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Reproductive Health > Contraception > Flashcards

Contraception Flashcards

1
Q

What need to know for OSCEs each contraception

A

Options
Suitability - contraindications and risks
Effectivemess
Mechanisms of action
Instruction on use

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2
Q

Methods of contraception

A

Family planning
Barrier - condoms
COCP
Progesterone only pills
Coils
Progesterone injection
Progesterone implant
Surgery - sterilisation, vasectomy
Emergency contraception

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3
Q

What is UKMEC

A

UK medical eligibility criteria - categorise risks of starting different contraception in different individuals

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4
Q

UKMEC levels

A

1 - no restricition in use (minimal risk)
2 - Benefits generally outweigh benefits
3 - Risks generally outweigh benefits
4 - unacceptable risk - contraindicated

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5
Q

Which contraceptive methods are user dependent for effectiveness

A

Family planning
Barrier
Pill

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6
Q

What contraceptives are not user dependent for effectiveness

A

Implant
Coil
Surgery

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7
Q

What does 99% effective contraception mean

A

Used correctly with regular partner for single year, 1% chance of getting pregnant

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8
Q

What contraception is >99% effective with perfect and typical use

A

Surgery
coils
Progesterone implant

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9
Q

What contraception avoid if high risk breast cancer?

A

Avoid hormonal contracepetion
Copper coil or barrier methdos

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10
Q

What avoid if high risk of cervical or endometrail cancer

A

Avoid intrauterine system (mirena coil, copper coil)

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11
Q

What contraception avoid in Wilsonds disease

A

Acoid copper coil

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12
Q

What risk factors are UKMEC 4 for the COCP?

A

Uncontrolled HPTN esp >160/>100
Migraine with aura
History of VTE
>35 years, >15 cigarettes per day
Major surgery w prolonged immobility
Vascular disease or stroke
Ischaemic heart disease, cardiomyopathy and atrial fibillation
Liver cirrhosis and liver tumours
SLE and antiphospholipid syndrome

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13
Q

Is HRT a contraceptive

A

No - additional contraceptive required on top of it

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14
Q

What age can the COCP pill be used up to

A

50

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15
Q

Why does teh depot injection have to be stopped before 50

A

Risk of osteoporosis

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16
Q

When should women a=who are amenorrheic and taking progesterone only contraception stop

A

FSH blood test >35 IU/L on two tests 6 weeks apart - 1 more year continue
>55

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17
Q

Why is depot injectio and coils n UKMEC 2 under 20

A

injection- bone mineral density
Coils - higher rate expulsion

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18
Q

What is UKMEC 1 for under 20

A

COCP or progesterone pills
Profesterone implant

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19
Q

When is contraception required after birth

A

21 days

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20
Q

What need to do when starting pills after pregnancy

A

Condoms 7 dyas - COCP
2 days - progesterone

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21
Q

How long is lactaitonal amenorrhea considered effective contraception

A

6 months
Fully breastfeeding and amenorrheic

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22
Q

What contraceptivs are safe and insage with breastfeeding

A

Porgesterone only pill and implant are safe
COCOP NOT SAFE

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23
Q

How long after pregnancy before can start COCP

A

UKMEC 4 before 6 weeks PP
UKMEC 2 after

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24
Q

When can copper coil or mirena coil be inserted after birth

A

Within 48 hours or more than 4 weeks after birth - UKMEC 1
If in between UKMEC 3
WHY

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25
Q

How effective are condoms typical vs perfect use

A

98% perfect
82% typical

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26
Q

What can make condoms more likely to ttea

A

Oil based lubricants damage latex condoms

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27
Q

How are diaphragms and cervical caps ised
How effective

A

Fitted before sex - silicone cups sit over cervix
leave in place 6 hours after sex
Used with spermicide gel + perfect = 95% effective

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28
Q

Can u use diaphragm or cap and condom

A
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29
Q

What is option for oral sex

A

Dental dam

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30
Q

How effective is the COCP with perfect use or typical use

A

99% effective - perfect
91% - typical use

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31
Q

How does COCP prevent pregnancy

A

Prevent ovulation - primary
Progesterone thickens cervical mmucus
And inhibits proliferation of endometrium reducing chance successful implantation

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32
Q

What effect does oestrogen and progesterone have on other reproductive hormones

A

Negative feedback -> hypothalamus and ant pituiatry, supress release of GnRH, LH and FSH
Prevent ovulation

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33
Q

What is a withdrawal bleed

A

Endometrial lining maintatined while taking pill - when come off have withdrawal bleed

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34
Q

What types of COCP are there

A

Monophasic pills - same amount hormones each oill
Multiphasic - varying amounts hormones to match cyclical hormonal changes more closely eg vary oestrogen and type progesterone

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35
Q

What do everyday formulations monophasic pill packs contain

A

seven inactive pills - take one everyday dont have to worry youreself

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36
Q

Examples of monophasic combined pills

A
  • Microgynon contains ethinylestradiol and levonorgestrel
  • Loestrin contains ethinylestradiol and norethisterone
  • Cilest contains ethinylestradiol and norgestimate
  • Yasmin contains ethinylestradiol and drospirenone
  • Marvelon contains ethinylestradiol and desogestrel
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37
Q

First line COCP NICE

A

Levonorgestrel or norethisterone - microgynon or leostrin
Lower risk VTE

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38
Q

What type of progesterone in COCP first line fro PMS

A

Drospirenone eg yasmin

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39
Q

Why dropirenone used pMS

A

Anti-mineralcorticoid and anti-androgen activity
Help with bloating, water retention, modd changes
Continious ise

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40
Q

What progesterone type in COCP targets acne and hirsutism and hwy

A

cyproterone aceteate eg dianette
Anti-androgen effects

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41
Q

Why is dianette stopped after 3 months

A

1.5-2 times higher risk VTE than first line COCP

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42
Q

Common regime optinos for COCP

A

21 days on 7 dyas off
63 days/3 packs on, 7 dyas off
Continious use

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43
Q

Side effects and risks of COCP

A

Unscheduled bleeding common in first 3 months - settles
Breast pain and tenderness
Mood changes and depression
Headahces
HPTN
VTE
Small increased risk breast and cervical cancer, returns to normal 10 years after stopping
Small increased risk MI and stroke

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44
Q

Benefits of COCP

A

Effective
Rapid return to fertility
Improvement in premnestrual sy,ptoms, menorrhageia, dysmenorrhea
Reduced endometrial, ovarian and colon cancer
Reduced risk benign ovarian cysts

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45
Q

What is BMI >35 UKMEC for COCP

A

3

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46
Q

What is BMI >35 UKMEC for COCP

A

3

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47
Q

How effective are the pills with perfect vs typical use

A

Perfect >99%
Typical - 91%

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48
Q

How efefctive are depot injection use

A

Percet - >99%
tYPical 94%

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49
Q

How effective is natural family planning perfect vs typical use

A

95-99.6% effective if perfcet
Typical use - 76%

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50
Q

When do you require extra protection and not when strating the pill

A

Start of dirst day of cycle up to day 5- none extra needed
After day 5 - contraception for first 7 days before protected. Have tom check not already pregnant

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51
Q

What do when switch COCPs

A

Immediately start next pack with no break

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52
Q

What do when switch traditional POPs

A

Switch any time but 7 dyas extra contraception ie condoms jeeded and ensure not pregnant before switching

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53
Q

Why no extra protection needed when switching from desogestrol

A

Stops ovulation = no additional contraceptiona needed

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54
Q

When is a pill considered missed

A

More than 24 hours late, 48 hours since last pill taken

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55
Q

What do if miss one pill - less than 72 hours since last pill taken

A

Take missed pill asap even if take two on same day
No extra protection needed

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56
Q

What do if miss more than one pill >72 hours since last pill taken

A

Take most recent missed pill asap even if take 2 same day
Additional contraception needed untul taken reguarly for 7 days straight

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57
Q

What do if days 1-7 missed pills

A

Emergency contraception if unprotected sex

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58
Q

If days 8-14, 15-21

A

8-14 - and day 1-7 fully complucant, no emergency contraception needed
15-21 - same (8-14 comlicant). Go back to back with next pack pills and skip pill free period
Technically no extra protection needed but recommended

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59
Q

How are POPs taken

A

Continiously

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60
Q

How are POPs taken

A

Continiously

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61
Q

What is the only UKMEC 4 for POP

A

Active breast cancer

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62
Q

Types of POP

A

Trafitional - norgestron, noriday
Desogestrol only pill - cerazette

63
Q

How long after delay is considered a missed pill for the traditional vs desogestrol only pills

A

> 3 hours for POP
12 hours for desogestrel

64
Q

How do traditional POPs work

A

Thicken cervical mucus
Alter endometrium, less accepting implant
Reduce ciliary action fallopian tubes

65
Q

How does desogestrel work

A

Same as traditional POP but ALSO inhibits ovulation

66
Q

How long is additional contraception required for if POP not started in first 5 days of menstrual cycle

67
Q

Can POP be started if risk of pregnancy

A

Yes - not harmful
Woman should do pregancy test 3 weeks after last unprotected intercourse - emergency contraception before pill considered if required

68
Q

Why COCP takes 7 days additional contraception POP only 48 hours

A

COCP - inhibiting ovulation
POP - thickening cervical mucus

69
Q

Can u switch POPs without extra prtoetciton

70
Q

When is best to switch from COCP to POP

A

First seven days of cycle 0 not ectra protection needed

71
Q

When need to switch to POP immeidatiatley how manage

A

If not had sex since finishing COCP pack can switch straight away, condoms for first 48 hours of POP
If had sex since completing last pack COCPs - 7 consecutive days of COCP before switching, use contraception for 48 hours. If not possible, emergency contraception

72
Q

Main side effect of POP

A

Unscheduled bleeding
Common in first three monthsOften settles, can persist

73
Q

% women unscheduled bleeding POP

A

20% amenorrhea
40% regular
40% irregular, prolonged, troublesome bleeding

74
Q

other side effects of POP

A

Breast tenderness
Headacjes
Acne

75
Q

Increased risk on POP of:

A

Ovarian cysts
Small risk ectopic pregnancy w traditional POPs - reduced ciliary action tubes
Minimal inctreased risk breast cancer, returns normal 10 years after stopping

76
Q

When is emergency cintraception necessary with missing a pill

A

Emergency contraception is required if they have had sex since missing the pill or within 48 hours of restarting the regular pills.

77
Q

How are episodes of diarrhoea or vomitting managed

A

As missed pills and extra contraception needed 48 hours after thye settel

78
Q

What is progesteroene only injection

A

Depot mdeoxyprogesterone aceteate - DMPA

79
Q

How is DMPA given

A

12-13 week intercals as SC or IM injection of MA

80
Q

How effectove is DMPA

A

> 99% perfect use
94% typical use - forget to book

81
Q

How long does it take fertility to return after DMPA injection

82
Q

Two types of injection

A

Depo-provera - IM
SAyana press - SC, can be self injected
Noristerat - alternative contains norethisterone, works for 8 weeks, used short term interim contraception

83
Q

UKMEC 4 for injection

A

Active breast cancer

84
Q

UKMEC 4 injection

A

Ishcaemic HD and stroke
Unexplained vaginal bleeding
Sev liver corrhosis
Liver cancer

85
Q

Age when start to not recommend depot and why

A

UKMEC 2 over 45
Alternative should have over 50
Cause osteoporosis - contraidicatied if on steroids for asthma or inflammatory conditions

86
Q

How does depot injection work

A

Inhibit ovulation by inhibiting FSH secretion by pituitary gland, prevents follicle development
THickens cervical mucus
Alters endometrium and makes less accepting of implantation

87
Q

When need extra protection when start injection

A

If start after day 5 menstrual cycle need seven days extra contraception for seven days before reliable

88
Q

What does FSRH guidelines say about when injection can be given

A

10 weeks to 14 weeks after last but unlicensed
Dealt past 13 weeks = risk of pregnancy

89
Q

Side effects of depot injection

A

CHANGES TO BLEEDING - may resolve, common in first 6 months, unpredicatbale
Weigh tgain
Acne
Reduced libido
Mood changes
Headaches
Flushed
Hair loss - alopecia
Skin reactions at injection sites
REDUCED BONE MD
V small increased risk of breast and cervical cancer

90
Q

What hormone helps maintain bone MD in women

91
Q

What need to do if irregualr bleeding on contraception continues past normal irregular expected

A

Alternatiev causes rule out
Sexual health screen
Pregnancy test
Cervical screening up to date

92
Q

What can be doone if problematic bleeding occurs with injection

A

COCP for 3 months in combination
Short course 5 days tranexamic acid to halt

93
Q

Benefits of depot injection

A

Improves dysmenorrhea
Improves endometriosis related symptoms
Reduces risk of ovarian and endometrial cancer
Reduces severity of sickle cell crisis in patients with sickle cell anaemia

94
Q

Benefits of depot injection

A

Improves dysmenorrhea
Improves endometriosis related symptoms
Reduces risk of ovarian and endometrial cancer
Reduces severity of sickle cell crisis in patients with sickle cell anaemia

95
Q

How long can you have the progesterone implant for

96
Q

What is the only UKMEC 4 for progesterone implant

A

Active breast cacner

97
Q

What is teh implant used in UK and what does it contatin and who is it licesed in

A

Nexplanon - 68 mg etonegetrel
18-40

98
Q

How does the progesterone onoly implant work

A
  • Inhibiting ovulation
  • Thickening cervical mucus
  • Altering the endometrium and making it less accepting of implantation
99
Q

When need extra protection with impant

A

If after day 5 of cycle need to use condoms for 7 dyas

100
Q

Where is it inserted implant

A

one third uo upper arm on medial side
Lidocaine used prior
Beneath skin adn above SC fat
Should be palpable, press one side other pops upwards against slin
Removal - small incision, pressure or forceps remove

101
Q

Benefits of progesterone implant

A

Effective and relibal
IMprove dysmenorrhea
Lighter or stop periods
Dont have to remember pills
Doesnt cause weight gain
No effect on bone mineral density
No increase in thrombosis risk
No restriction for use in obese patients

102
Q

Drawbacks of implant

A

Minor operation to insert and remoce
Can make acne worse
No STI preotect
Problematic bleeding
Can be bent or facutred
Can become impalpable or deeply implanted -> additional management

103
Q

What happens if implant becomes impalpable

A

Extra contraception
US or X ray to locate
Barium sulphate - radio-opaque so seen on X ryas
Can be in blood vessel and travel to lings - CXR

104
Q

What to do when problematic bleeding occurs with implant

A

COCP for 3 months

105
Q

Bleeding on the implant

A

1/3 - in frequent
1/4 - frequent or prolonged
1/5 - no bleeding
Remainder - normal bleeds

106
Q

Types of coil

A
  • Copper coil (Cu-IUD): contains copper and creates a hostile environment for pregnancy
  • Levonorgestrel intrauterine system (LNG-IUS): contains progestogen that is slowly released into the uterus
107
Q

When does fertility t=return after removal of IUD/IUS

A

Immediately
Need to use condoms or abstain for 7 dyas prior or risk of pregnancy

108
Q

Contraindications for IUD/IUS

A

PID/infection
Immunosupression
Pregnancy
Unexplained bleeding
Pelvic cancer
Uterine cavity distrotion eg fibroids

109
Q

What need to do in women under 25 getting the coil

A

Screen for chalmydia and gonorrhea - higher risk for STIs

110
Q

What is done before fitting the coil

A

Bimanual exam - position and size of uterus
BP and HR
Speculum inserted

111
Q

What happens after procedure coils

A

Temporary crampy period pain - NSAIDs
seen 3-6 weeks after insertion to check threads and taught to check themselves erguarly

112
Q

Risks inserting the coil

A

bleeding
Vasovagal reactions - dizzy, brady, arrhtyhmias
Pain on insertion
Uterine perforation - 1 in 1000
PID esp in first 20 dys
Expulsion in first 3 months

113
Q

What needs to be excluded if cant feel threads

A

Expulsion
Pregnancy
Uterine perforation

114
Q

Investgiations if cant feel thread

A

US
Abdo and pelvic x ray - look for coil or peritoneal cavity after uterine perforation
Hysteroscopy or laparoscopic surgery

115
Q

How long can have copper coil

A

5-10 years

116
Q

When can the copper coil act as emergency contraception

A

Inserted up to 5 days after unprotected sex

117
Q

Mechanism copper coil

A

Toxic to ovum and sperm
Alters endometrium less likely to implant

118
Q

Benefits copper coil

A

Reliable
Inserted at any time in cycle and immediately effective
No hormones - safe for women at risk VTE/hormone related cancers
Reduce risk of endometrial and cervical cancer

119
Q

Drawbacks of copper coil

A

Procedure required
Heavy or intermenstrual bleeding - often sttely
Pelvic pain for some
Increases risk ectopic pregnancies
5% fall out

120
Q

the 4 types of IUS

A
  • Mirena
  • Levosert
  • Kyleen
  • Jaydess: effective for 3 years
    All effective for 5 years except last
    All contain levonorgestrel
121
Q

What can the mirena coil and levosert be used for aswell as contracetpiton

A

Mirena - menorrhagia, endometrial protection for women on HRT
Levosert - menorrhagia

122
Q

How long is mirena licensed for for HRT

123
Q

How do IUS work

A

Thicken cervical mucus
Alter endometrium, less aceepting implant
INhibit ovulation in small number

124
Q

When can an IUS be inserted in a cycle

A

Up to day 7, no additional contraception needed
After extra protection needed for 7 dyas

125
Q

Benefits of IUS

A

Periods lighter or stop
improve dysmenorrhea or pelvuc pain related to endometriosis
No effect on bone MD
No increased thrombosis risk
No restrictions in obese patients

126
Q

Drawbacks IUS

A

Procedure with risks
Can cause spotting and irrgular bleeding - COCP 3 months
Some - pelvic pain
Increased risk ectopic pregnancies
Increased incidence ovarian custs
Cna be systemic abdsoprtion causing acne, headaches, breast tenderness
Can occasionally fall out

127
Q

What can be seen on smear tests in women with the coil

A

Actinomyces-like orgnaisms
No treatment unless symptomatic - pain, bleeding, then remove device

128
Q

Options for emergnecy contraception

A

Levonorgestrel - within 72 hours
Ulipristal - 120 hours
Copper coil - 5 days (or 5 days of est ovulatino date)

129
Q

What is the most effective emergnecy contraception

A

Copper coil (unaffected by BMI, enzyme inducing drugs or malabsorption)

130
Q

What does efficacy of oral emergency contraception depend on

A

Earlier taken more effective it is

131
Q

When is oral contraception unlikely to be effective

A

After ovulationn has occured
Can still be offered on any day of the menstrual cycle

132
Q

Can oral emergency contraception be used more than once in a menstrual cycle

133
Q

What to consider when starting emergency contracwption

A

Confidentiality
STIs
Future contracpetion plans
Safeguarding, rape, abuse

134
Q

When does ovulation occur

A

14 days before end of cycle

135
Q

What is recommended by FSRH as first line emergency contraception

A

Copper coil

136
Q

What consider if copper coil put in and woman at high risk of STIs

A

Empirical treatment of pelvic infections to prevent PID

137
Q

When can coil be removed after used as emergency contracetption

A

Kept in til next period then can be removed or can be left as long term contraception

138
Q

How does levonorgestrel work

A

Progestogen that prevents or delays ovulation
Not known to be harmful if pregnancy then occurs

139
Q

How does levonorgestrel work

A

Progestogen that prevents or delays ovulation
Not known to be harmful if pregnancy then occurs

140
Q

Dose for levonorgestrel

A

1.5mg single dose
3mg single dose women > 70kg or BMI >26

141
Q

Side effects of levongorgestrel

A

N+V
Spotting and changes to next menstrual period
Diarrhoea
Breast tenderness
Dizziness
Depressed mood

142
Q

When should levonorgestrel be re[rescribed after N+V

A

If N+V within 3 hours

143
Q

Cna you take levonorgestrel when breast feeding

A

Yes
But avoid for 8 hours to reduce exposure to baby

144
Q

What is ulipristal

A

Selective progesterone receptor modulaor works by delaying ovulation - ellaone

145
Q

Which oral contraceptive is more effective

146
Q

How soon can you start the combined pill or progesterone only pill after taking ulipristal vs lenorgestrel

A

5 days - ulipristal + extra cpntraception for 7 dyas COCP, 2 dyas w POP
Straight away with levorgestrel

147
Q

Side effects of ulipristal

A
  • Spotting and changes to the next menstrual period
  • Abdominal or pelvic pain
  • Back pain
  • Mood changes
  • Headache
  • Dizziness
  • Breast tenderness
148
Q

Restrictions with ulipristal

A

Breastfeeding avoided for 1 week after, milk expressed and discarded
Avoided in patients with severe asthma
WHY

149
Q

Restrictions with ulipristal

A

Breastfeeding avoided for 1 week after, milk expressed and discarded
Avoided in patients with severe asthma
WHY

150
Q

What does the NHS not provide after sterilisation

A

Reversal procedures - have to go private and success rate is low - considered permanent

151
Q

What is female sterilisation procedure

A

Tubal occlusion - GA + laprascopy
Occluded using filshie clips or ties and cut
Elective or during C section

152
Q

Is contraception required after sterilisation

A

Yes until next menstrual period as ovum may have already reached the uterus to be fertilised

153
Q

What is a vasectomy

A

cut the vas deferens, prevent sperm tracel to testes to join ejaculated fluid
Stops sperm being released into vagina, preventing pregnnacy
15-20 minutes under local, less invasive than female

154
Q

How ong is alternative contracetpiton required for after vasectomy

A

2 months
Testing of semen to confirm absence of sperm necessary before can be relied upon, normally 12 weeks after to clear any sperm left in tubes
May require second analysis for confirmation

Reproductive Health (69 decks)

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