Brainscape's Knowledge GenomeTM

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


See full index

Gynaecology > Contraception > Flashcards

Contraception Flashcards

1
Q

Name types of contraception (21)

A

Traditional

  • rhythm method
  • coitus interruptus
  • abstinence

Barrier/mechanical

→ short acting (need to be used more than Once per month)
- male condoms
- female condoms
- diaphragm
- cervical cap
- cervical sponge
- spermicides (nonoxynol 9 )

Hormonal

→ short acting
- Oral (pop/COCP)
- vaginal ring: Nuva
- transdermal patch: EVRA

→ long acting
- injectable (progesterone only/newer combined)
- progestogen vaginal ring : PVR
- intrauterine: IUCD - copper, progestogen
- subdermal Implants

post coital/emergency contraception

  • single high dose progestogen
  • Copper IUD
  • coc 2 double high doses 12 hours apart + antiemetic

Irreversible

→ female
- fallopian tube ligation: laparoscopic / laparotomy / with C section
> tie and cut eg parkland technique
> elastic band tie
> close with metal tip
> cauterise
> remove
→ male
- vasectomy (additional contraception up to 4 months after until male proven azoospermic)

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

Name 3 advantages male condoms

A
  • Inexpensive
  • easily available for immediate use
  • reduce transmission HIV + STI
  • easy to use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Name 5 disadvantages male condoms

A
  • Failure rate 2-15%, Additional contraception recommended
  • female must negotiate use
  • slippage
  • allergy, especially latex (polyurethane more expensive)
  • loss of sensation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Name advantages female condoms
How work?

A

Protective against HIV, STI; female controlled

Pouch lines vagina. Internal ring covers cervix ; outer ring outside vagina, covers perineum.
Made of polyurethane

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

Name disadvantages female condoms

A
  • Not properly used - difficult/ unmotivated
  • high failure rate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Name 3 advantages diaphragm contraception

A
  • safe, with or without spermicides (improve efficacy)
  • reduce risk STI, tubal infertility
  • different sizes, arcing easier
  • affordable, reusable, female controlled
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Name 4 disadvantages diaphragm contraception

A
  • Vaginal irritation
  • UTI, not protect against STI
  • abrasions
  • must insert 6 hours before sex and leave in till 6 hours after, high failing rate 16 %
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Name 2 advantages cervical cap contraception

A
  • Can be left in place up to 48 hours
  • no need for spermicide (but increase efficacy)
  • affordable, reusable, female controlled
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Name 4 disadvantages cervical cap contraception

A
  • efficacy depends on placement
  • less effective in parous women
  • offensive vaginal discharge
  • must be left in for 8 hours after sex. Must make sure cap is over cervix after sex. High failure rate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Name advantages cervical sponge contraception. How work?

A

Lower STI infection rates.

Sustained release system for spermicide. Absorbs semen. Blocks entry to cervical canal.

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

Name 2 disadvantages cervical sponge contraception

A
  • Must insert before 6 and leave in for 6 hours after
  • possibly increase HIV transmission risk due to vaginal mucosal damage + irritation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Name 8 indications / benefits hormonal contraception

A
  • Contraception
  • reduce menstrual disorders
  • reduce functional ovarian cysts and cancer
  • reduce endometrial cancer
  • reduce ectopic occurrence
  • reduce benign breast disease
  • protect against PID
  • reduce rheumatoid arthritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Name 6 contraindications hormonal contraception

A
  • Pregnancy
  • undiagnosed genital tract bleed
  • increased risk vTE
  • increased risk CVD
  • liver disease
  • estrogen dependent tumour (breast)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Name 2 progestogen only pills

A
  • Micro-novum (norethisterone 35 mcg)
  • microval (levonorgestrel 30 mcg)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name advantages progestogen only pills

A
  • Safe post partum and in breadfeeding
  • menstrual volume reduced
  • indicated when oestrogen contraindicated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Name 2 disadvantages progestogen only pills

A
  • Must be meticulous pill taker, no more than 3h delay daily dose
  • higher failure rate, doesn’t prevent ovulation reliably
  • commonly irregular light bleeding because doesn’t control cycle

Contraindications: increased grade cardiovascular and liver disease

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

How classify combined oral contraceptives?

A
  • Phases: mono ( all pills identical ) /bi/triphasic
  • dose: low /ultra low with placebo
  • type of estrogen and progestogen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Name 3 types oestrogen used in combined oral contraceptives

A
  • Mestranol
  • ethinyl estradiol!
  • estradiol valerate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Name and describe 6 types progestogens used in combined oral contraceptives

A
  • Norethisterone : low potency, not androgenic.
  • levonorgestrel: more potent, more androgenic (nordette), lowest risk Vte
  • desogestrol: more estrogenic, less androgenic
  • gestodene: as above (femodene)
  • cyproterone acetate: anti androgenic (Diane 35)
  • drosperinone: anti androgenic, analogue spironolactone (Yasmin)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How start combined oral contraceptives? (4)

A

Quick start method

Start immediately with no pregnancy test if
- first day LMP < 5 days ago

Start immediately after negative pregnancy test if
- LMP started >5 days ago, no unprotected intercourse since then
- LMP started > 5 days ago and unprotected intercourse > 5 days ago (also do home pregnancy test 2 weeks after starting pills)

Start next day after emergency contraception today if
- LMP started >5 days ago and unprotected sex 5 days or less ago (also do home pregnancy test 2 weeks after starting pills)

  • must use backup contraception for first 7 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Name 2 injectables and contents

A
  • depot provera DMPA (medroxy progesterone acetate) 150 mg q 12 weekly IM
  • nur - isterate (norethisterone enanthate ) 200 mg q 8 weekly IM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Name 5 advantages depo provera injectable progestogen

A
  • Minimal effort
  • very effective, failure rate 0-1 /100 women
  • same advantages as coCp
  • protect against PID
  • treat endometriosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Name 4 disadvantages depo provera injectable progestogen

A
  • Irregular bleeding
  • average 6 - 10 months delay return to fertility
  • weight gain, headache
  • decrease BMD with longer duration use
  • need to visit clinic regularly: can lead to non- compliance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Name 4 disadvantages nur-isterate injectable progestogen

A
  • More androgen than depo
  • more weight gain
  • more acne
  • 7 months average return to fertility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Name 3 types intrauterine contraceptive devices

A
  • Copper T
  • Mirena, kyleena (levenorgestrol)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Name 5 advantages intrauterine contraceptive devices

A
  • Fit and forget
  • very safe and effective
  • very good continuation rates
  • failure rate copper T 0,6 - 0,8%; Mirena 0,1%
  • copper T last up to 10 years, Mirena 5 years
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Name 6 disadvantages Mirena intrauterine contraceptive devices

A
  • Irregular bleeding, esp initial spotting/ bleeding
  • perforation <1 %
  • expulsion 4,9%
  • Pid
  • expensive
  • androgen progestogen effects: acne, appetite, fluid retention,amenorrhoea!
28
Q

What does Mirena release? Dose?

A

Levonorgestrel 20 mCg /day

Last 5-7 years

29
Q

Name 7 advantages Mirena intrauterine contraceptive devices

A
  • Long acting reversible contraceptive
  • less menstrual blood loss in ml, fewer bleeding days
  • less dysmenorrhea
  • less anaemia, iron deficiency
  • less PMS
  • treats endometriosis
  • little drug interactions
30
Q

Name 4 types emergency contraception and how they work

A
  • cocp: 2 tablets 50 mcg ethinylestradiol + 0,25 mg LNG. Take 12 hours apart (max benefit up to 72 hours). 97% efficient. Se = vomiting.
  • progestogen only: 0,75 mg LNG (total 1,5 mg). Take 12 hours apart. More effective than cocp esp < 24h. Fever se. 99% effective (norlevo)
  • copper IUD: up to 5 days after sex. Not recommended for nulliparous women. 99,9% effective
  • anti progesterone: ulipristal acetate 30 mg / mifepristone 10 or 20 mg single dose 3 daysafter
31
Q

Which hormones are used for combination injectables Lunelle?

A

Estradiol cypionate 5mg + MPA medroxyprogesterone acetate 25 mg
IM every 28 days

32
Q

Name 4 advantages combination injectables Lunella

A
  • Good compliance
  • good cycle control
  • bleeding predictable (2-3 weeks after injection)
  • quicker return to fertility
33
Q

Which hormones are used in nuvaring? How work?

A

Ethinyl estradiol (ee) 15 mcg + etonorgestrol 120mcg (DSG)

Flexible polymer ring inserted into vagina. Last about 3 weeks, remove 4th week to allow withdrawal bleed.in situ during intercourse. Can remove <3h duration.

Very good efficacy and cycle control, less side effects bc avoid first pass metabolism

34
Q

Which hormones used in implanon? How work?

A

Steady release etonorgestrol 75 ug/day (DSG metab)

Last 3 years.

Follicular activity not suppressed. Great efficacy. Estrogen levels adequate to maintain BMD.

35
Q

Name 2 side effects and disadvantages implanon

A
  • Weight gain!
  • irregular bleeding
  • headache, mood changes, acne, hair loss
  • mild local complications at insertion site
  • reduced efficacy from drug interactions with arVs
36
Q

What is EVRA and how work? (3)

A
  • Transdermal combined contraception
  • Square adhesive patch 4,5 x 4,5 cm
  • 1x per week for 3 weeks, 4th withdrawal bleed
  • efficacy maintained a days after free week
  • 20 ug ethinylestradiol (EE), 150 ug norelgestromin
37
Q

Name 5 disadvantages transdermal combined contraceptive

A
  • Detachment, skin sensitivity <3 %
  • breast discomfort first 2-3 cycles but improves
  • nausea worse than OCP
  • potential decreased efficacy in weight > 90kg
  • DvT risk same as OCP
38
Q

Name 10 absolute contraindications estrogen

A
  • History thrombotic disease self or family
  • CVD, ihd and risk factors eg old, smoking, dm, ht; previous stroke; valvular disease
  • breast cancer
  • endometrial cancer
  • unexplained vaginal bleeding
  • migraines with focal neurological signs (aura)
  • hepatic dysfunction, carcinoma, adenoma
  • smoking (>15/day) > 35 years (→strokes, mi)
  • uncontrolled ht (>160/100)
  • diabetes with any complication

Acute porphyria

39
Q

Which coc combinations are more effective in obese patients?

A

24/4 instead of 21/7. Less mood swings

40
Q

Moa coc? (5)

A

Oestrogens
- prevent ovulation by inhibiting mid-cycle lh surge
- prevent selection and maturation of dominant follicle by suppress FSH

Progestogen’s
- thicken cervical mucus so impenetrable to sperm
- thin endometrium and makes it unreceptive to implantation
- Decrease tubal mobility

41
Q

Name 8 relative contraindications estrogen (coc)

A
  • > 35 and smoke
  • ht > 140/90
  • adequately control ht
  • gallbladder disease (risk stones)
  • bariatric surgery with malabsorption (abnormal bleeds, less effective)
  • superficial venous thrombosis
  • Ibd
  • risk factors Vte eg immobilization
42
Q

Name 6 risk and side effects coc

A
  • Vte
  • cardiovascular: mi, stroke esp in obese, ht, smokers
  • elevate bp (rare)
  • uncertain impact breast cancer
  • possible increased risk cervical cancer (but protective ovarian, endometrial ca )
  • increased risk chlamydia but not other infections (protective)
    Possible mood disorders, but more likely in patients with underlying
43
Q

Name 6 advantages coc

A
  • Very effective
  • hyper androgenism countered
  • menstrual cycle disorders improved: regularity, blood loss reduced
  • dysmenorrhea improve
  • protect against ovarian cyst
  • cancer risk reduction: ovary, endometrium, possibly colorectal
44
Q

Name advantages transdermal patch

A
  • no first pass metabolism through liver so less side effects
  • better compliance: once weekly application then patch free week with withdrawal bleed
  • good efficacy: 0,3% failure rate with perfect use, 8% with typical use
45
Q

Name 6 side effects oestrogen

A
  • Gastrointestinal
  • headaches
  • breast tender
  • mood changes
  • decreased libido
  • hypertension rarely
46
Q

Name 5 side effects progestogens

A
  • Fluid retention

Androgenic progestogens:
- acne
- weight gain
- fatigue
- depression

47
Q

Name 3 types coc and contents

A
  • Nordette: monophasic, levonorgestrel 150 ug + ee 30 ug
  • Diane, Minerva: monophasic, cyproterone acetate 2 mg + ee 35 ug
  • yaZ, yaZ plus.: drosperinone (mineralocorticoid effects) 3 mg + ee 20 ug
48
Q

What does kyleena release?

A

17,5 levonorgestrel ug/day
Last 5 years

49
Q

Moa copper T IUD?

A
  • Copper ions cause inflammation in endometrium, inhibiting implantation
  • cytotoxic to oocyte
  • spermicidal and impairs sperm mobility, viability and fertilisation capability
50
Q

Name 5 disadvantages copper IUD

A
  • Increase menstrual volume and discomfort
  • perforation
  • infection
  • expulsion
  • need skill to insert, procedure
51
Q

Name 6 contraindications IUD

A
  • pregnancy
  • uterine anomalies
  • undiagnosed bleeding
  • pelvic infection
  • pelvic malignancy
  • for kyleena / Mirena: any contraindications to progesterone
52
Q

Name 6 methods fallopian tube ligation

A
  • Metal clips by laparoscopy (isthmic portion of tube) (most common) Z
  • elastic band / rings (fallope ring) banding
  • electrocautery (not preferred) (isthmic portion of tube)
  • salpingectomy (only option post partum) (careful not to compromise ovarian blood supply)
  • partial salpingectomy
  • fimbriectomy
53
Q

Name 5 contraindications copper IUD

A
  • Purulent cervicitis
  • pelvic inflammation
  • HIV related severe immune compromise
  • gynae cancer
  • Tb

LNG IUD safe in all of the above.

54
Q

Name 4 preferred methods of contraception for women using art and/or Tb drugs

A

Hormone independent or high dose hormones

  • Cu IUD
  • LNG IUD
  • DMPA (rather than net - en or implants ) injectable
  • higher dose coc (rather than low dose or POP)
55
Q

Identify picture 16

A

Vaginal sponge
See picture 17

56
Q

Identify picture 18

A

Cervical cap

57
Q

Identify picture 19

A

Diaphragm
See picture 20

58
Q

Identify picture 22

A

Vaginal ring

59
Q

Which contraceptives can be prescribed to breastfeeding moms <6 weeks postpartum? (2)

A
  • POP
  • LNG / ETG / implants

Not coc/ patch / ring
Not DMPA / net-en injection

60
Q

Which contraceptives can be prescribed to breastfeeding moms 6 weeks - 6 months postpartum? (3)

A
  • POP
  • DMPA / net-en
  • LNG / ETG /implants

No oestrogen.

61
Q

Which contraceptives can be prescribed to breastfeeding moms 6 months or more postpartum?

A

Any

62
Q

When can oestrogen containing contraception be prescribed to non-breastfeeding post partum?

A

After 21 days

63
Q

When can intrauterine devices be inserted post partum? (4)

A
  • <48 hours including insertion immediately after delivery placenta
  • not 48 hours - 4 weeks (risk perforation, expulsion)
  • not if puerperal sepsis
  • can insert again after 4 weeks
64
Q

Which 2 forms of contraception use contraindicated if patients have multiple risk factors for CvD?

A
  • Oestrogen containing
  • DMPA /net-en
65
Q

Which contraception can be used if current DVT / pe

A

Copper IUD only. No hormones.

66
Q

Which contraception is contraindicated in severe / advanced HIV clinical disease (WHO 3 or 4)

A

Intrauterine devices

67
Q

Which contraception is contraindicated with anticonvulsant therapy?

A

Oestrogen containing
POP for most except lamotrigine

(Interfere with metabolism)

Gynaecology (40 decks)

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