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Reproduction & Sexual Health > Contraception > Flashcards

Contraception Flashcards

1
Q

If no contraception is used what is the chance of getting pregnant?

A

85%

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2
Q

What percentage of pregnancies are unplanned?

A

40%

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3
Q

Name three mechanisms of action of contraception

A

Prevention of ovulation
Prevention of fertilisation
Prevention of implantation

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4
Q

How does contraception prevent ovulation?

A

Suppresses FSH and LH by negative feedback

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5
Q

How can fertilisation be prevented?

A

Mechanical Barrier - condoms/diaphragm
Surgical Barrier - sterilisation
Direct toxicity - spermacide/IUD

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6
Q

How is implantation prevented?

A

Thinning of womb lining to create a hostile environment

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7
Q

What does LARC stand for?

A

Long Acting Reversible Contraception

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8
Q

What methods of contraception are not advised?

A

Withdrawal and abstinence

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9
Q

State some of the factors to consider when choosing contraception

A
  • Personal preference
  • Age
  • Mental Capacity
  • Wellbeing/child protection
  • Relationship
  • Pregnancy risk/future planning
  • STI
  • Practical issues (storage of pill etc)
  • Compliance
  • Allergy/medications
  • BMI/BP
  • PMH
  • Family history
  • Invasive procedure
  • Side effects
  • Non-contraceptive benefits
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10
Q

Describe the two types of effectiveness

A

Typical use/user failure rate

Perfect use/method

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11
Q

Why are condoms often not effective?

A

Put on too late, wrong lube (oil based), wrong technique, wrong size, damaged, expired

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12
Q

Why are diaphragms often not effective?

A

Put in too late, removed too early, wrong technique

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13
Q

Why is the pill often not effective?

A

Compliance problems, too late starting, drug interaction, quick starting

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14
Q

What are the three main types of LARC?

A

Copper Coil
Hormonal Coil
Rod

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15
Q

State the complications of the procedure to insert the coil

A

Perforation
PID
Malposition/expulsion

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16
Q

When are coils contraindicated?

A

Submucosal fibroids

Uterine malformation

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17
Q

How long does the copper coil last?

A

10 years, if >40years old it can stay until menopause

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18
Q

What is a down side of the copper coil?

A

Often periods become heavier and longer and more painful - NSAIDs can help

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19
Q

In what circumstances may the copper coil be the only option?

A

After breast cancer

Emergency - up to 5 days after sex

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20
Q

Name four types of hormonal coil

A

Mirena
Levosert
Kyleena
Jaydess

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21
Q

What is the non-contraception use of mirena coil?

A

HRT
Endometriosis
Hyperplasia

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22
Q

What happens to bleeding on the mirena coil?

A

Irregular spotting/PV bleeding common in first months then high chance of no/irregular periods after 6 months

23
Q

How long can the implant be kept in for?

A

3 years

24
Q

What is the main side effect of the subdural implant?

A

PV bleeding - very unpredictable but important to exclude other causes if it does occur

25
Q

How can bleeding with the implant be controlled?

A

COCP

26
Q

How do LARC methods work?

A

Prevent fertilisation and implantation

27
Q

How do combined hormonal methods work?

A

Prevention of ovulation

28
Q

What is the efficacy of combined hormonal methods?

A

Perfect use 0.3%

Typical 8%

29
Q

How do you start the combined hormonal methods?

A

Start in first 5 days of period

At any time in the cycle when not pregnant but use condoms for 7 days

30
Q

What are the three regimes?

A

Take daily for 21 days followed by 7 days break (withdrawal bleed)
Continuously for 3 packs, then stop for 7 days (tricycling)
Continuously until bleed, stop for 4 days and then start again

31
Q

What are the risks of combined oral contraceptive pill?

A 
Venous thromboembolism (5-12%)
Systemic hypertension (140/90)
Arterial disease (MI/Stroke)
Migraine with aura 
Age >35 years 
Breast cancer 
Cervical cancer - HPV/condom use and smear
32
Q

What can alter the effectiveness of COCP?

A

Impaired absorption
Increased metabolism
Forgetting

33
Q

State the benefits of combined oral contraception

A

Reduction in ovarian cancer and endometrial cancer
Improvement of acne
Less PMS, PCOS, bleeding, fewer functional cysts

34
Q

What are the common side effects of combined hormonal contraception?

A

Nausea
Bleeding
Acne
Breast tenderness

35
Q

What is the efficacy of the progestogen only pill?

A

Perfect <1%

Typical 9%

36
Q

How does the progestogen only pill work?

A

Inhibits ovulation

- older forms not as reliable as act on cervical mucous

37
Q

Describe starting progesterone only pill

A

Start in day 1-5 of period

Anytime if not pregnant but must use condoms for 7 days (injection/implant), 2 days for pill

38
Q

What is the only contraindication for the progesterone only pill?

A

Breast cancer

39
Q

What are the common side effects of the progesterone only pill?

A

Nausea, spots, irregular bleeding, headaches

40
Q

What is the regime for taking the pill?

A

Take the pill at the same time everyday, >12 hours late it won’t work for 2 days

41
Q

How do the injections work?

A

Lower estradiol and suppress FSH

42
Q

What is the efficacy of injections?

A

Perfect 0.3%

Typical 3%

43
Q

When are the injections very useful?

A

Epilepsy - unaffected by enzyme inducing drugs

44
Q

What are the side effects of injections?

A

Nausea, weight gain, spots, headache, bleeding

45
Q

Why must the injection be used with caution?

A

Bone health - it can reduce peak bone mass

46
Q

Describe the diaphragm

A

71-88% effective
Not often used but involves no hormones. Used with spermicide and must be kept in for at least 6 hours post sex. Wash in warm water and put in a box.

47
Q

What are the three types of emergency contraception?

A

Levonorgestrel
Ella one - ulipristal
Copper coil

48
Q

How does emergency contraception work?

A

Delays/inhibits ovulation

49
Q

How long after sex can emergency contraception be used?

A

Levonorgestrel - within 72 hours
ella one - within 120 hours
copper coil - within 5 days

50
Q

Which type of emergency contraception makes the pill less effective?

A

ella one

51
Q

Which form of emergency contraception can be used more than once in a cycle?

A

Lenonorgestrel

52
Q

Name the side effects of emergency contraception

A

Menstrual irregularities
Nausea, vomiting
Headache, dizziness, breast tenderness, diarrhoea

53
Q

What forms of contraception are safe to use in patients on epilepsy medication?

A

Depo provera/Sayana press
Hormonal IUD
Copper IUD

Reproduction & Sexual Health (36 decks)

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