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Obs And Gynae > Contraception > Flashcards

Contraception Flashcards

1
Q

What is the “ideal” contraceptive?

A

> cheap
user independent
highly effective
convenient
medically safe

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2
Q

What is the age of consent to intercourse in South Africa?

A

18 years

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3
Q

What is the age of consent for treatment, including contraception in South Africa?

A

12 years old

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4
Q

Pros vs cons of condoms

A

Pros
>ease of use
>readily available
>protection against HIV/STI

Cons
>male control
>15% failure rate
>loss of sensation
>allergic reaction

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5
Q

Failure rate of diaphragm/cervical cap?

A

16% with optimal use

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6
Q

What are the hormones contained in combined oral contraceptives?

A

1) Oestrogen
>ethinyl oestrodiol (EE)
>oestrodiol valerate (E2)

2) progestogen (synthetic progesterone)

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7
Q

What are the dosages of oestrogen per pill?

A

Ethinyl oestrodiol range 15-50 micrograms
Oestrodiol valerate range 1-3mg

Increased dose = increased side effects

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8
Q

What determines the effects of progestogens?

A

Varying androgenic, anti-androgenic
Oestrogenic, anti-oestrogenic
Mineralcorticoid
Glucocorticoid
Activity

Ie dosages not comparable like oestrogens

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9
Q

Further classify combined oral contraceptives

A

Monophasic
Biphasic
Multiphasic

(Describes variations in dosage per active pill)

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10
Q

Failure rate of perfect and typical use of COC

A

Perfect = 0,1-0,3%
Typical 3-8%

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11
Q

Explain the COC pills (no of pills etc)

A

Placebo = 2-7 pills
Active pills = 21-26

Lower dose of active pills = few placebo to prevent breakthrough ovulation
Starting placebo = decrease progesterone = breakdown of endometrial lining

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12
Q

Mechanism of action of COC

A

Oestrogen
>negative feedback to pituitary = prevents ovulation by inhibiting mid-cycle LH surge
>prevents selection and maturation of dominant follicle by suppressing FSH

Progesterone
>thickens cervical mucus = sperm can’t penetrate
>thins endometrial lining = can implant
>decrease tubal motility

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13
Q

Compare COC to transdermal patch

A

Both combined hormonal
Patch = better compliance (apply new patch 1/week x3 followed by patch free week)
Bypass first pass metabolism through liver = fewer side effects of patch

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14
Q

How does the combined hormonal vaginal ring work

A

Leave in 3 weeks
Remove for 1 week (experience withdrawal bleed)
Same efficacy as COC and transdermal patch

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15
Q

Progesterone only pill vs combined oral contraceptives

A

DOES NOT REGULATE CYCLE
Simply acts by increasing cervical mucus, thinning endometrium and decreasing tubal motility.
Therefore NB to take regularly as ovulation is not regulated.
NO PLACEBOS

Indicated when oestrogens are CI
>older women
>post pregnancy contraception as well as breastfeeding

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16
Q

What are oestrogenic side effects?

A

> gastrointestinal
headaches
breast tenderness
mood changes
decreased libido
hypertension

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17
Q

What are progestogen side effects?

A

Vary per type
Often related to fluid retention

Androgenic progestogens
>acne
>weight gain
>fatigue
>depression

18
Q

What do you do if you missed a dose of your COC?

A

Take it as soon as it’s recognised, and the next pill at the time you’re supposed to take it without extra protection.
If the missed pill was the first active pill, 7 day extra protection needed.
If more than one pill missed, take the last one that was missed immediately, followed by the next one at the usual time and 7 days of extra protection

19
Q

Long acting vs short acting benefits

A

Long acting
>better compliance (less user dependent)
>more cost effective
>low failure rates
>easily reversible

Short acting
>barrier = prevent STI transmission

20
Q

What types are injectables are there in SA?

A

1) Depot medroxyprogesterone (DMPA)
2) norethisterone enanthate (NET-EN)

21
Q

What is the MOA of injectables?

A

Same as other progesterone only modalities
>increase cervical musus
>thin endometrial lining
>decrease tube motility

IM = slow release therefore 3 monthly injections

22
Q

What are the side effects of progesterone injectables?

A

> headache
weight gain
loss of bone density (long term use)
infertility for months after cessation (6-9 months)

23
Q

MOA of copper IUD

A

Copper causes inflammatory response in endometrium which inhibits implantation. Copper is cytotoxic to the oocyte, spermicidal, impairs sperm motility, viability and fertilisation capacity

24
Q

Benefits of copper IUD

A

> reliable
user independent
cost effective
effective
reversible
no hormonal side effects

25
Q

Disadvantage of copper IUD

A

> increases volume of menses
increases discomfort
insertion requires skill
risk of perforation, infection, expulsion

26
Q

Contraindications of copper IUD

A

> pregnancy
uterine anomalies
undiagnosed bleeding
pelvic infection
malignancy

27
Q

What progesterone is released by the progesterone releasing IUD?

A

Levonorgestrel

28
Q

What is the MOA of the progesterone releasing IUD?

A

Systemic effects of progesterone
>increased cervical mucus
>thinning of endometrial lining
>decreased tubal motility

29
Q

Advantages of progesterone releasing IUD

A

> decrease menstrual volume loss and discomfort (amenorrhoea is common) = even considered first line for tx excessive menstrual blood loss
used when oestrogen is contraindicated

30
Q

Disadvantages of progesterone releasing IUD

A

> expensive (but still cost effective)
requires expertise to insert
acyclical bleeding in first weeks is common
hormonal SE (acne)
increased incidence ovarian cysts

31
Q

What drug/hormone does the subdermal implant contain?

A

Etonogesterel

32
Q

Length of use of subdermal injectables

A

3 years

33
Q

MOA of subdermal injectable

A

Systemic effects of progesterone (same as other progesterone only methods)
>increase cervical mucus
>thin endometrial lining
>decrease tubal motility

34
Q

SE of subdermal injectable?

A

> irregular bleeding
headaches
mood changes
acne
hair loss
weight gain

35
Q

What effects the efficacy of subdermal injectables, particularly applicable in the SA setting?

A

Interaction with ARV’s (as daily released dosage diminishes over time)

36
Q

Return of fertility after subdermal injectables?

A

1 month after removed

37
Q

What are the emergency contraceptive options?

A

> single high dose progesterone ASAP
copper IUD insertion (up to 5 days after unprotected sex)
2 x double doses of high dose COC 12 hours apart combined with antiemetic
antiprgesterone (3 days post-intercourse) eg Ulipristal acetate, mifepristone single doses

38
Q

How do you decide which contraceptive method a patient should be offered?

A

Consider
>age
>wishes in terms of future children
>health and medical conditions
>sexual habits/relationship status

Full workup
>HIV status
>medical conditions
>RF influencing safety of contraceptive options

39
Q

When are oestrogen containing contraceptive methods contraindicated?

A

> breastfeeding
RF for arterial disease (HPT, elevated lipids, DM, smoker, >35, ischaemic heart disease)
RF for venous thrombosis (previous thrombosis, SLE, postpartum)
older than 35 years old
porphyria
liver disease
hormone sensitive cancer

40
Q

What contraceptive methods are recommended in HIV patients?

A

Copper IUD
Progesterone IUD
DMPA (depot)
Higher dose COC

41
Q

What is the WHO epically eligibility criteria categories used to evaluate contraception?

A

Category 1: A condition with no restriction to the contraceptive method
Category 2: A condition for which the advantages of the contraceptive outweigh the theoretical/proven risks
Category 3: A condition for which the risks of the contraceptive method outweigh the benefits
Category 4: A condition that represents an unacceptable health risk if contraceptive method is used.

42
Q

Indications for an Implanon

A

Smoking
Current STI/PID
Obesity
DVT
Breastfeeding
Post abortion

Obs And Gynae (16 decks)

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