Contraception Flashcards
What is the UK medical eligibility guidelines ?
Used to categorise the risks of starting different methods of contraception in different individuals
What are the 4 levels of UK medical eligibility ?
UKMEC1-no restriction
UKMEC2 - benefits outweigh the risks
UKMEC3 - risks generally outweigh the benefits
UKMEC4 - unacceptable risk
What contraception should be avoided in breast cancer ?
Avoid any hormonal contraception
Advise copper coil and barrier methods
What contraception should be avoided in cervical or endometrial cancer ?
Intrauterine system - Mirena coil
What contraception should be avoided in Wilson’s disease ?
Copper coil
What are some specific risks that should make you avoid the COCP ?
Uncontrolled HTN
Migraine with aura
History of VTE
Aged over 35 smoking more than 15 cigarettes
Major surgery with prolonged immobility
Vascular disease or stroke
Ischaemic heart disease
Liver cirrhosis
SLE or antiphospholipid syndrome
Which is the only method of contraception that protects against STI’s ?
Barrier methods
What are some barrier methods ?
Condoms
Diaphragms and cervical caps
Dental dams
What infections can be spread through oral sex ?
Chlamydia
Gonorrhoea
Herpes simplex 1 and 2
HPV
Ecoli
Pubic lice
Syphilis
HIV
How does the COCP work as a contraception ?
Preventing ovulation
Progesterone thickens the cervical mucus
Progesterone inhibits proliferation of the endometrium
What are some side effects and risks of the COCP ?
Unscheduled bleeding
Breast pain
Mood changes and depression
Headaches
HTN
VTE
Small increased risk of breast and cervical cancer
Small increased risk of MI or stroke
What are the benefits of using the COCP ?
Effective contraception
Rapid return of fertility after stopping
Improvement of premenstrual symptoms, Menorrhagia and dysmenorrhoea
Reduced risk of endometrial, ovarian and colon cancer
Reduced risk of benign ovarian cysts
What is classed as missing a pill in contraception ?
When the pill is more than 24 hours late ( 48 hours since the last pill was taken )
What advice is given if a contraceptive pill is missed ( less than 72 hours since last pill was taken )?
Take the extra pill as soon as possible
No extra protection is required if other pills were taken correctly and less than 72 hours since last pill was taken
What advice is given if a contraceptive pill is missed ( more than 72 hours since last pill was taken )?
Take most recent pill as soon as possible
Additional contraception is needed until they have taken the pill regularly for 7 days straight
When should the COCP be stopped before a major operation ?
4 weeks before the operation
What is the only UKMEC4 criteria for the POP ?
Active breast cancer
How do traditional progestogen only pills work ?
Thickening cervical mucus
Altering the endometrium and making it less accepting of implantation
Reducing ciliary action in the fallopian tubes
How does Desogestrel POP work ?
Inhibits ovulation
Thickens the cervical mucus
Alters the endometrium
Reduces ciliary action in the Fallopian tubes
What are some side effects of the POP ?
Amenorrhoea
Regular bleeding
Irregular, prolonged or troublesome bleeding
Breast tenderness
Headaches
Acne
What are some potential risks of the POP ?
Ovarian cysts
Small risk of ectopic pregnancy
Minimal risk of breast cancer
What is classed as a missed pill for a traditional POP ?
More than 3 hours late ( more than 26 hours after the last pill )
What is classed as a missed pill for the Desogestrel POP ?
More than 12 hours late ( more than 36 hours after the last pill )
At what intervals is the progestogen-only injection given ?
12-13 weeks
How long does it take for fertility to return after the progestogen-only infection ?
12 months
What are the UKMEC4 contraindications for the progestogen-only injection ?
Active breast cancer
What are some UKMEC3 contraindications for the progestogen - only injection ?
Ischaemic heart disease
Unexplained vaginal bleeding
Severe liver cirrhosis
Liver cancer
What is the mechanism of action of the progestogen only injection ?
Inhibition of ovulation by inhibiting FSH secretion
Thickens cervical mucus
Alters the endometrium
What are some side effects of the progestogen only infection ?
Changes to bleeding schedule
Weight gain
Reduced libido
Mood changes
Headaches
Flushes
Hair loss
Skin reactions
Osteoporosis
What are some potential benefits of the progestogen only injection ?
Improves dysmenorrhoea
Improves endometriosis related symptoms
Reduces the risk of ovarian and endometrial cancer
What is the progestogen only implant ?
A small flexible plastic rod that is placed in the upper arm beneath the skin and above the subcutaneous fat. It slowly releases progestogen into the systemic circulation.
What UKMEC4 contraindications are there for the progestogen only implant ?
Active breast cancer
What is the mechanism of action for the implant ?
Inhibition of ovulation
Thickens cervical mucus
Alters endometrium
How long is the implant effective for ?
3 years
What are the benefits of the implant ?
Effective and reliable contraception
Improves dysmenorrhoea
Make periods lighter or stop altogether
Does not cause weight gain
No effect on bone density
No increase in thrombosis risk
No restrictions in obese patients
What are the negatives of the implant ?
Requires a minor operation
Can lead to worsening of acne
No protection against STI’s
Can cause problematic breast feeding
Can be bent or fractured
What are the 2 types of intrauterine devices ?
Copper coil
Levonorgestrel intrauterine system
What are some contraindications of the coil ?
Pelvic inflammatory disease or infection
Immunosuppression
Pregnancy
Unexplained bleeding
Pelvic cancer
Uterine cavity distortion - fibroids
What are some risks relating to the insertion of the coil ?
Bleeding
Pain on insertion
Vasovagal reactions
Uterine perforation
Pelvic inflammatory disease
If the coil threads are not visible or palpated what should be excluded ?
Expulsion
Pregnancy
Uterine perforation
If the threads aren’t visible what investigations should be performed ?
USS
Abdo and pelvic x ray can be used if there has been a uterine perforation
Hysteroscopy or laparoscopic surgery may be required depending on the location of the coil
What is the copper coil ?
A long acting reversible contraception licensed for 5-10 years after insertion.
Can be used as an emergency contraception if inserted up to 5 days after sexual intercourse
What is the mechanism of action of the copper coil ?
Copper is toxic to the ovum and sperm.
What are the benefits of using the copper coil ?
Reliable contraception
Can be inserted at any time in the menstrual cycle and is effective immediately
Contains no hormones
May reduce the risk of endometrial and cervical cancer
What are the negatives of the copper coil ?
A procedure is required
Can cause heavy bleeding
Some women experience pelvic pain
Does no protect against sexually transmitted infections
Increased risk of ectopic pregnancy
How does the
How does the Levonorgestrel intrauterine system work ?
Thickens cervical mucus
Alters endometrium
Inhibits ovulation
What are the benefits of the Levonorgestrel intrauterine system ?
Can make periods lighter
Improves dysmenorrhoea or pelvic pain
No effect on bone density
No increase in thrombosis risk
No restrictions in obese patients
What are the negatives of the Levonorgestrel intrauterine system ?
A procedure is required
Can cause spotting or irregular bleeding
Pelvic pain
Do protection against STI’s
Increased risk of ectopic pregnancy
Increased incidence of ovarian cysts
Falling out
What are the 3 types of emergency contraception and their timeframes ?
Levonorgestrel - taken in 72 hours
Ulipristal - taken in 120 hours
Copper coil - inserted within 5 days
What are some side effects of using levonorgestrel as an emergency contraception ?
Nausea and vomiting
Spotting and changes to the next menstrual period
Diarrhoea
Breast tenderness
Dizziness
Depresses mood
What is Ulipristal ?
A selective progesterone receptor modulator that works by delaying ovulation.
What are some side effects of Ulipristal ?
Nausea and vomiting
Spotting and changes to the next menstrual period
Back pain
Mood changes
Headache
Dizziness
Breast tenderness
What is the method for female sterilisation ?
Tubal occlusion using filshie clips preventing the ovum travelling from the ovary to the uterus.
What is the male sterilisation method ?
Vasectomy which involves cutting the vas deferens preventing sperm travelling from the testes to join the ejaculated fluid.
For how long should alternative contraception be used for after a vasectomy ?
2 months
What is gillick competence ?
Refers to a judgment about whether the understanding and intelligence of the child is sufficient to consent to treatment. Needs to be made on a decision by decision basis.
