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Year 1 > Contraception > Flashcards

Contraception Flashcards

1
Q

How long can sperm survive?

A

7 days

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2
Q

How long can oocyte survive?

A

24hrs

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3
Q

What is the fertile window?

A

8-9 days

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4
Q

When does conception occur most likely?

A

Day of ovulation or 24 hours before it

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5
Q

What are the natural forms of concpetion?

A

Fertilitiy awareness and the lactational amonorrhoea method and coitus interruptus.

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6
Q

What is the fertility awareness method?

A

Symptomatic tracking of the calender of ovulation, cervical mucus and basal body temperature to track fertility in cycle. It has a higher efficacy with user motivation. It has no drugs so no contraindications and works alongside the cycle. However, it is unreliable, user dependent and does not protect against STIs.

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7
Q

How does the female tract change during menstruation?

A

Cervical mucus in the follicular phase is thin and runnier due to oestrogen levels being high and allowing sperm entry. Cervical mucus in the luteal phase is thick and stickier due to oestrogen and progesterone, to catch and prevent sperm.

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8
Q

What is lactational amenorrhoea method?

A

Breastfeeding delays ovulation. Prolactin inhibits gonadotorphin releasing hormone from hpyothalamus for release of FSH and LH for the menstrual cycle. It persists for 6 months post breastfeeding

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9
Q

How is prolactin released?

A

Suckiling stimulates mechanoreceptors and this triggers the hypothalamus to secrete oxytocin and vasoactive intestinal peptide to inhibit dopamine. Then hypothalamus releases prolactin releasing factor to act on lactotrophin region of naterior pituitary gland and stimulate prolactin release and cause smooth muscle contraction of the glands.

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10
Q

What is the restriction of LAM and FAM?

A

Irregularity in menstrual cycle, medication afffects fertility indicators, medical conditions may increase risk of pregnancy, alternative to teratogenic drugs. Post partum ovulation can occur as early as 28 days.

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11
Q

What is a teratogenic drug?

A

Contraindicated drug for pregnancy because it causes structural and functional changes to foetus.

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12
Q

What is coitus interruptus?

A

Removal of penis from vagina prior to ejaculation. However pre-eaculation contains sperm. It is effective when properly used 94% of time and 76% is the effectivity of typical use.

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13
Q

Which stage of the menstrual cycle does the contraceptive target?

A

Luteal phase

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14
Q

What is the combined oral contraceptive?

A

Contains both oestrogen and progesterone. It prevents ovarian and endometrial cancer and relieves menstrual disorders. Its primary effect is to prevent ovulation and its secondary effect is increased thickness and viscosity of cervical mucus. It increases risk of breast and uterine cancer however this stops when usage stops. It also increases risk of thromboembolism which is worsened in smokers and long time users over 35, obesity and hypertension. It provides no protection against STIs and is user reliant and has contraindications and side effects.

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15
Q

What is the unopposed contraceptive?

A

Contains progesterone only, useful for those who cannot take combined contraceptive. It causes thickness and viscosity of cervical mucus to increase. The unnopposed contracpetive is reversible and can be used over 55 years of age. It provides no STI protection and is user reliant. It provides dysmenorrhoea.
However, adverse effects are hormonal distubrances and menstrual disorders.

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16
Q

What is dysmenorrhoea?

A

Period pain

17
Q

How are oestrogen processed?

A

Natural and synthetics are absorbed in the GI tract. It can also be absorbed in the skin and mucous membranes. It is metabolised in the liver and excreted in the urine as sulfates and glucoronides.

18
Q

How is progesterone processed?

A

It is absorbed in the GI tract and metabolised in the liver and excreted in the urine as glucoronic acid.

19
Q

How is the oral contraceptive efficacy reduced?

A

By increasing the enzyme cytochrome p450 action. THis occurs with the use of antiepileptics such as carbomzine and phenytoin. It increases with antibiotics such as rifampicin and St John’s wort.

20
Q

What enhances oestrogen absorption?

A

Soya products which reduce its storage in adipose and muscle and reduces T12 of drug

21
Q

How does progestogen injectables act?

A

They are absorbed and inhibit ovulation, endometrial proliferation and cause cervical mucus thickening. It is provided at 12 week appointment intervals. There is no user risk, suitable when combined oral contraceptive is contraindicated. There are adverse effects of weight gain, loss of bone mass density and weak association with breast and cervical cancer. It is not reversible, delays fertility return for 1 year and no STI protection.

22
Q

How does the progestogen implant work?

A

Progesterone is released intermittently which inhibits ovulation and endometrial proliferation and thickens cervical mucus. It is reliable with no user risk, lasts of 3 years and rapid fertility return. Adverse effect is irregular menstruation and risks of fitting the device such as infection and nerve damage. Disadvantages is no STI protection and procedure for insertion.

23
Q

What are the types of intrauterine contraception?

A

Intrauterine system and intrauterine device. They are convenient and highly effective and have long term use. However, there are risks with fitting, no STI protection and reliant on clinics to fit and remove.

24
Q

What is the intrauterine system?

A

Progesterone releasing device which inhibits ovulation and endometrial proliferation for egg implantation. It lasts 3-5 years.

25
Q

Intrauterine device

A

Plastic device with copper that is toxic to sperm and ovum to prevent fertilisation, with secondary effect of inflammation ot endometrium for implantation. Lasts 5-10 years.

26
Q

What are the emergency contraceptives?

A

Emergency IUD, Levonorgestrel which contains progesterone and Ulipristal acetate which is a selective progesterone receptor modulator

27
Q

What are important considerations for emergency contraceptives?

A

Liver enzyme cytochrome P450 induces will reduce the effectiveness of the tablet Levonorgestrel and Ulipristal acetate. UPA will have reduced effectivity if progesterone was taken in previous 7 days or following 5 days. Cautions are in breast feeding as milk must be discarded for 7 days. There is higher perforation risk with IUD. UPA is contraindicated for asthma.

28
Q

What is UPA?

A

Selective progesterone receptor modulator which is used as an emergency contraceptive. It is contraindicated in asthma. Any breastfed milk containing UPA must be discarded after 7 days.

29
Q

What are the windows of action for emergency contraception?

A

UPA and Levonorgestrel can only be used before ovulation because it delays it.
IU device can be used before and after ovulation.

30
Q

What are the male and female barrier methods?

A

Female diaphragm is placed over cervix before sex- fitted by HCP. Male is more widely available- condom. Used alongside spermicide. Protection against STI and has high efficacy. However, there is latex sensitivity, not as effective as alternatives and a diaphragm cap for females requires HCP to fit.

31
Q

What is male surgical sterilisation?

A

Male vasectomy where vas deferens is disconnected and requires contraception until sterility is confirmed. Immediate symptoms are bleeding, pain, infection and vasovagal episode. Long term is late failure for sterility and chronic pain.

32
Q

What is a vasovagal episode?

A

Sudden drop in BP

33
Q

What is female surgical sterilisation?

A

Tubal occlusion of uterine tube using ring/clip.

34
Q

What is a partial- salpingectomy?

A

Removal of part of uterine tube for female surgical sterilisation.

35
Q

What is a laparoscopy?

A

Incision into the abdomen

36
Q

What is a laparotomy?

A

Surgical incision into abdominal cavity to prepare for surgery

37
Q

What are the adverse effects of female surgical sterilisation?

A

Bowel perforation, bleeding, infection, ectopic pregnancy, post operative pain and failure.

Year 1 (191 decks)

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