Contraception Flashcards
Discuss your approach to management of contraceptive problems
-History
Problem and hx of problem
Onset, duration and severity of problem
Hx of prev contraceptive
Menstrual cycle
Relevant medical hx
Family hx
Drug usage
Lifestyle
-Examination
-Investigations
How would you manage a patient presenting with condom breakage
Give ECPs
Demonstrate correct usage and advice
Change or add another contraceptive
List the side effects of progesterone injection and how you would manage them (4)
Menstrual changes
-Irregular bleeding (reassure, usually settles with continued use)
-Amenorrhea (reassure, change if unacceptable)
-heavy, prolonged or frequent bleeding
-Weight gain (advice to watch diet and exercise)
For heavy prolonged bleeding
1. Examine to excl pathology incl pregnancy
2. Give 1or2 cycles of COC (Biphasil), if continues advice change in injection or method
3. NSAIDS
Tabulate the differences between DMPA and Net-En injections differences
Injection schedule (3 months and 2 months)
Menstrual changes (More and Less)
Average delay in return to fertility (9months and 6months)
Cost (Lower and Higher)
List some of the side effects of COCs
Change in menstruation(amenorrhea, irregularity&heavy period)
Weight gain
Cardiovascular complications (MI)
Carbohydrate and lipid metabolism
Cancer risk
DVT, PE
Nausea/vomiting
Dizziness
Headache
Breast tenderness
Mood changes
BTB
Weight gain/loss
Risk low in young
Increase risk with age, smoking, HPT, obesity, DM
List the causes of breakthrough b,ending on COC (6)
The Ds
Default
Drugs
Disturbance of pregnancy
Disease
Disturbance of absorption
Distress
Diet
Dose
Duration of use
Discuss the management of breakthrough bkeeding on COC
-Exclude unrelated cause
-Reassure client, reinsure correct pill taking
-Break through bleeding early in cycle (day1-13)- oestrogen deficiency -Treat with phasic oral contraceptive eg Triphasil
-Breakthrough late in cycle (14 to 28) - Progesterone deficiency- Increase Progestagen, prescribe a diff Progestogen, use a 50 up pill eg Ovral
I’d side effects persist and are unacceptable switch method
Discuss what you would advice someone who missed their COC
Missed 1 acute pill - take asap and continue
Missed 2 active pills -;take 2 on D3 and 2 on D4 + additional precautions *7 days
Missed 2 active pills on week 3 start new pack and additional precautions
Missed pills in week 1 & unprotected sex- Emergency contraceptive
Discuss management of missed POPs
Missed 1 pill, take immediately plus precautions for 2-7 days
If more than 2, EC if unprotected intercourse
List some of the side effects of IUDs (5)
- Menstrual changes (increased Pain and bleeding or intermittent menstrual bleeding)
-Management:
Examine to exclude low lying device, infection or unrelated pathology
Prescribe NSAID (Ibuprofen)
Discuss changing to alternative method
Remove device - Missing strings
- coiled up inside uterus, expelled out, perforation
Management- exclude pregnancy
US
Forceps to locate strings in endocervical canal
Retrievers
XRay
Hysterectomy
Laparoscopy - Infections/PID
Treat infection - Pregnancy
- Explulsion
Replace, if expulsion again change method
List some of the side effects of implants
Headache
Weight gain
Acne
Breast tenderness
Mood changes
Abdominal pain
List some of the contraindications of COC according to absolute and relative
Absolute
-smoking in over 35 y/o (15cigs a day)
Relative
-Thromboembolics PE/MI/DM/HPT (metabolic syndrome)
-liver disease
-oestrogen receptor dependent breast cancer
-irregular menstrual bleeding (hormonal caused so don’t give hormones)
What is the mechanism of action of a subdermal implant
Prevents ovulation
Thickens cervical mucus
What is the duration of a subdermal implant
3years
When is it safe to insert an implant
3 weeks post partum
5 days post abortion
5 days of menstrual cycle
On or before during date for injection
On stopping COC/ POP
5 days after IUD removal
Any other time with 7 days of additional protection
