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Contraception Flashcards

1
Q

What happens to temperature across menstrual cycle

A

Increased after ovulation by about 1^C due to progestogen production

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2
Q

What is an oestrogen versus a progestogen

A

Oestrogen- substance which induces proliferation of the endometrium
Progestogen- substance which induces secretory changes in the endometrium

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3
Q

What are 3 main oestrogens

A

17-b oestradiol- main oestrogen of menstrual cycle
Oestrone- precursor
Oestriol- main oestrogen of pregnancy

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4
Q

Pathway for production of oestrogens

A

Androstenedione -> Oestrone-> 17 beta oestradiol
Androstenedione -> testosterone -> Oestrone

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5
Q

What are the 2 FSH and LH sensitive cells

A

Theca cells respond to LH producing androgens
Granulosa cells FSH producing aromatase which convert androgens
FSG

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6
Q

How do oestogen levels increase so much in the follicular phase

A

FSH binds to granulosa cells which produce aromatase converting androgens to 17beta oestradiol which binds to oestrogen receptors on same granulosa cells causing even more conversion
Auto positive feedback

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7
Q

What happens in ovulation

A

Oestrogen causes surge in LH and some FSH which releases graaffian follicle, remaining follicle becomes corpus luteum producing oestrogen and progesterone

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8
Q

What happens in luteal phase

A

Corpus luteum produces oestrogen and progestogens which thicken endometrium and induce secretory changes
Oestrogen and progestogens inhibit FSH and LH preventing another follicle being released

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9
Q

What does corpus luteum become

A

Corpus albicans

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10
Q

What causes start of menstruation

A

After about 2 weeks the corpus luteum degenerates into corpus albicans which stops oestrogen and progesterone release- this prevents maintenance of endometrium so is sloughed away

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11
Q

What are the 3 emergency contraception methods available

A

Copper intrauterine device
Oral ulipristal acetate
Oral levonorgestrel

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12
Q

Copper IUD MOA, advantages and disadvantages

A

MOA- toxic effects on sperm and sterile inflammation on uterus which prevents implantation
Advantages- most effective regardless of time in ovulation
Disadvantages- none everyone should be offered if meet criteria

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13
Q

How does ulipristal acetate work

A

Progesterone receptor modulator which inhibits ovulation

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14
Q

Criteria for using copper IUD as emergency contraception

A

Within 5 days of UPSI or 5 days after ovulation

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15
Q

Risks of using copper IUD

A

Can be expelled especially in first 3 months
Risk of PID soon after insertion
Pain on doing so and then can get pelvic pain longer term too
Can perforate the wall of uterus on insertion

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16
Q

What happens if vomit within 3 hours of taking emergency contraception pill

A

For both retake them ASAP

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17
Q

Side effects of ulipristal and levonorgesterol as morning after pill

A

Vomiting
Menstrual irregularities- mild bleeding and can have later or earlier
Ectopic pregnancy
Standard headace, tummy pain or diarrhoea etc

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18
Q

How does levonorgestel work as emergency contraception

A

Progestogen which stops ovulation and inhibits implantation

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19
Q

When can contraceptive pills be restarted after levonorgestel and ulipristal

A

Levonorgestel straight away
Ulipristal wait 5 days

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20
Q

When need to double the dose of levonorgestel

A

BMI over 26
Weight over 70kg
On liver induces such as carbamezapine and rifampicin

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21
Q

How long after UPSI can you use each oral emergency contraceptive

A

Ulipristal- 120 hours
Levonorgestel- 72 hours

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22
Q

What condition should ulipristal not be used in

A

Severe asthma

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23
Q

Can you breastfeed after taking levonorgestel or ulitpristal

A

Levonorgestel- yes
Ulipristal- no wait 1 week

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24
Q

Can you use ulipristal or levonorgestel more than once in same menstrual pregnancy

A

Yes can use more than once

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25
What are methods of contraception offered in the UK
Combined hormonal contraception Progestogen only Intrauterine contraception Barrier method Sterilisation
26
What are options for combined hormonal contraception
Oral pill Transdermal patch Combined vaginal ring
27
What are options for progestogen only contraception
Progestogen only pill Progestogen implant Progestogen injectable
28
What are intrauterine contraception methods
Copper IUD Levonorgestel intrauterine system
29
What are the sterilisation methods for men and women
Men- vasectomy Women- tubal occlusion
30
What factors need to be assessed in contraception
Preferred method Future plans for children Personal views and beliefs Attitudes of partner and family
31
In contraception assessment history what need to do
Exclude pregnancy Take history - PMH - allergies - reproductive history Risk of STI - sexual circumstances - partners - activity - use of substances Risk assess for sexual assault
32
How can pregnancy be excluded
Not had intercourse since last period Currently correctly using contraception Within 7 days of onset of period Within 4 weeks of giving birth and not breastfeeding Within 6 months of giving birth and breastfeeding Within 7 days of termination or miscarriage Negative pregnancy test sooner than 3 weeks of last UPSI
33
If person under age of 16 requesting contraception what need to do
Assess fraser competent - understands practitioners advice - cannot persuade to tell parents or allow doctor to tell tem - going to continue having sex with or without the contraception - physical or mental health will deteriorate unless receives the treatment - best interests require practitioner to give contraception without telling parents
34
What do if someone with learning disabilities asks for contraception
Support her own decisions Assess competence to consent If cant take responsibility then other carers/parties should be involved
35
What drugs need to look out for when giving contraception
Teratogenic- sodium valproate, lithium Liver inducing enzymes Lamotrigine Griseofulvin Vomiting inducing
36
What do for contraception if taking a teratogenic drug
Use a highly efficient method like Cu-IUD, LNG-IUS or progestogen injection + Advise to use barrier protection OR If want to use other method like combined hormone contraception or progestogen MUST use barrier protection
37
What are liver enzyme inducing drugs
Rifamycins Anti-epileptics - carbamezapine - pheytoin - topiramate Anti-virals - protease inhibitors (tenofovir etc) - non-nucleoside reverse transcriptase inhibitors
38
What do with contraception if taking a liver enzyme inducing drug
Warn that they affect the efficacy of combined hormonal contraception plus oral and implantable progesterone Recommend Cu-IUD, LNG-IUS and progestogen injections
39
What do with contraception if taking lamotrigine
Recomend that with CHC and POP it will reduce seizure protection and increase toxicity of the drug
40
What do with contraception if taking griseofulvin
Do not use any hormonal therapy as reduces the efficacy
41
What do with contraception if taking a drug that causes vomiting
Recommend against oral options however if do take then advise if vomits within 3 hours of taking then must treat as if is a missed pill
42
Does a previous pelvic inflammatory disease influence contraception choice
NO can use any
43
Does a current PID affect contraception choice
Yes you would not insert an intrauterine device Hormonal methods can be used
44
What do if current chlamydia or gonorrhoea/prurulent cervicitis
Do not initiate Cu-IUD or LNG-IUS Use hormonal methods fine
45
What do with contraception if have BV or trichomonas
Any method can be used
46
What do with contraception if idiopathic menorrhagia that has been investigated
Any method can be used 1st line- LNG-IUS as can help with symptoms 2nd line- COCP 3rd line- POP or progestogen injectable
47
What do for contraception if unexplained vaginal bleeding
Can leave in implantable devices but DO NOT apply Progestogen only implant and injectable are contraindicated but all other hormonal methods are fine
48
What do for contraception if history of ectopic pregnancy
All methods are fine
49
What do for conrtaception if uterine fibroids present
Depends on if distortion of uterine cavity - if is not then any is fine - implantable not acceptable but can use hormonal
50
What do with contraception if DM
No vascular disease - any method is fine Vascular disease or complication like nephropathy etc - combined hormal therapy contraindicated
51
What do with contraception if history of gestational DM
Any method is fine
52
What do with contraception if migraine
If aura dont use CHC If no aura is fine but then if develops one then not recommended
53
What do with contraception if history of migraine with aura
If history over 5 years then do not use CHC
54
In women with multiple CVD risk factors what do with contraception
Any CHC or progestogen injectables are contraindicated
55
What do with contraception if obese
BMI under 35 anything is acceptable BMI over 35 do not used CHC
56
What do with contraception if HTN
Never use Combined If vascular disease too do not use progestogen injectable
57
What do if someone has a gastric sleeve for contraception
Can not use oral
58
In patients considering taking progestogen contraception what must always check
Cervical screening history
59
With the progestogen oral pill, what are important considerations
Cervical screening Anything causing hyperkalaemia - renal failure - K+ losing drugs - hypoaldosteronism
60
If going to take progestogen only injectable what are considerations
Cervical screening Osteoporosis risk
61
Risks of combined hormonal contraceptive
Risk of VTE Breast and endometrial cancer risk
62
How should assess someone for LNG-IUS and Cu-IUD
Perform Bimanual before insertion If at high risk of STI then offer testing Exclude unexplained bleeding
63
What is MOA of CHC
Inhibits ovulation
64
What is MOA of injectable contraceptive
Inhibits ovulation Thickens cervical mucous
65
What is MOA of Cu-IUD
Reduces sperm motility
66
What is MOA of LNG-IUS
Prevents endometrial proliferation Thickens cervical mucous
67
What are family awareness methods
Methods of monitoring own body to plan pregnancy or avoid it Monitor cycle length and dates, temperature and cervical mucous
68
How long can sperm survive inside a womans body
7 days
69
How long after ovulation can sperm successfully fertilise
2 days before graffian follicle becomes corpus luteum
70
What are methods of barrier protection
Men- condoms Women- caps and diaphragms
71
Who are diaphragms and caps contraindicated in
Poor vaginal tones Shallow pubic edge Distorted anatomy Cant touch vagina without discomfort
72
How long after partum do you need to use contraception
21 days
73
When after birth can Cu-IUD or intra uterine system be used
Within 48 hours or after 4 weeks
74
What is nexplanon
Progestogen implantable device
75
What is the difference between the UKMEC categories
1- no contraindication 2- advantages generally outweigh the disadvantages 3- disadvantages outweigh advantages 4- absolute contraindication
76
What are some category 4 UKMEC
Migraine with aura More than 35 smoking over 15 cigarettes a day History of VTE History of stroke or IHD Uncontrolled HTN Major surgery Current breast cancer Breastfeeding and under 6 weeks post partum
77
What are some category 3 UKMEC
Less than 35 smoking over 15 cigarettes a day Family history of thromboembolic disease under 45 Carriers of BRCA Immobility- wheel chair use Current gallbladder disease Previous breast cancer
78
Adverse effects of injectable contraceptives
Weight gain Irregular bleeding Osteoporosis risk and should only use in children if absolutely have to
79
How long do injectable contraceptives work for
12 weeks
80
What happens if miss a progestogen only pill
Typical ones - less than 3 hours late is fine - over 3 hours action needed Desogestrel - less than 12 hours late is fine - over 12 hours action needed
81
What is action needed for missed progestogen only pill
Take pill as soon as possible and if more than 1 is missed take only 1 Use condoms for 48 hours
82
What are the progestogen only pills and how do they work
Typical- thicken cervical mucous - include norgeston, noriday Desogestrel- inhibit ovulation
83
How long does it take contraceptives to work
IUD- immediately 2 days- POP 7 days- COC, implantable, injectable
84
What is best post partum contraception
Can insert Cu-IUD 2 days post partum if not Progestogen only pill - good as will not suppress lactation - good as also not increased VTE risk which post partum people at risk of for 28 days post partum
85
What are typical side effects of progestogens
Nausea Breast pain Headache
86
What do if miss 1 COCP
Take it even if means taking 2 in one day then continue 1 each day
87
What do if miss 2 or more COCP
Take 2 on a day and discount other missed ones Use condoms until taken pills for 7 days If on week 1- consider emergency contraception if UPSI If week 2- no need for emergency contraception If week 3- finish the pack and then omit pill free period
88
How to manage severe irregular bleeding if on injectable or implantable
3 months of COCP
89
How does it work with application of Evra combined hormonal patch
Change every week for 3 weeks then 1 patch free week where can get bleeding
90
What happens if is delayed removal of Evra patch
If end of week 1 and 2 - fine if delayed less than 48 hours - if delayed over then need barrier protection for 7 days however if has had UPSI in last 5 days need to use emergency contraception If end of week 3 - remove and apply new one at start of next cycle If delayed before start of new cycle use barrier protection for 7 days
91
Ideal choice of contraception if under 18
Progesterone implant IUD/IUS UKMEC 2
92
When is the predicted ovulation date
14 days before start of next cycle If 30 day cycle then day 16
93
When can you share information about someones sexual relationship if under 18
Too immature to understand Person in a position of trust Big difference in maturity/age Bribery/payment Substances involved
94
Where is implantable device put
Non-dominant arm
95
What contraception is most associated with delayed return to fertility
Depo-provera
96
How does pearl index work
Number of women in 100 women who would get pregnant over a year of exposure
97
Which cancer is COCP protective against
Endometrial Ovarian
98
What drugs can be used for males wanting to transition
Oestradiol GNRH analogs Finasteride Cytoperone
99
What effect do drugs used to transition males have on fertility
Reduce sperm production but must still use condoms or vasectomy as not 100% effective
100
What is seen as most appropraite contraception in a trans person
Either a vasectomy or a tube occlusion
101
What contraception methods are appropriate in a trans man with a uterus
- oestrogen not recommended as antagonises testosterone supplements - progestogen has no impact on testosterone - LNG-IUS good as would allow for menstrual cessation - Cu-IUD will not interact with hormones however can affect potentiate menstrual bleeding
102
Side effects of progestogen only pill
Irregular bleeding- most common Breast pain Nausea Headache
103
What is done with regards to COCP around a surgery
Stop 4 weeks before and start 2 weeks after
104
How does using the vaginal ring work
21 days of ring in, 7 days off then replace OR Can keep in for 28
105
When does vaginal ring work from
If on menses straight away If not then 7 days so use barrier
106
Side effects of vaginal ring
Some discharge initially Breast pain Headache
107
With what contraceptive can the COCP be used to treat bleeding
Implantable progestogen
108
What effect do the intrauterine contraceptives have on periods
CuIUD- heavy and more painful LNG-IUS- bleeding irregularly at start but then amenorrhoea or light menses
109
How long can use patch or COCP without a break
Technically forever it depends if want withdrawal bleeds
110
Why is COCP not given if breastfeeding
Reduced milk produced
111
When can fully determine if someone is not pregnant
Do pregnancy test 3 weeks after last UPSI
112
If someone has had UPSI in last 3 weeks what do before prescribing a long term contraception
Give pill or tell them to abstain
113
Oestrogen SEs
Breast tenderness Premenstrual syndrome Nausea CVD and breast cancer risk
114
SEs of progesterone contraception
Acne Abnormal bleeding
115
If want to use lactational method what need to do
Exclusively breastfeed Cant use anything else Includes giving in the middle of night
116
For family awareness method when take temp
As soon as wake up
117
What is the investigation of choice for lost coil threads and if it is not seen in cervical or uterine cavity
Pelvic TVUSS Abdo x-ray
118
If coil is in abdomen what do
Laparoscopy and removal
119
How long after IUS should abnormal bleeding be investigated
6 months
120
When need to check threads of IUS/D
Every month post period
121
How can intrauterine coils dislodging present
Discoloured discharge Abdo pain
122
How successful are condoms when use them properly
98%
123
How long does spermatogenesis take
64 days
124
If develop irregular bleeding on progesterone implant or injection what is management
Rule out other causes like STIs Then can initiate COCP
125
What do if on COCP and reach 50
Stop it as CI in over 50s

Gynae (11 decks)

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