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GUM > Contraception > Flashcards

Contraception Flashcards

1
Q

Give examples of LARCs (long-acting reversible contraceptive methods)

A

Progesterone-only subdermal implant

Copper IUD

Progestogen- only IUS

Progestogen-only injection

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2
Q

What is the progrestogen-only subdermal implant?

A

flexible rod containing 68 mg of progestogen etonogestrel

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3
Q

How does the progrestogen-only subdermal implant primarily work?

A

suppressing ovulation by preventing LH and FSH surge

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4
Q

How does the copper IUD work?

A

preventing fertilisation as copper is toxic to sperm

inflammation on endometrium prevents inflammation

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5
Q

What is in the progestogen-only IUS?

A

progestogen levonorgestrel

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6
Q

How does the progestogen-only IUS work?

A

prevents pre-fertilisation by thickening cervical mucous

prevents implantation by thinning endometrial lining

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7
Q

What does progestogen-only injection contain?

A

depot medroxyprogesterone acetate (DMPA) - available as Depo Provera and Sayana Press

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8
Q

How often are Depo Provera and Sayana Press injections given?

A

every 13 weeks

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9
Q

How do Depo Provera and Sayana Press injections work?

A

suppressed ovulation

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10
Q

What is the combined oral contraceptive pill?

A

oestrogen and progestogen

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11
Q

What are types of combine hormonal contraception?

A

Combined oral contraception (COC)
Combined vaginal ring (CVR)
Combined transdermal patch (CTP)

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12
Q

How do combined hormonal contraceptions work?

A

inhibit ovulation, by thickening cervical mucus and impacting endometrial lining

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13
Q

How do progestogen-only pills work?

A

thicken cervical mucus and inhibit sperm penetration

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14
Q

What are the 3 permanent contraceptive methods?

A

Vasectomy
Tubal occlusion with clips/rings (usually via laparoscopy)
Tubal occlusion via hysteroscope

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15
Q

What are the methods of emergency contraception?

A

Copper bearing intrauterine device (Cu-IUD)
Ulipristal acetate (UPA)
Levonorgestrel (LNG)

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16
Q

What are the conditions for use of copper IUD as emergency contraception?

A

fit within 120hrs of UPSI or within 5 days of earliest predicted ovulation

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17
Q

What are the conditions for use of UPA as emergency contraception?

A

effective up to 120hrs of UPSI

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18
Q

What are the conditions for use of LNG as emergency contraception?

A

effective up to 72hrs after UPSI

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19
Q

What is UKMEC for contraception?

A

recommendations which identify health conditions (e.g. hypertension) or characteristics (e.g. smoking) which may affect the safety of the method

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20
Q

What is category 1 UKMEC?

A

A condition for which there is no restriction for the use of the method

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21
Q

What is category 2 UKMEC?

A

A condition where the advantages of using the method generally outweigh the theoretical or proven risks

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22
Q

What is category 3 UKMEC?

A

A condition where the theoretical or proven risks usually outweigh the advantages of using the method

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23
Q

What is category 4 UKMEC?

A

A condition which represents an unacceptable health risk if the method is used

24
Q

When are the combined hormonal and progestogen-only contraceptive pills licensed to be initiated?

A

1-5 days of the natural menstrual cycle

25
Q

When can the IUS be fitted without requiring extra precautions?

A

days 1-7 of a menstrual cycle

26
Q

Which method is preferred for efficacy?

A

LARC

27
Q

Which method is preferred for making periods lighter?

A

combined hormonal pill or progesterone-only contraception

28
Q

Which examination is needed for those wanting to initiate a CHC?

A

BP measurement
BMI

29
Q

What is monophasic CHC?

A

21 identical tablets followed by 7-pill free days (some may contain 7 placebo pills) e.g. Microgyon

30
Q

What is phasic CHC?

A

different hormone strengths in each pill - mimic fluctuating cycle e.g. Qlaira

31
Q

What are non-contraceptive benefits of CHC?

A

Reduce heavy periods
Acne
PMS
Reduce risk of endometrial, ovarian and colorectal cancer
Endometriosis
PCOS

32
Q

What are risks of CHC use?

A

VTE
Ischaemic stroke
Migraine with aura
Cervical cancer
Breast cancer

33
Q

If COC is chosen, what is the typical first line formulation?

A

<30ug EE with levonorgestrel or norethisterone

34
Q

On which days of the cycle can CHC be started without additional need for contraception?

A

Day 1 to 5 of the cycle

35
Q

When is the combined transdermal patch applied?

A

New CTP applied weekly on same day for 3 consecutive weeks

4th week is patch-free (withdrawal bleed)

36
Q

Where is the combined transdermal patch applied?

A

buttock, abdomen, torso or upper-arm

37
Q

How is the combined vaginal ring inserted? How long for?

A

inserted in the vagina and retained for 3 weeks, then 7-day free interval

does not need to be positioned precisely

38
Q

What are the two vaginal rings?

A

Nuvaring® and Syreniring®

39
Q

Which are the current progestogen-only pills?

A

levonorgestrel (LNG) and norethisterone (NET)

desogestrel (DSG)–containing pills

40
Q

How can the progestogen only injectables be injected?

A

IM or SC

41
Q

What are contraindications to progestogen only contraception?

A

Breast cancer
Severe cirrhosis

42
Q

What is the timing of NET/LNG POP for it to be effective?

A

within 3 hours of the same time each day

43
Q

What is the timing of DSG POP for it to be effective?

A

within 12 hours of the same time each day

44
Q

What are side effects of POP’s?

A

Reduced libido
Mood changes
Altered bleeding patterns
Acne
Breast tenderness
Weight changes
Headaches

45
Q

When may POPs be started without need for additional contraception?

A

Up to day 5 of a natural cycle

Up to 5 days after first or second trimester termination of pregnancy or miscarriage

Up to 21 days postpartum

46
Q

What are side effects of DMPA injection?

A

Weight gain
Reduction in bone density

47
Q

What are the types of subdermal implants?

A

Nexplanon and Implanon

48
Q

How does nexplanon SDI differ from implanon SDI?

A

Nexplanon contains barium sulphate to enable X-ray detection

Applicator for nexplanon has been modified to reduce risk of deep insertion

49
Q

How long is an SDI licensed for?

A

3 years

50
Q

How does the SDI work?

A

Inhibition of ovulation by preventing LH surge

Increased viscosity of cervical mucus inhibits sperm penetration

Thinning endometrium to prevent implantation

51
Q

What are disadvantages of an SDI?

A

Change in bleeding pattern

Change in weight, mood, libido

Acne (improves/worsens)

Headache

Breast cancer risk

52
Q

When can the SDI be inserted without additional contraception?

A

Day 1-5 of cycle

53
Q

What are the licensed IUDs?

A

Mirena
Lecosert
Kyleena
Jaydess

54
Q

Complications of IUD

A

Perforation
Infection
Ectopic pregnancy
Expulsion

55
Q
A

GUM (10 decks)

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