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Primary Care Block Year 3 > Contraception > Flashcards

Contraception Flashcards

1
Q

What are the types of contraception available? (13)

A

COCP
POP
IUD
IUS
Depot injection
Patch
Implant
Condom
Diaphragm
Nuvaring
Tubal ligation
Vasectomy
Fertility Awareness Method

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2
Q

What approach should be taken when a woman is on COCP and is due to have a surgery?

A

Stop the pill 4 weeks before surgery and restart 2 weeks after

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3
Q

Why must COCP be stopped before surgery?

A

Both COCP and surgery are risk factors for venous thromboembolism. The pill needs to be stopped to prevent clotting

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4
Q

When can COCP be restarted post-partum?

A

After six weeks due to increased risk of venous thromboembolism

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5
Q

How soon after taking Levonorgestrel emergency contraception can a woman restart COCP?

A

Immediately - patient should be advised to use a condom for 7 days after restarting

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6
Q

How soon after taking Ulipristal Acetate emergency contraception can a woman restart COCP?

A

5 days

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7
Q

How long after UPSI can Ulipristal Acetate be used?

A

120 hours ( 5 DAYS )

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8
Q

How long after UPSI can Levonorgestrel be used?

A

3 days

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9
Q

What can patients with suspected STI or PID not have as emergency contraception?

A

Copper IUD

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10
Q

What type of contraception can be offered immediately to post-partum women?

A

POP

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11
Q

What effect does the Mirena ( IUS ) have on periods?

A

Initially irregular bleeding later followed by light menses or amenorrhoea
80%

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12
Q

What is the primary effect of the implant?

A

Inhibition of ovulation. Progesterone inhibits the secretion of FSH and LH from the pituitary.

Secondary effect of thickening cervical mucous

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13
Q

Can Levonorgestrel and Ulipristal Acetate be used in the same cycle?

A

Yes

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14
Q

What is the most common side effect occurring within the first 6 months of insertion of the IUS?

A

Irregular bleeding

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15
Q

How long until the IUD is effective? ( Not inserted on first day of period )

A

Immediately

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16
Q

How long until the POP is effective? ( Not taken from first day of period )

A

2 days

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17
Q

How long until the COCP is effective? ( Not taken from first day of period )

A

7 days

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18
Q

How long until the injection is effective? ( Not injected on first day of period )

A

7 days

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19
Q

How long until the implant is effective? ( Not put in on first day of period )

A

7 days

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20
Q

How long until the IUS is effective? ( Not put in on first day of period )

A

7 days

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21
Q

What is the correct way to use the patch effectively?

A

Change patch weekly with a 1 week break after 3 patches

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22
Q

Where is the implant inserted?

A

Sub-dermal , non-dominant arm

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23
Q

How long is the window for the POP?

A

3 hours

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24
Q

How long is Nexplanon ( implant ) effective?

A

3 years

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25
Q

Which method of contraception is most associated with delayed return to fertility?

A

Depo Injection

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26
Q

When can the IUS be inserted post child-birth?

A

Within 48 hours of delivery or 4 weeks after delivery

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27
Q

What does UKMEC 3 mean?

A

A category for hormonal contraception where risk outweighs benefit

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28
Q

What are some examples of UKMEC 3 conditions?

A

More than 35 years old and Smoking less than 15 cigarettes/day
BMI > 35 kg/m^2*
Family history of thromboembolic disease in First degree relatives < 45 years
Controlled hypertension
Immobility e.g. wheel chair use
Carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
current gallbladder disease

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29
Q

What effects does the COCP have on cancer risks?

A

Increased risk of breast and cervical cancer
Protective against ovarian and endometrial cancer

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30
Q

What are examples of UKMEC 4 conditions?

A

More than 35 years old and smoking more than 15 cigarettes/day
Migraine with aura
History of thromboembolic disease or thrombogenic mutation
History of stroke or Ischaemic heart disease
Breast feeding < 6 weeks post-partum
Uncontrolled hypertension
Current breast cancer
Major surgery with prolonged immobilisation
Positive antiphospholipid antibodies (e.g. in SLE)

31
Q

If a person vomits within 3 hours of taking Levornogestrel what should they do?

A

Take another dose

32
Q

What contraceptives are unaffected by enzyme-inducing drugs e.g Carbamazepine ?

A

Copper IUD
Progesterone injection
Mirena coil ( IUS )

33
Q

What should be done if a child under 13 presents to the GP for contraception?

A

A child under 13 is always considered unable to consent for sexual intercourse so relevant safeguarding should be contacted

34
Q

If the pearl index score of a contraception is 0.1, what would it mean?

A

1/1000 women a year will get pregnant if using it correctly

35
Q

What does a migraine with aura present like?

A

Starts with visual changes then severe left sided headache

36
Q

Why is the COCP contraindicated in women who suffer migraine with aura?

A

The pill worsens the condition

37
Q

What are some fertility awareness methods?

A

Cervical secretions
Basal body temperatures
Length of menstrual cycle

38
Q

What does the lactational amenorrhea method involve?

A

Breastfeeding delays the return of ovulation after childbirth
Suckling stimulus disrupts release of GnRH
Affects feedback cycle of HPG axis

39
Q

How long is the lactational amenorrhea method effective for?

A

Up to 6 months after giving birth

40
Q

What are the advantages and disadvantages of barrier contraception?

A

Advantages: reliable, protection from STIs, widely available (male condom)
Disadvantages: disrupt romantic nature, reduce sexual pleasure, can expire, allergy/sensitivity to latex/ spermicide

41
Q

Identify 2 long-acting reversible contraceptives (LARC)

A

Progesterone Depot
Progesterone Implant

42
Q

What is the role of progesterone in moderate/high doses?

A

Progesterone enhances the negative feedback of natural oestrogen – reducing LH and FSH secretion
No LH surge means no ovulation

43
Q

What is the role of progesterone in lower doses?

A

Progesterone does not inhibit the LH surge
Ovulation is still likely
Cervical mucus thickens

44
Q

What is the principal action of the COCP?

A

Principal action: prevents ovulation

45
Q

Principal action: prevents ovulation

A

Reduces endometrial receptivity to inhibit implantation
Thickens cervical mucus to inhibit penetration of sperm

46
Q

Identify 4 clinical conditions which are at increased risk when on the COCP

A

Breast and cervical cancer
Venous thromboembolism
MI
Stroke

47
Q

What is the principal action of High Dose Progestogen contraception? ( depot, patch, implant)

A

Principal action: prevents ovulation

48
Q

What is the principal action of High Dose Progestogen contraception? ( depot, patch, implant)

A

Thickens cervical mucus to inhibit penetration of sperm
Prevents endometrial proliferation

49
Q

What are the advantages and disadvantages of the High Dose Progestogen Implant?

A

Advantages: reliable, LARC, used by women who can’t use contraception with oestrogen, natural fertility returns quickly
Disadvantages: minor procedure to insert, side effects, no STI protection

50
Q

What are the advantages and disadvantages of the Low Dose Progestogen in the POP ?

A

Advantages: quickly reversible, used where COCP is contraindicated
Disadvantages: common menstrual problems, interacts with other medication, risk of ectopic pregnancy, no STI protection

51
Q

What is the intrauterine system (IUS)?

A

IUS is a progestogen-releasing plastic device
Works for 3–5 years

52
Q

What is the intrauterine device (IUD)?

A

UD is a plastic device with added copper
Works for 5-10 years

53
Q

What are the principal and secondary actions of the IUD?

A

Principal action: copper is toxic to sperm and ovum
Secondary action: endometrial inflammatory reaction prevents implantation and changes consistency of cervical mucus

54
Q

Identify 2 forms of sterilisation

A

Vasectomy
Tubual ligation/clipping

55
Q

How is a vasectomy performed?

A

Vas deferens cut/tied to prevent sperm entering ejaculate
Performed under local anaesthetic

56
Q

How is the success of a vasectomy confirmed?

A

Post-operative semen analysis to confirm no sperm in ejaculate
Approx. 12-16 weeks after surgery

57
Q

How is a tubual ligation performed?

A

Fallopian tubes are cut/blocked to stop the ovum travelling from the ovary to the uterus
Performed under local/general anaesthetic

58
Q

Identify 3 forms of emergency contraception

A

Emergency IUD
Emergency pill with ulipristal acetate
Emergency pill with levonorgestrel

59
Q

What is subfertility?

A

Subfertility is the failure of conception in a couple having regular, unprotected coitus for one year

60
Q

What is primary infertility?

A

Primary infertility is when someone who has never conceived a child in the past has difficulty conceiving

61
Q

Identify the 5 main causes of subfertility

A

Male factors (30%)
Unexplained (25%)
Ovulatory disorders (25%)
Tubal damage (20%)
Uterine or peritoneal disorders (10%)

62
Q

Identify 2 genetic causes for male subfertility

A

Klinefelter syndrome
Y chromosome deletion

63
Q

Identify 4 antispermatogenic agents

A

Heat
Irradiation
Drugs
Chemotherapy

64
Q

Identify 2 coital problems which can lead to male subfertility

A

Ejaculatory failure
Erectile dysfunction

65
Q

Identify the 3 groups of different ovulatory disorders

A

Hypothalamic-pituitary failure (10%)
Hypothalamic-pituitary-ovarian dysfunction (85%)
Ovarian failure (5%)

66
Q

Identify 2 clinical conditions which result from hypothalamic-pituitary failure

A

Hypothalamic amenorrhea
Hypogonadotrophic hypogonadism

67
Q

Identify 2 clinical conditions which result from hypothalamic-pituitary-ovarian dysfunction

A

Polycystic ovary syndrome
Hyperprolactinaemic amenorrhoea

68
Q

Identify 2 clinical conditions which result from ovarian failure

A

Premature ovarian failure
Primary ovarian insufficiency

69
Q

Identify 3 uterine/peritoneal disorders

A

Uterine Fibroids
Endometriosis
Pelvic Inflammatory Disease

70
Q

With what condition should Ulipristal Acetate not be given ?

A

Asthma controlled by oral steroids , due to the anti-glucocorticoid effect of UA

71
Q

Which method is associated with weight gain?

A

Depo injection

72
Q

For an under 50 woman, how long should they be amenorrhoeic before it is recommended they can stop contraception?

A

2 years

73
Q

For an over 50 woman, how long should they be amenorrhoeic before it is recommended they can stop contraception?

A

1 year ( True menopause)

Primary Care Block Year 3 (5 decks)

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