary: Inhibits ovulation
Also thickens cervical mucus

17
Q

What are the progesterone-only options?

A

Mirena coil: 3-5 y

Progesterone depot: given every 3 months. Can’t be given to extremes of reproductive age, will affect fertility for up to a year after cessation

Implant: SC Nexplanon, lasts 3y

Progesterone only pill

18
Q

How does the copper coil work?

A

Sterile inflammation of endometrium
Decreases sperm motility + survival

Lasts 5y or 10y

NOT SUITABLE FOR WOMEN WITH HEAVY PERIODS

19
Q

What is the most effective form of emergency contraception?

A

Copper IUD (120h, OR within 5 days of the earliest estimated date of ovulation)

20
Q

What are the hormonal forms of emergency contraception?

A

Levonorgestrel (72 hours)

Ulipristal acetate (120 hours/5 days)

21
Q

How long after delivery can a woman get a IUS?

A

Immediately if no complications (within 48h)

OR

After 4 weeks

22
Q

How long after birth can a woman get POP?

A

Immediately after birth up to 21 days, no additional contraception.

If start after 21 days, additional contraception needed for first 2 days

23
Q

How long after birth can a woman get the COCP?

A

Breastfeeding: 6w

Not breastfeeding: 3w + need condoms for 7 days

24
Q

How many days for COCP to start working?

A

7 days

25
Q

How long should be the COCP be stopped for elective surgery?

A

4 weeks pre-operatively

2 weeks post-operatively

26
Q

How long after taking emergency ulipristal acetate can a woman restart COCP?

A

5 days

27
Q

How long after taking emergency levonorgesterol can a woman restart COCP?

A

Immediately

28
Q

If a woman takes emergency levonorgesterol and vomits within 3 hours, what should she do?

A

Repeat dose

29
Q

If a woman takes emergency ulipristal and vomits within 3h, what should she do?

A

Repeat dose

30
Q

Which emergency contraceptive pill if safe whilst breastfeeding?

A

Levonorgestrel

31
Q

Which emergency contraceptive is contraindicated in severe asthmatics?

A

Ulipristal

32
Q

What emergency contraception is advised in those >70kg or BMI >26?

A

Ulipristal
If Levonorgestrel, need double dose

33
Q

Which form of contraception has a reduced efficacy in obese patients?

A

combined contraceptive transdermal patch

34
Q

What is the MOA of the mirena coil?

A

Prevents endometrial proliferation
Prevents implantation
Also: Thickens cervical mucus

35
Q

What can the IUS be used for in older women?

A

Endometrial protection for women taking oestrogen-only hormone HTN
Licensed for 4y

36
Q

How does bleeding change with the IUS?

A

initial frequent uterine bleeding + spotting.

Later: intermittent light menses with less dysmenorrhoea + some become amenorrhoeic

37
Q

What are the risks of implantable contraceptives?

A

Expulsion: 1/20
Infection: small increased risk of PID
Uterine perforation: 2/1000
Ectopic pregnancy: proportion increased, but absolute no. reduced vs. no contraception

38
Q

Give 2 disadvantages of the injectable contraceptive

A

Weight gain
Delay in return of fertility: up to 1y

YR5 Obstetrics and Gynaecology (73 decks)

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