Brainscape's Knowledge GenomeTM

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


See full index

Gynae > Contraception > Flashcards

Contraception Flashcards

1
Q

How should you assess a woman requesting contraception?

A
  • Exclude pregnancy
  • Assess comorbidities (HTN, migraine breast Ca…)
  • Lifestyle factors (smoking, breast feeding)
  • Concurrent medications (enzyme-inducing drugs)
  • Assess risk of STI (test if appropriate)
  • Assess risk of sexual abuse / rape
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which contraceptive methods are covered by UKMEC?

A
  • COCP
  • POP
  • IUD & IUS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which contraceptive methods are covered by WHO?

A
  • Barrier
  • Sterilisation
  • Natural family planning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which groups are at risk of STI?

A
  • Age <25
  • Frequent change in sexual partners
  • Involvement in prostitution
  • MSM
  • People who are from / visited areas of high HIV prevalence and been sexually active there
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the legal age of consent for sexual activity in the UK?

A

16

  • Sexual activity under age of 16 is an offence
  • Sexual activity under age of 13 is statutory rape
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How can you be reasonably certain that a woman is not pregnant?

A
  • No intercourse since last period
  • Correct and consistent use of reliable contraception
  • Within 7 days of onset of normal menstrual period
  • Less than 4 week post-partum and not breastfeeding
    Less than 6 months post-partum, fully breast feeding and amenorrhoeic
  • Within 7 days of miscarriage or termination
  • A pregnancy test is performed at least 21 days from last episode of UPSI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the approach to contraception if pregnancy can’t be reasonably excluded?

A
  • Consider need for EC
  • If requiring contraception consider quick starting:
    – CHC (except cyprindiol)
    – POP
    – Progesterone only implant
    These can then be stopped if pregnancy confirmed
  • Prog injection (DMPA) is less preferred as can’t be stopped / removed if pregnancy diagnosed- unknown fetal exposure to DPMA. Consider if other methods not acceptable though
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Contraceptive options for women with idiopathic menorrhagia

A

All hormonal and IU methods can be used, however recommend:
1. LNG-IUS
2. COC
3. POP or Depo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Contraceptive options for women with unexplained vaginal bleeding

A
  • Unexplained vaginal bleeding should be investigated to r/o underlying conditions like pregnancy / malignancy.
  • Do not initiate IU methods (UKMEC4)
  • Do not use Progesterone implants or injectables (UKMEC3)
  • All other hormonal methods can be used (UKMEC2)
  • If already in place can continue use of IU methods (UKMEC2)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Contraceptive options for women with history of ectopic pregnancy

A

All hormonal and IU methods can be used without restriction (UKMEC1)

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

Contraceptive options for women with uterine fibroids

A

If no distortion of uterine cavity
- All hormonal and IU methods can be used (UKMEC1)

If distortion of uterine cavity
- IU methods not recommended (UKMEC3)
- All other hormonal methods can be used (UKMEC1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Contraceptive options for women with PID or STD

A

Past infection with PID / gonorrhoea / chlamydia / purulent cervicitis, treated
- All hormonal an IU methods OK (UKMEC1)

Current infection
- DO NOT initiate IU options (UKMEC4). (Asymptomatic chlamydia is UKMEC3)
- If IU already in place can be left in (UKMEC2)
- All other hormonal methods acceptable (UKMEC1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Contraceptive options for women with vaginitis (Trichomonas, BV), other current STIs (excluding HIV, Hep, Gon, Syph), or at increased risk of STIs

A

All hormonal and IU methods can be used (UKMEC1 or 2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the guidelines around lU options in post-partum women?

A
  • Can be inserted within the first 48 hours
  • Then after 4 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the contraceptive options for post-partum women, not breastfeeding?

A
  • IU method if within 48 hours, or after 4 weeks for all women
  • All hormonal methods UKMEC1 after 6 weeks

If no additional risk factors for VTE
- Can use Implant or POP UKMEC1
- <3 weeks Depo MEC2 and COC MEC3
- >3 weeks Depo MEC1, COC MEC2

If other risk factors for VTE
- Can use Implant or POP (MEC1)
- <3 weeks Depo MEC2, COC MEC4
- >3 weeks Depo MEC2, COC MEC3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the contraceptive options for post-partum women who are breastfeeding?

A
  • IU method if within 48 hours, or after 4 weeks for all women
  • All hormonal methods UKMEC1 after 6 months

If <6 weeks PP
- Implant and POP UKMEC1
- Depo UKMEC2, COC UKMEC4

If >6 weeks PP
- Implant, Depo and POP UKMEC1
- COC UKMEC2

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

What are the contraceptive options for post-TOP, and post-TOP sepsis?

A

1st trimester
- All hormonal contraceptives UKMEC 1

2nd trimester
- IU methods UKMEC2
- All others MEC1

Post-TOP sepsis
- IU methods UKMEC4
- All others UKMEC1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the contraceptive options for smokers?

A

Only a consideration for COC, all others UKMEC1

Age <35
- COC UKMEC2

Age >35
- And stopped smoking >1y ago, COC UKMEC 2
- Active smokers or recent quit UKMEC 3-4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the contraceptive options for obesity?

A

Only a consideration for COC, all other methods UKMEC1

  • BMI 30-34, COC MEC2
  • BMI 35+, COC MEC3
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the contraceptive options for organ transplant?

A

In genera all hormonal contraceptive options are UKMEC2
Including if IU methods being CONTINUED

  • Initiating IU methods is UKMEC3
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the contraceptive options for CVD?

A

People with multiple risk factors (such as T2DM, obesity, dyslipidaemia, smoking, HTN)
- Copper coil UKMEC1
- LNG-IUS UKMEC2
- POP and Implant UKMEC2
- Depo and COC UKMEC3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the contraceptive options for HTN?

A
  • Avoid COC for all

If with vascular disease:
- Depo UKMEC3
- POP, Implant, IUS UKMEC2
- IUD UKMEC1

If no vascular disease:
- Depo UKMEC2
- All others UKMEC1

*If only a Hx of HTN during pregnancy COC UKMEC2, all others UKMEC1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the contraceptive options for IHD, Stroke?

A
  • Avoid COC and Depo
  • IUD safe

Continuing IUS, Implant and POP is UKMEC3
Initiating IUS, Implant and POP is UKMEC 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the contraceptive options for known dyslipidaemias?

A
  • IUD UKMEC1
  • All others UKMEC2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the contraceptive options for breast Ca?

A

Current or past breast Ca
- Only IUD

Family Hx of breast Ca
- All hormonal methods UKMEC1

Known carrier of gene mutations assoc w breast Ca
- IUD UKMEC1
- Others UKMEC2
- COC UKMEC 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the contraceptive options for endometrial and ovarian Ca?

A

Endometrial Ca
- Continuing IU methods UKMEC2
- Initiating IU UKMEC4
- All others UKMEC1

Ovarian Ca
- All hormonal methods UKMEC1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the contraceptive options for AF?

A

Avoid COC

  • IUD UKMEC1
  • Others UKMEC2
  • COC UKMEC4
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the contraceptive options for longQT?

A
  • Implant, POP and continuing IU methods UKMEC1
  • Depo and COC UKMEC2
  • Do not initiate IU methods, UKMEC3
29
Q

What are the contraceptive options for migraine?

A

IUD is safe

Without aura:
- Continuing COC MEC3, continuing POP MEC2
- Initiating COC MEC2, Initiating POP MEC1
- IUS, Implant, Depo MEC2
- IUD MEC1

With aura:
- COC MEC4
- Others MEC2
- IUD MEC1

30
Q

What are the contraceptive options for gallbladder disease and cirrhosis?

A

Symptomatic:
- IUD UKMEC1
- Other UKMEC2
- COC UKMEC3

Asymptomatic:
- IUD UKMEC1
- All others UKMEC2

History of COC related cholestasis
- Avoid COC

Cirrhosis
Mild- no limitations
Severe- only Use IUD

31
Q

What are the contraceptive options for anaemias (thalassaemia, sickle cell, IDA)?

A
  • IUD is UKMEC2 for all
  • COC UKMEC2 for sickle cell

Otherwise all other hormonal contraceptives OK

32
Q

LNG-IUS inserted- when is additional contraception required?

A
  • Insertion on day 1-7 of cycle= no additional contraception
  • Insertion after day 7 of cycle= need 7 days additional contraception
33
Q

What is the mode of action of IU methods?

A

IUD= prevent fertilisation by causing decreased sperm motility and survival, also prevent implantation

IUS= Levonegestrel prevents endometrial proliferation and causes cervical mucous thickening

34
Q

How long are IUS licensed for?

A

For contraception= 5 years
For endometrial protection in HRT = 4 years

Although new Jaydess= 3 years

35
Q

What is the method of action of COC?

A

Inhibits ovulation
- by reducing LH and FSH there is no surge in these hormones to stimulate ovaries to ovulate

They also have contraceptive effects on cervical mucus and the endometrium
- Oestrogen causes endometrial proliferation
- Progestogen opposes proliferative effects of oestrogen and prevents hyperplasia
- During pill free interval hormone levels drop causing oestrogen-primed endometrium to slough
- No need for pill-free interval, buth this use is off label

36
Q

What is the method of action of POP?

A

Thickens cervical mucus

37
Q

What is the method of action of Depo?

A
  1. Inhibits ovulation
  2. Thickens cervical mucus
38
Q

What is the method of action of Implant?

A
  1. Inhibits ovulation
  2. Thickens cervical mucus
39
Q

Which contraceptive is most associated with weight gain?

A

Depo

40
Q

How long until contraceptives are effective?

A

IUD= instant
POP= 2 days
IUS, COC, Depo, Implant= 7 days

If started day 1-5 of cycle no additional precautions required… I think

41
Q

Which POP is contraindicated in renal disease?
- What special considerations are there?

A

Drospirenone

  • Contraindicated in severe renal insufficiency and acute renal failure
  • Should be avoided in hyperkalaemia, untreated hypoaldosteronism, with potassium sparing diuretics or potassium supplements
    – Consider baseline bloods, monitoring U&E and BP, discussing with renal / endocrinology in people with renal / adrenal disease
42
Q

When can COC be started?
Is additional contraception required initially?

A

Regular periods
- Starting on day 1-5 of menstrual cycle, no additional contraception required
- Starting any other time, 7 days additional protection (9d for Qlaira)
(Unless Qlaira / Zoely, if they are started after day 1 of cycle need 9d and 7d protection)

Amenorrhoeic
Start any time, additional protection 7 days (9d Qlaira)

Post-partum, not breastfeeding
- Start 3 weeks post partum if no other VTE risks exist, additional contraception for 7 days
- If after 3 weeks PP and periods started

Post-partum and breastfeeding
- Do not start <6 weeks PP
- Otherwise same rules as if menstruating / amenorrhoeic

Miscarriage / TOP
- Gestation less than 24 weeks, day of termination equates to day 1 of menstruation- same rules
- Gestation 24+ weeks- follow rules as per post-partum

43
Q

What’s the efficacy of the COC?

A

Perfect use= 99.7% effective
Typical use= 91% effective

44
Q

How to manage missed COC

A

For all except Qlaira and Zoely:

If 9d or more since taken last active pill (so forgotten to restart after HFI:
– Consider EC
– Take missed pill ASAP
– Continue taking rest at usual time
– Additional contraceptive for 7 days
– Consider f/u pregnancy test

If 1 pill missed 3d or less in Week 1 of pack:
– No need for EC
– Take missed pill ASAP
– Take rest at usual time, may mean taking 2 in 24h
– No additional contraceptive, if consistent use in the previous 2 weeks

If 1 pill missed 3d or less in Week 2/3 of pack:
– No need for EC
– Take missed pill ASAP
– Take rest at usual time, may mean taking 2 in 24h
– No additional contraceptive if correct use previous 1 week

If 2-7 pills missed 3d since last pill in Week 1:
– Consider EC
– Take missed pill ASAP
– Continue rest as usual, may mean taking 2
– Additional contraceptive for 7 days, consider f/u pregnancy test

If 2-7 pills missed 3d since last pill in Week 2/3:
– No need for EC if correct use the previous 7 days
– Take most recent pill ASAP
– Continue rest as usual, may mean taking 2 in 24h
- Use additional contraception until 7 consecutive pills been taken (overcautious)

If more than 7 pills missed in any week:
– Consider EC
– Re-start COC as new user
– Additional contraception for 7 days
– Consider f/u pregnancy test

45
Q

What advice to give if diarrhoea or vomiting when taking the COC

A
  • If vomits within 3 hours of taking the pill, take another ASAP

If D/V persists more than 24 hours advise that:
- each day of D/V counts as ‘missed pill’
- Use additional contraception during illness and 7 days afterwards
- If illness occurs in Week 3 then avoid the HFI

46
Q

What are the risks and benefits of COC?

A

Benefits
- More effective than barrier
- Menstruation usually regular, lighter, less painful
- Reduces risk of ovarian and endometrial Ca which continues after stopping
- Reduces risk of colorectal Ca, and of functional and benign ovarian cysts
- Can improve acne
- Immediate return to fertility on stopping

Risks
- No protection against STIs
- Less effective than LARCs
- S/E nausea / headache / breast pain / irregular bleeding (up to 20%)
- HTN, MI, stroke
- VTE
Breast Ca
- Cervical Ca
- Mood changes

47
Q

How to manage unscheduled bleeding in women using COC?

A

Exclude or manage
- missed pills / drug interactions
- STIs
- Pregnancy
- Gynae Ca (cervical / endometrial)
— Women <45 consider 2ww endometrial ref if risk factors present, plus persistent problematic bleeding after 3 months of use, or change in pattern of bleeding after 3 months of use

Gynae exam if
- Persistent bleeding beyond 3 months of use
- Not UTD with smears
- If pelvic pain / dyspareunia / post-coital bleeding
- If woman requests

If Hx / exam reassuring for COC related bleeding and no other Sx:
- Encourage to persevere up to 3 months
- Change to higher dose oestrogen / progesterone, or a different progesterone
- Change to another form of contraception
(may be less unscheduled bleeding with combined vaginal ring)

48
Q

How do liver enzyme inducing drugs affect COC?
List some liver enzyme inducers

A
  • Can reduce the efficacy of COC

Examples: CRAP GPs T
Carbamazepines
Rifampicin Rifabutin Ritonavir
Alcohol
Phenytoin Phenobarbital
Griseofulvin
Prednisolone Primidone
Sulfonylureas StJohns wort
Topiramate

49
Q

How should you manage COC in a woman who is on short term (<2months) treatment with liver enzyme-inducing drugs?

A

If taking Rifampicin / Rifabutin always advise to change to another method
- One-off Depo good option, will cover short term treatment as well as 28 days after

With all other enzyme inducing drugs, if wants can choose between:
1. Continue COC at usual dose
– Advise taking extended / tricycling regime with HFI of only 4 days
– Advised additional contraception for duration of Rx as well as 28 days after stopping
2. Take two COC pills to make total 50micg ethinylestradiol daily
– Advise taking extended / tricyclic regime with HFI of only 4d, for the duration of Rx and for 28 days after
– No additional precautions required

50
Q

What are the disadvantages of Depo?

A

(Perhaps because delivers higher dose of progestogen than other methods)

  • Associated with increased risk of DVT
  • Can have adverse effect on lipid profile
  • Can cause weight gain
  • Can be 1y delay in fertility upon completion
  • Associated with reduced BMD, resolves on stopping- no increased risk of #
51
Q

How should you manage COC in a woman who is on long term (>2months) treatment with liver enzyme-inducing drugs?

A

If taking Rifampicin / Rifabutin advise to change to alternative method

If using Any Other liver enzyme inducing drugs and wants to continue on COC, advise:
- Take 2 COC pills daily to bring to minimum 50micg/day. Continue for duration of Rx and for 28 days after
- Use extended / tricyclic regimen with 4d HFI
- No need for additional contraception
- If develops breakthrough bleeding could signify low serum oestrogen levels
— In this case assess to r/o other causes of bleeding and consider increasing ethinylestradiol up to maximum of 70micg

52
Q

Which COC pills are suitable for extended or tricycling of packs?

A

Monophasic pills only

53
Q

What are the considerations when taking Lamotragine and COC?

A

Concurrent use of lamotragine and COC may lower seizure control

  • Advise to switch to alternative contraception
  • If wishes to continue COC seek specialist advice
    — Lamotragine dose may need to be doubled with use of COC
    — Advise to seek medical advice before stopping, as lamotragine dose may need to be halved
  • If taking lamotragine and Sodium Valproate, the COC is unlikely to affect seizure control
54
Q

What advice on surgery and immobilisation should be given to patients taking COC?

A
  • No precautions necessary if duration of anaesthesia / immobilisation is short (<30 mins) i.e varicose veins / tooth extractions
  • Stop COC 4 weeks before major surgery (op lasting >30mins), all surgery to the legs, or that involves prolonged immobilisation of a lower limb
  • Stop COC if emergency surgery or immobilisation
  • If stopping COC advise on other suitable methods of contraception (IUD= MEC1, IUS / depo / implant / POP= MEC2)
  • Re-start COC 2 weeks after full mobilisation
55
Q

How long can hormonal contraceptives be used for?

A

COC until age 50
— Can be until 51 if used as Rx for premature menopause

Progesterone only contraceptives and IUD can be continued beyond 50

56
Q

How should POP be initiated?
(except post-partum or post-TOP)

A

Days 1-5 of cycle:
- start immediately
- No additional precautions required

Except for drosperinone- can only be started without additional contraception if on Day 1

After day 5 (or after day 1 for drosperinone):
- Start immediately
- Additional precautions for 2 days
— (or 7 days for drosperinone)

If amenorrhoeic:
- Perform pregnancy test
- Start immediately
- Additional precautions for 2 days (7 for drosperinone)

57
Q

How should POP be initiated post-partum and post-TOP?

A

Post-partum breastfeeding and non:
- POP can be started any time after child birth, including immediately after child birth
- Within the first 21 days no additional precautions required
- If starting after day 21, and pregnancy unlikely, start immediately, additional precautions 2 days (7 with drosperinone)

Post-TOP both first and second trimester:
- Day 1-5 (just day1 drosperinone) start immediately, no additional precautions
- Thereafter start immediately and additional precautions for 2 days (7 with drosperinone)

58
Q

How should you switch from COC to POP?

A
  • On day 1-2 of HFI start POP immediately, no additional precautions required
  • On day 3-7 of HFI, or week 1 following that, if unlikely pregnant, start immediately with additional precautions for 2 days (7 drosperinone)
  • On day 3-7 of HFI or Week 1 following that, if UPSI occurred- re-start CHC until 7 consecutive pils taken, then switch to POP, no additional precautions required
  • If CHC can’t be continued, start POP, consider need for EC, and additional precautions required for 2 (7) days
  • On week 2/3 of CHC use
  • Switch immediately to POP, no additional precautions required
59
Q

How would you switch from one POP to another?

A

Most POPs can be directly switched with no additional precautions required

Drospirenone
POP –> Drospirenone
- start immediately, advise 7 days additional precautions

Drospirenone –> POP
- During HFI (last 4 days) and Week 1, if no UPSI since start of HFI, start POP immediately and recommend additional precautions for 7 days
- If during HFI or Week1, with UPSI since start of HFI, re-take drospirenone for 7 days, then switch to POP. No additional precautions.
- If Day 8-24 (active pills), Start immediately, no additional precautions

Note, starting POP after Drospirenone, advise 7 days precautions (not 2)

60
Q

How would you switch from Depo to POP?

A
  • If 14 weeks or less since injection
    – Start POP immediately, no additional precautions required
  • If >14 weeks, and reasonably certain can exclude pregnancy
    – Start POP immediately
    – Additional precautions for 2 days (or 7 with drosperinone)
61
Q

How to switch from IUS to POP

A

IUS within 5 years old
- No UPSI last 7 days- start POP immediately, additional precautions for 2 (or 7) days
- UPSI in last 7 days- start POP immediately, retain IUS for 7 days after UPSI, additional precautions for 2 (or 7) days

IUS out of date, 5-7 years old
- UPSI 7+ days ago
– Perform pregnancy test, start POP immediately, additional precautions for 2 (or 7) days

  • UPSI within last 7 days
    – as above, also retain IUS for 7 days after UPSI

IUS out of date 7+ years old
- If UPSI, check pregnancy test, start POP immediately, extra precautions for 2 (or 7) days
– If UPSI within last 7 days consider retaining the IUS, and consider need for EC

62
Q

What are the adverse effects of POP?

A
  • Menstrual irregularities, bleeding problems reduce with duration of use
  • Ectopic pregnancy, small increased risk
  • Breast tenderness
  • Ovarian cysts
  • Libido changes
  • Mood change
  • Headache
  • Possibly weight change
63
Q

How do you manage POP with short term (<2 months) Rx with liver enzyme-inducing drugs?

A

Efficacy of POP may be reduced by liver enzyme inducing drugs
– Advise to stop POP and have one off Depo injection
– If unable to receive Depo, advise continue POP and use additional contraceptives for duration of Rx and the 28 days following

64
Q

How do you manage POP with long term (>2 months) Rx with liver enzyme-inducing drugs?

A
  • Advise to change to method unaffected by liver enzyme inducing drugs
    – Such as Depo, barrier
  • Do not increase dose of POP
65
Q

How does POP and lamotragine interact?

A

Lamotragine may increase plasma levels of progesterone: monitor for adverse effects

66
Q

How much of a delay in taking POP is considered a missed pill?

A

Most POP= 3 hours
Desogestrel= 12 hours
Drospirenone= 24 hours

67
Q

How would you manage vaginal bleeding on the POP?

A
  • Assess consider other causes of bleeding
  • If likely secondary to POP use advise
    – 50% will become amenorrhoeic or have infrequent bleeding at 1y
    – 40% will have one spotting episode a month
    – 10-20% will have 2 or more bleeding episodes a month or prolonged bleeding
  • Do not increase dose of progesterone
  • Can consider switching to alternate POP, though no evidence that this will improve bleeding
  • Consider different type of contraceptive method
68
Q

Missed POP advice

A
69
Q

What’s the advice for women taking COCP / HRT before surgery… continue / stop?

A

Stop 4 weeks before surgery

Gynae (4 decks)

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