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Gynaecology > Contraception > Flashcards

Contraception Flashcards

1
Q

What is the most effective emergency contraception?

A

Copper IUD

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2
Q

How long after sex is a copper IUD effective for emergency contraception?

A

120 hours (5 days)

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3
Q

How does the copper IUD work?

A

It prevents implantation as it is toxic to both egg and sperm

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4
Q

How long can a copper IUD stay in place?

A

Up to 10 years

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5
Q

What are the contraindications to the copper IUD?

A

Up to 28 days postpartum
Repeated history of STIs
Current pelvic infection
Distorted uterus
Abnormal cervix
Unexplained bleeding

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6
Q

What is the UKMEC criteria?

A

UKMEC1 - no restriction in use
UKMEC2 - benefits outweigh risks
UKMEC3 - risks outweigh benefits
UKMEC4 - absolute contraindication

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7
Q

What contraception should women with breast cancer avoid?

A

Any hormonal contraception
- Copper IUD or barrier methods are best choice

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8
Q

What contraception should women with Wilson’s disease avoid?

A

Copper IUD

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9
Q

What contraception should women with cervical or endometrial cancer avoid?

A

IUS

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10
Q

What are diaphragms and cervical caps?

A

Silicone caps that fit across the cervix to prevent semen from entering the uterus

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11
Q

How is a diaphragm/cervical cap used?

A

Fitted before sex, and left in for 6 hours after sex
Used alongside spermicide gel

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12
Q

How effective is the COCP?

A

99% with perfect use
91% with typical use

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13
Q

How does the COCP prevent pregnancy?

A

Prevents ovulation (primary method)
Progesterone thickens cervical mucus
Progesterone inhibits proliferation of the endometrium

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14
Q

How does the COCP prevent ovulation?

A

Oestrogen and progesterone have negative feedback on the release of GnRH from the hypothalamus
In turn, less FH and LSH is released from the anterior pituitary, without which ovulation cannot occur

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15
Q

What are the first line choices of progesterone for the COCP?

A

Levonorgestrel or norethisterone

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16
Q

Why are levonorgestrel and norethisterone the first line choices of progesterone?

A

They have a lower VTE risk

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17
Q

What is the first line COCP for PMS?

A

Yasmin - containing drospirenone

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18
Q

Which is the first line COCP for acne and hirtruism?

A

Dianette - containing cyprotenone acetate

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19
Q

What are the three regimes for COCP use?

A

21 days on, 7 days off
63 days on, 7 days off
Continuous use

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20
Q

What are the common side effects of the COCP?

A

Unscheduled bleeding in first 3 months
Breast pain and tenderness
Mood changes and depression
Headaches

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21
Q

What are the risks of the COCP?

A

Hypertension
Small increase in risk of breast cancer, and cervical cancer
VTE
Small risk of MI and stroke

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22
Q

What are the contraindications to the COCP?

A

Over 35 and smoking more than 15 cigarettes per day
Migraine with aura
History of VTE
Uncontrolled hypertension
Ishcaemic heart disease
History of vascular disease or stroke
Liver cirrhosis
SLE

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23
Q

What extra protection is required when starting the COCP?

A

Up to day 5 - no extra protection required
Day 5 onwards - condoms for the first 7 days of pill taking

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24
Q

What extra protection is required in the case of a missed pill?

A

If it is less than 72 hours since the last pill taken:
- Take the missed pill as soon as possible
- No extra action requried

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25
Q

What extra protection is required in the case of more than 1 missed pill?

A

Take the missed pill as soon as possible
Additional contraception needed for 7 days

Day 1-7 of packet - emergency contraception needed
Day 8-14 - no emergency contraception needed
Day 15-21 - no emergency contraception required, but skip 7 day pill free period

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26
Q

Can the COCP be used during a major operation?

A

No - the COCP should be stopped 4 weeks before a major operation

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27
Q

What is the only absolute contraindication to the POP?

A

Breast cancer

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28
Q

What are the two types of POP?

A

Traditional POP
Desogestrel only pill

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29
Q

What is the time window for taking the traditional POP?

A

3 hours

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30
Q

What is the time window for taking the desogestrel only pill?

31
Q

What is the mechanism of action of the traditional POP?

A

Inhibits proliferation of the endometrium
Thickens cervical mucus
Reduces ciliary action in the fallopian tubes

32
Q

What is the mechanism of action of the desogestrel only pill?

A

Inhibits ovulation
Inhibits proliferation of the endometrium
Thickens cervical mucus
Reduces ciliary action in the fallopian tubes

33
Q

What extra protection is needed when starting the POP?

A

No extra protection needed if started on days 1-5
Day 6 onwards - additional contraception required for 48 hours

34
Q

What are the side effects of the POP?

A

Unscheduled bleeding during first three months
Breast tenderness
Headaches
Acne

35
Q

What are the risks of the POP?

A

Increased risk of ovarian cysts
Risk of ectopic pregnancy with traditional POP
Increased risk of breast cancer

36
Q

What extra protection is required in the case of a missed POP pill?

A

Take the missed pill as soon as possible
Use additional contraception for the next 48 hours

37
Q

How often is the progestogen-only injection given?

A

Every 12 to 13 weeks

38
Q

How long can it take for fertility to return after stopping the progestogen-only injection?

39
Q

What are the two types of progestogen-only injection given in the UK?

A

Depo-provera - IM injection
Sayana Press - self administered SC injection

40
Q

What are UKMEC3 contraindications to the POP?

A

Ischaemic heart disease and stroke
Liver disease
Unexplained vaginal bleeding

41
Q

What is the main mechanism of action of the depo injection?

A

Inhibits ovulation
(also works by inhibiting proliferation of the endometrium and thickening cervical mucus)

42
Q

When is extra protection required when starting the depo injection?

A

No extra protection required before day 5
After day 5 - additional protection required for 7 days

43
Q

What are the side effects of the depo injection?

A

Weight gain
Acne
Reduced libido
Mood changes
Headaches
Flushes
Hair loss
Skin reactions at injection sites

44
Q

What is the most important side effect of the depo injection?

A

Reduced bone mineral density

45
Q

What is the progestogen only implant?

A

A small 4cm plastic rod that is inserted underneath the skin, above the subcutaneous fat

46
Q

How long does the implant last for?

47
Q

What is the only UKMEC4 criteria for the implant?

A

Active breast cancer

48
Q

How does the implant work?

A

Inhibits ovulation
Makes the endometrium less accepting of implantation
Thickens cervical mucus

49
Q

What are the two types of coils?

A

IUD - copper containing coil
IUS - levenorgestrel containing coil

50
Q

What are the contraindications to the coil?

A

PID
Immunosuppression
Pregnancy
Unexplained bleeding
Pelvic cancer
Distortion of the uterus by fibroids

51
Q

What are the risks relating to insertion of the coil?

A

Bleeding
Pain on insertion
Vasovagal reactions
Uterine perforation
PID
Expulsion

52
Q

How long can an IUD remain in place?

A

5-10 years

53
Q

How does the IUD work?

A

Copper is toxic to ova and sperm
Also makes the endometrium less accepting of implantation

54
Q

When is the copper coil contraindicated?

A

In wilson’s disease

55
Q

What are the types of IUS and how long can they be used for?

A

Mirena - 5 years
Levosert - 5 years
Kyleena - 5 years
Jaydess - 3 years

56
Q

What other uses is the mirena coil licensed for?

A

Contraception, menorrhagia and HRT

57
Q

What other uses is the levosert coil licensed for?

A

Contraception and menorrhagia

58
Q

How does the IUS work?

A

Thickens cervical mucus
Makes the endometrium less accepting of implantation
Inhibits ovulation in some women

59
Q

What are the side effects of the IUS?

A

Can cause spotting or irregular bleeding
Pelvic pain
Acne
Headaches
Breast tenderness

60
Q

What are the risks of the IUS?

A

Ectopic pregnancies
Ovarian cysts

61
Q

What are the three types of emergency contraception?

A

Copper IUD
Levonorgestrel (Levonelle)
Ulipristal acetate (EllaOne)

62
Q

When can levonelle be taken?

A

Within 72 hours of unprotected sex

63
Q

When can EllaOne be taken?

A

Within 120 hours of unprotected sex

64
Q

What is the most effective form of emergency contraception?

A

Copper IUD

65
Q

What are the side effects of levonelle?

A

Nausea and vomiting
Spotting and changes to the next menstrual period
Diarrhoea
Breast tenderness
Dizziness
Depressed mood

66
Q

What are the side effects of EllaOne?

A

Nausea and vomiting
Spotting and changes to the next menstrual period
Back pain
Mood changes
Headache
Dizziness
Breast tenderness

67
Q

What is the Pearl Index?

A

The number of pregnancies that would be seen if 100 women used that form of contraception for one year

68
Q

At what age should a woman stop taking the COCP?

69
Q

When can the mirena coil or IUD be inserted after childbirth?

A

Within 48 hours of childbirth or after 4 weeks

70
Q

When can the COCP be started after childbirth?

A

After 21 days
or
After 6 weeks if breastfeeding

71
Q

When can the progesterone only pill be started after childbirth?

A

Can be started at any time

72
Q

When can patients be given the copper IUD after 5 days post intercourse?

A

If the patient is up to 5 days after their earliest ovulation date

73
Q

When after childbirth is contraception needed?

A

After 21 days postpartum

Gynaecology (27 decks)

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