Contraception Flashcards
What are the types of contraception available? (13)
COCP
POP
IUD
IUS
Depot injection
Patch
Implant
Condom
Diaphragm
Nuvaring
Tubal ligation
Vasectomy
Fertility Awareness Method
What approach should be taken when a woman is on COCP and is due to have a surgery?
Stop the pill 4 weeks before surgery and restart 2 weeks after
Why must COCP be stopped before surgery?
Both COCP and surgery are risk factors for venous thromboembolism. The pill needs to be stopped to prevent clotting
When can COCP be restarted post-partum?
After six weeks due to increased risk of venous thromboembolism
How soon after taking Levonorgestrel emergency contraception can a woman restart COCP?
Immediately - patient should be advised to use a condom for 7 days after restarting
How soon after taking Ulipristal Acetate emergency contraception can a woman restart COCP?
5 days
How long after UPSI can Ulipristal Acetate be used?
120 hours ( 5 DAYS )
How long after UPSI can Levonorgestrel be used?
3 days
What can patients with suspected STI or PID not have as emergency contraception?
Copper IUD
What type of contraception can be offered immediately to post-partum women?
POP
What effect does the Mirena ( IUS ) have on periods?
Initially irregular bleeding later followed by light menses or amenorrhoea
80%
What is the primary effect of the implant?
Inhibition of ovulation. Progesterone inhibits the secretion of FSH and LH from the pituitary.
Secondary effect of thickening cervical mucous
Can Levonorgestrel and Ulipristal Acetate be used in the same cycle?
Yes
What is the most common side effect occurring within the first 6 months of insertion of the IUS?
Irregular bleeding
How long until the IUD is effective? ( Not inserted on first day of period )
Immediately
How long until the POP is effective? ( Not taken from first day of period )
2 days
How long until the COCP is effective? ( Not taken from first day of period )
7 days
How long until the injection is effective? ( Not injected on first day of period )
7 days
How long until the implant is effective? ( Not put in on first day of period )
7 days
How long until the IUS is effective? ( Not put in on first day of period )
7 days
What is the correct way to use the patch effectively?
Change patch weekly with a 1 week break after 3 patches
Where is the implant inserted?
Sub-dermal , non-dominant arm
How long is the window for the POP?
3 hours
How long is Nexplanon ( implant ) effective?
3 years
Which method of contraception is most associated with delayed return to fertility?
Depo Injection
When can the IUS be inserted post child-birth?
Within 48 hours of delivery or 4 weeks after delivery
What does UKMEC 3 mean?
A category for hormonal contraception where risk outweighs benefit
What are some examples of UKMEC 3 conditions?
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
What effects does the COCP have on cancer risks?
Increased risk of breast and cervical cancer
Protective against ovarian and endometrial cancer
What are examples of UKMEC 4 conditions?
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)
If a person vomits within 3 hours of taking Levornogestrel what should they do?
Take another dose
What contraceptives are unaffected by enzyme-inducing drugs e.g Carbamazepine ?
Copper IUD
Progesterone injection
Mirena coil ( IUS )
What should be done if a child under 13 presents to the GP for contraception?
A child under 13 is always considered unable to consent for sexual intercourse so relevant safeguarding should be contacted
If the pearl index score of a contraception is 0.1, what would it mean?
1/1000 women a year will get pregnant if using it correctly
What does a migraine with aura present like?
Starts with visual changes then severe left sided headache
Why is the COCP contraindicated in women who suffer migraine with aura?
The pill worsens the condition
What are some fertility awareness methods?
Cervical secretions
Basal body temperatures
Length of menstrual cycle
What does the lactational amenorrhea method involve?
Breastfeeding delays the return of ovulation after childbirth
Suckling stimulus disrupts release of GnRH
Affects feedback cycle of HPG axis
How long is the lactational amenorrhea method effective for?
Up to 6 months after giving birth
What are the advantages and disadvantages of barrier contraception?
Advantages: reliable, protection from STIs, widely available (male condom)
Disadvantages: disrupt romantic nature, reduce sexual pleasure, can expire, allergy/sensitivity to latex/ spermicide
Identify 2 long-acting reversible contraceptives (LARC)
Progesterone Depot
Progesterone Implant
What is the role of progesterone in moderate/high doses?
Progesterone enhances the negative feedback of natural oestrogen – reducing LH and FSH secretion
No LH surge means no ovulation
What is the role of progesterone in lower doses?
Progesterone does not inhibit the LH surge
Ovulation is still likely
Cervical mucus thickens
What is the principal action of the COCP?
Principal action: prevents ovulation
Principal action: prevents ovulation
Reduces endometrial receptivity to inhibit implantation
Thickens cervical mucus to inhibit penetration of sperm
Identify 4 clinical conditions which are at increased risk when on the COCP
Breast and cervical cancer
Venous thromboembolism
MI
Stroke
What is the principal action of High Dose Progestogen contraception? ( depot, patch, implant)
Principal action: prevents ovulation
What is the principal action of High Dose Progestogen contraception? ( depot, patch, implant)
Thickens cervical mucus to inhibit penetration of sperm
Prevents endometrial proliferation
What are the advantages and disadvantages of the High Dose Progestogen Implant?
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
What are the advantages and disadvantages of the Low Dose Progestogen in the POP ?
Advantages: quickly reversible, used where COCP is contraindicated
Disadvantages: common menstrual problems, interacts with other medication, risk of ectopic pregnancy, no STI protection
What is the intrauterine system (IUS)?
IUS is a progestogen-releasing plastic device
Works for 3–5 years
What is the intrauterine device (IUD)?
UD is a plastic device with added copper
Works for 5-10 years
What are the principal and secondary actions of the IUD?
Principal action: copper is toxic to sperm and ovum
Secondary action: endometrial inflammatory reaction prevents implantation and changes consistency of cervical mucus
Identify 2 forms of sterilisation
Vasectomy
Tubual ligation/clipping
How is a vasectomy performed?
Vas deferens cut/tied to prevent sperm entering ejaculate
Performed under local anaesthetic
How is the success of a vasectomy confirmed?
Post-operative semen analysis to confirm no sperm in ejaculate
Approx. 12-16 weeks after surgery
How is a tubual ligation performed?
Fallopian tubes are cut/blocked to stop the ovum travelling from the ovary to the uterus
Performed under local/general anaesthetic
Identify 3 forms of emergency contraception
Emergency IUD
Emergency pill with ulipristal acetate
Emergency pill with levonorgestrel
What is subfertility?
Subfertility is the failure of conception in a couple having regular, unprotected coitus for one year
What is primary infertility?
Primary infertility is when someone who has never conceived a child in the past has difficulty conceiving
Identify the 5 main causes of subfertility
Male factors (30%)
Unexplained (25%)
Ovulatory disorders (25%)
Tubal damage (20%)
Uterine or peritoneal disorders (10%)
Identify 2 genetic causes for male subfertility
Klinefelter syndrome
Y chromosome deletion
Identify 4 antispermatogenic agents
Heat
Irradiation
Drugs
Chemotherapy
Identify 2 coital problems which can lead to male subfertility
Ejaculatory failure
Erectile dysfunction
Identify the 3 groups of different ovulatory disorders
Hypothalamic-pituitary failure (10%)
Hypothalamic-pituitary-ovarian dysfunction (85%)
Ovarian failure (5%)
Identify 2 clinical conditions which result from hypothalamic-pituitary failure
Hypothalamic amenorrhea
Hypogonadotrophic hypogonadism
Identify 2 clinical conditions which result from hypothalamic-pituitary-ovarian dysfunction
Polycystic ovary syndrome
Hyperprolactinaemic amenorrhoea
Identify 2 clinical conditions which result from ovarian failure
Premature ovarian failure
Primary ovarian insufficiency
Identify 3 uterine/peritoneal disorders
Uterine Fibroids
Endometriosis
Pelvic Inflammatory Disease
With what condition should Ulipristal Acetate not be given ?
Asthma controlled by oral steroids , due to the anti-glucocorticoid effect of UA
Which method is associated with weight gain?
Depo injection
For an under 50 woman, how long should they be amenorrhoeic before it is recommended they can stop contraception?
2 years
For an over 50 woman, how long should they be amenorrhoeic before it is recommended they can stop contraception?
1 year ( True menopause)
