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MRCOG - Part 2 > Contraception > Flashcards

Contraception Flashcards

1
Q

IUDs available in UK

A

Copper intrauterine devices (Cu-IUDs) - highly effective method of contraception or emergency contraception

Levonorgestrel intrauterine devices (LNG-IUDs) -

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2
Q

Mechanism of action of Cu IUD

A
  • Copper effect on:
    . On ovum and sperm: inhibition of fertilization
  • on cervical mucus: inhibits the passage of sperm into the upper reproductive tract
  • endometrium: causes an inflammatory response within the endometrium, which could impair implantation.
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3
Q

What is LNG-IUD action

A

Progestogenic effects on:
- cervical mucus prevent the passage of sperm into the upper reproductive tract
- the endometrium may inhibit implantation
- In some individuals the LNG-IUD will also inhibit ovulation.

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4
Q

Are IUS effective immediately

A

Cu-IUD - effective immediately following insertion
LNG-IUD - effective 7 days after insertion

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5
Q

Gynecological benefits of IUD

A

52 mg LNG-IUD helps in management of:
- HMB
- dysmenorrhoea
- endometrial protection as part of HRT

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6
Q

Duration of use of Cu Iud

A

5-10 years
(Can be extended if inserted over age of 40y)

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7
Q

Duration of use of LNG-IUD

A

5 years
(If inserted before 45y: extended to 6 y)
(If inserted after 45y: extended to age 55)

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8
Q

Duration of use of LNG-IUD

A

5 years
(If inserted before 45y: extended to 6 y)
(If inserted after 45y: extended to age 55)

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9
Q

Mirena can be used for how long as a ENDOMETRIAL protection as HRT

A

5 years (FSRH recommends 6y)

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10
Q

CU IUD failure rate

A

Typical use: 0.8%
perfect used: 0.6%

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11
Q

LNG IUD failure rate

A

0.2% (perfect and typical use)

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12
Q

IUC cannot be used by young people, individuals who have never been pregnant and individuals who have never been sexually active. True or False ?

A

False

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13
Q

When can IUC be inserted post-partum ?

A

UKMEC 1 - Immediately post-partum within 48 hrs or after 4 wks/28 days - interval insertion

UKMEC 3 - Between 48 hrs - 4 wks

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14
Q

UKMEC in postpartum sepsis ?

A

4

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15
Q

Should any investigations be done prior to insertion of IUC ?

A

-STI screening (Current PID, known gonorrhoea infection, symptomatic chlamydial infection, purulent cervicitis are all contraindications to IUC insertion)

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16
Q

Can IUC be inserted in a female with uterine cavity malformations ?

A

Decision made on individualized basis
According to:
- the degree of distortion
- uterine cavity size
- the accuracy of imaging available
- the indication for use and other suitable alternatives
- the type of device being inserted
- the potential consequence of complications for that particular individual.

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17
Q

How to insert IUD in case of fibroids, distortion or malformations

A

should be in a specialist setting with access to ultrasound or hysteroscopy

18
Q

What is Ehlar Danlos Syndrome

A

connective tissue disorder associated with an increased risk of uterine rupture in pregnancy and/or joint hyperlaxity, both of which may be relevant to IUC procedures

19
Q

Any CI of IUD with cardiac disease

A

No

But should require MDT, insertion in hospital settings

20
Q

Cu-IUD use is not recommended for individuals with which metabolic disorder?

A

Wilson’s disease

21
Q

Health risks with IUC use ?

A

May be an association between hormonal IUDs and breast cancer - however, any potential increased risk appears to be small.

22
Q

Presence of (or history of) ovarian cysts or PCOS is a contraindication to IUC use?

A

No

23
Q

S/E of LNG-IUD

A

Acne , mood swings, headache, breast tenderness

24
Q

Emergency contraception

A
  1. LNG-IUD
  2. Ulipristal Acetate
    3.Cu IUD
25
Q

How long to used combined vaginal ring

A

Stays in the vagina for 3 weeks and is removed for 1 week to allow menstruation

26
Q

All Combined contraception contains what type of estrogen? except what?

A

Synthetic Estrogen (Mestranol)
Except: Qlaira contains Estradiol Valerate

27
Q

When to start CHCs

A

At any time of the cycle (as long as she isn’t pregnant)

If started in 1st to 5th day of menses: efficient immediately
If afterwards: additional contraception for 7 days

28
Q

Non contraceptive benefits of CHCs

A
  • improve acne
  • cycle regularity
  • inprove 1ry dysmenorrhea
  • reduce HMB
  • reduce some menopausal symptoms
  • reduce incidence of ovarian, endometrial & colorectal cancer, benign ovarian tumor& benign breast disease
29
Q

Do CHC causes weight gain

A

No evidence

30
Q

Risk of VTE with use of CHC compared to non users?

A

Double

But absolute risk is still low

31
Q

Risk of CVS disorders with CHC

A

Very small increased risk of ischemic stroke, which is influenced by smoking, HTN -and migraine with aura

32
Q

CHC in a women >35y who smokes?

A

Not recommended

<15 cigarettes/d: UKMEK 3
>15 cigarettes/d: UKMEK 4

33
Q

If a woman stopped smoking for > 1 year, can she take CHC

A

UKMEK 2

34
Q

Using CHC in women with HTN

A

Risk outweighs advantages, high risk of stroke and MI

Adequately controlled: UKMEK 3
Consistently elevating : UKMEK 3&4

35
Q

Women with migraine w/aura, can take CHC

A

No
risk of stroke and MI

36
Q

What are the risk of use of CHCs

A
  1. VTE
  2. Stroke and MI (smoking, HTN, migraine with aura)
37
Q

Only method of contraception used in case pf ischemic heart disease

A

Cu IUD
(Not any hormones)

38
Q

Best contraception used with epilepsy AEDs

A

DMPA
(COC decreases the effect of lamotrigine)
(OET C3P decreases the effect of CHC)

39
Q

Do contraceptions cause depression

A

Not any contraception causes depression
(May be mood changes)

40
Q

In case of Endometriosis what is the best contraception to be.used?

A

All are safe
(cu ius increases dysmenorrhea)

41
Q

When to stop CHC or HRT prior to surgeries

A

4 weeks

42
Q

BMI>35 is it safe to use CHC

A

Risks outweigh benefits - UKMEK 3

MRCOG - Part 2 (44 decks)

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