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repro > contraception > Flashcards

contraception Flashcards

1
Q

contraindiactions to coils

A

pelvic inflammatory disease
immunosuppression
pregnancy
unexplained bleeding
pelvic cancer
uterine cavity distortion - fibroids

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2
Q

copper coils

A

99% effective
fertility returns immediately after
can be left for 5-10yrs
can be used as emergency contraception

NOT in Wilsons - excessive accumulation of copper in body + tissues

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3
Q

copper coil mode of action

A

copper = toxic to ovum + sperm

also alters endometrium + makes it less accepting of implantation

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4
Q

copper coils pros/cons

A

reliable, effective immediately at any time of cycle
no hormone - safe for VTE, hormone related cancers
may reduce risk of endometrial + cervical cancer

cons
- requires procedure
- can cause heavy or intermentrual bleeding
- pelvic pain sometimes
- increase risk of ectopic pregnancies

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5
Q

mirena coil (IUS) MoA

A

releases levonorgestrel (progesterone) into local area
- thickens cervical mucus
- altering endometrium + making it less accepting of implantation
- prevents endometrial proliferation

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6
Q

insertion of mirena coil

A

can be inserted up to day 7 of menstrual cycle without any need for additional contraception

if inserted after - extra protection required for 7 days

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7
Q

benefits / drawbacks of mirena coil

A

make periods lighter/stop
may improve endometriosis assoc pain
no effect on bone mineral density
no increase VTE risk
aditional uses - HRT, menorrhagia

cons
- can cause spotting - settles 6months
- increased risk of ectopic
- increased incidence of ovarian cysts
- systemic absorption - acne, headaches, breast tenderness

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8
Q

progestogen only implant

A

last 3 years
99% effective with perfect + typical use

UKMEC4 in ACTIVE BREAST CANCER

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9
Q

MoA of progestogen only implant

A

inhibits ovulation
thickens cervical mucus

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10
Q

pros / cons of progestogen only implant

A

can improve dysmenorrhoea - painful menstruation
make periods lighter/stop

cons
- minor operation
- lead to worsening acne
- can cause problemative bleeding

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11
Q

progesterone only injection

A

given at 12-13wk intervals as IM or SC injection of medroxyprogesterone acetate

99% effective with perfect use, 94% with typical

can take 12months for fertility to return once stopped
- bad for those trying to get pregnant soon

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12
Q

MoA of pogesterone only injection

A

inhibit ovulation - inhibits FSH preventing development of follicle
thickens cervical mucus

altering endometrium + making it less accepting of implantation

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13
Q

progesterone only injection contraindications

A

UKMEC4 = active breast cancer
UKMEC3
- ischaemic heart disease + stroke
- unexplained vaginal bleeding
- severe liver cirrhosis
- liver cancer

can cause osteoporosis - old women, steroids
–> due to block of oestrogen
weight gain

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14
Q

benefits of progesterone only injection

A

improve dysmenorrhoea - painful periods
improved endometriosis-related symtpoms

reduces risk of ovarian + endometrial cancer
reduces severity of sickle cell crisis in patients with sickle cell anaemia

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15
Q

progestogen only pill

A

99% effective perfect, 91% typical
UKMEC4 active breast cancer

addition contraception required for 1st 48hrs - time takes to thicken mucus

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16
Q

MoA of progestogen only pill

A

thickening cervical mucus
altering endometrium + making it less accepting of implantation
reducing ciliary action in fallopian tubes

17
Q

side effects of progestogen only pill

A

unscheduled bleeding common in first 3 months

increased risk of
- ovarian cysts
- small risk of ectopic pregnancy due to reduced ciliary action
- minimal increased risk of breast cancer, return to normal 10yrs after stopping

18
Q

“missed pill” POP

A

> 3hrs (26hrs after last)
12hrs (36hrs) if desogestrel-POP

take pill ASAP, take next pill at usual time (even if taking 2 in 24hrs)
- use extra contraception for next 48hrs

emergency contraception required if had sex since missing the pill or within 48hrs of restarting regular pills

vomiting, diarrhoea = missed pills, extra contraception until 48hrs after settles

19
Q

combined oral contraceptive pill (COCP)

A

contains combination of oestrogen + progesterone
licensed for use up to age 50yrs
takes 7 days before protected from pregnancy

20
Q

COCP MoA

A

prevents ovulation
progesterone thickens cervical mucus + inhibits proliferation of endometrium, reducing chance of successful implantation

oestrogen+progesterone have neg feedback on hypothalamus + ant pituitary - GnRH, LH + FSH (without LH+FSH ovulation does not occur)

lining of endometrium is stable while taking pill, when stopped - uterus breaks down + sheds
- leads to “withdrawal bleed” - not classed as a menstrual period

21
Q

side effects of COCP

A

unscheduled bleeding - common in first 3 months
mood changes + depression
hypertension
VTW
small risk of -
- breast + cervical cancer - risk returns to normal 10yrs after stopping
- MI + stroke

22
Q

benefits of COCP

A

rapid return of fertility after stopping
improved menstrual symptoms
reduced risk of endometrial, ovarian + colon cancer
reduced risk of benign ovarian cysts

23
Q

contraindications (UKMEC4) of COCP

A

uncontrolled hypertension
migraine with aura - risk of stroke
aged >35 + smoking more than 15 a day
major surgery with prolonged immobility
vascular disease or stroke

ischaemic heart disease, cardiomyopathy or Afib
liver cirrhosis + liver tumours
SLE, antiphopholipid syndrome

BMI>35 = UKMEC3

24
Q

missed pills COCP

A

> 24hrs late (48hrs since last pill)

missing 1 pill (<72hrs since last pill)
- take missed pill ASAP
- no extra protection required provided other pills before + after are taken correctly

missing >1 (>72hrs)
- take ASAP
- additional contraception required for 7 days
- if day 1-7 -> emergency contra if unprotected sex
- if day 8-14 -> none needed (if fully compliant 1-7)
- if day 15-21 -> none needed, skip free period

25
Q

emergency contraception - Levonrgestrel (Levonelle)

A

acts to stop ovulation + inhibit implantation
take ASAP - efficacy decreases with time
- must be taken within 72hrs of unprotected sex

1.5mg dose, double dose if BMI >26 or weight of 70kg
if vomiting occurs within 3hrs then dose should be repeated
can be used more than once in a menstrual cycle

hormonal contraception can be started immediately after

26
Q

emergency contraception - Ulipristal (EllaOne)

A

selective progesterone receptor modulator - inhibition of ovulation
30mg taken ASAP - no later than 120hr (5hrs) post sex

restart contraception 5 days after taking - barrier method should be used during this period
caution in severe asthma

can be used more than once in same cycle
**breastfeeding should be delayed for a week

27
Q

emergency contraception - IUD

A

most effective method of emergency contraception + should be offered to all

must be inserted within 5days of UPSI
- if later, then may be fitted up to 5 days after the likely ovulation date

may inhibit fertilisation or implantation
99% effective regardless of where it is used in cycle

28
Q

specific risk factors for contraceptives

A

breast cancer - any hormonal, go for IUD or barrier
cervical or endometrial - avoid IUS
wilsons - avoid copper

COCP UKMEC4 long list (see other card)

29
Q

how long after last ever period in older ladies is contraception required for?

A

2yrs in women under 50
1yr in women over 50

HRT does NOT prevent pregnancy - added contraception is required

30
Q

COCP + progestogen-injection for age 50s?

A

COCP can be used up to age 50 - can treat perimenopausal symtpoms

progestogen injection should be stopped before 50s - due to osteoporotic risks

31
Q

when to stop progestogen only contraception if amenorrhoeic? (older)

A

until either -
- FSH blood test are above 30 on 2 test take 6wks apart - if not, continue for a year
- 55yrs old

32
Q

contraception in under 20s

A
  • Combined + progestogen-only pills are unaffected by younger age

Progestogen-only implant is a good choice of long-acting reversible contraception (UKMEC1)
- Progestogen-only injection is UK MEC2 due to concerns about bone mineral density
- Coils are UKMEC2 as they have higher rate of expulsion

33
Q

how long does infertility last for post giving birth?

A

fertility not considered to return until 21 days after giving birth, and contraception is not required up to this point
- after 21days, will need contraception, including condoms for 7 days when startin the combined pill or 2days for progestogen only pill

34
Q

lactational amenorrhea

A

fully breast feeding + amenorrhoeic

98% as effective as contraception for up to 6month after birth

35
Q

contraception options after childbirth

A

progestogen only pill + implant safe in breastfeeding + can be started anytime after birth

IUD/IUS can be inserted wither within 48hrs or >4wks after birth

COCP should be avoided in breastfeeding
- UKMEC4 before 6weeks postpartum
- UKMEC2 after

repro (33 decks)

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