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obs and gynae > Contraception > Flashcards

Contraception Flashcards

1
Q

what are some risk factors associated with contraceptive methods

A

Breast cancer: avoid any hormonal contraception and go for the copper coil or barrier methods
Cervical or endometrial cancer: avoid the intrauterine system (i.e. Mirena coil)
Wilson’s disease: avoid the copper coil

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2
Q

what are specific risk factors that should make you avoid the combined contraceptive pill

A

uncontrolled BP
migrane with aura
H.VTE
35 or above with 15 ciggars
vascular disease or stroke
IHD
Liver cirrhosis or liver tumors
SLE
Major surgery (4 weeks avoid)

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3
Q

In older woman after last period how long is contraception required for age +/- 50.

A

contraception is required for 2 years in women under 50 and 1 year in women over 50

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4
Q

How long can the COCP be used
The progestogen injection

A

Up to age 50 and can treat perimenopausal symptoms. DEPO-PROVERA should be stopped before 50 years due to risk of osteoporosis

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5
Q

how long should women who are amenorroheic and taking progestogen only contraception should continue for until the stop (menopause)

A

FSH blood test results are above 30 IU/L on two tests taken six weeks apart (continue contraception for 1 more year)
55 years of age

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6
Q

When does fertility return after labour and if they using combined pills or P-OP what precautions need to be taken

A

21 days before fertility,
with COCP- use 7 days condoms
with P-OP use for 2 days

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7
Q

what is the choice of contraception for women under 20 years and what is not recommended

A

combined and progestogen-only pills are unaffected by younger age
-coils have high rate of expulsion
-Proj-only injection can reduce bone mineral density
-Proj-only implant is a good choice of long-acting reversible contraception

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8
Q

How long is lactation amenorrhea effective for

A

98% effective form of contraception for 6 months after birth but women must be fully breastfeeding and amenorrhoeic

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9
Q

after childbirth when should the COCP be used and when can the P-OP or implant be started

A

COCP shouldn’t be started before 6 weeks in women who are breastfeeding
P-OP safe to use any time after birth

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10
Q

what is the time frame for copper coil pr intrauterine system (mirena) used

A

A copper coil or intrauterine system (e.g. Mirena) can be inserted either within 48 hours of birth or more than 4 weeks after birth (UKMEC 1), but not inserted between 48 hours and 4 weeks of birth (UKMEC 3).

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11
Q

how does COCP prevent pregnancy in 3 ways

A

Preventing ovulation (this is the primary mechanism of action)
Progesterone thickens the cervical mucus
Progesterone inhibits proliferation of the endometrium, reducing the chance of successful implantation

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12
Q

what affect does oestrogen and progesterone have on the hypothalamus

A

Oestrogen and progesterone have a negative feedback effect on the hypothalamus and anterior pituitary, suppressing the release of GnRH, LH and FSH. Without the effects of LH and FSH, ovulation does not occur. Pregnancy cannot happen without ovulation.

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13
Q

why would there be ‘withdrawal bleeding’ when COCP in stopped.

A

The lining of the endometrium is maintained in a stable state while taking the combined pill. When the pill is stopped the lining of the uterus breaks down and sheds. This leads to a “withdrawal bleed“. This is not classed as a menstrual period as it is not part of the natural menstrual cycle. “Breakthrough bleeding” can occur with extended use without a pill-free period.

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14
Q

what are the two type pf COCP

A

Monophasic pills contain the same amount of hormone in each pill
Multiphasic pills contain varying amounts of hormone to match the normal cyclical hormonal changes more closely

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15
Q

what is the ‘everyday’ formulation and what type of pill is it

A

Everyday formulations (e.g. Microgynon 30 ED) are monophasic pills, but the pack contains seven inactive pills, making it easier for women to keep track by simply taking the pills in order every day.

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16
Q

Name some monophasic COCP

A

Microgynon contains ethinylestradiol and levonorgestrel
Loestrin contains ethinylestradiol and norethisterone
Cilest contains ethinylestradiol and norgestimate
Yasmin contains ethinylestradiol and drospirenone
Marvelon contains ethinylestradiol and desogestrel

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17
Q

What type of pill is good to reduce risk of VTE

A

Levonorgestrel and norethisterone (Microgynon or loestrin)

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18
Q

what is suitable for premenstrual syndrome

A

yasmin and COCP: Drospirenone
Drospirenone has anti-mineralocorticoid and anti-androgen activity, and may help with symptoms of bloating, water retention and mood changes. Continuous use of the pill, as opposed to cyclical use, may be more effective for premenstrual syndrome.

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19
Q

what is the regime for COCP

A

21 days on and 7 days off
63 days on (three packs) and 7 days off (“tricycling“)
Continuous use without a pill-free period

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20
Q

what are some side effects and risks

A

Unscheduled bleeding is common in the first three months and should then settle with time
Breast pain and tenderness
Mood changes and depression
Headaches
Hypertension
Venous thromboembolism (the risk is much lower for the pill than pregnancy)
Small increased risk of breast and cervical cancer, returning to normal ten years after stopping
Small increased risk of myocardial infarction and stroke

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21
Q

what are some benefits of COCP

A

Effective contraception
Rapid return of fertility after stopping
Improvement in premenstrual symptoms, menorrhagia (heavy periods) and dysmenorrhoea (painful periods)
Reduced risk of endometrial, ovarian and colon cancer
Reduced risk of benign ovarian cysts

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22
Q

give some contraindications for COCP

A

It is worth noting that a BMI above 35 is UKMEC 3 for the combined pill (risks generally outweigh the benefits).
Uncontrolled hypertension
Migraine with aura (risk of stroke)
History of VTE
Aged over 35 and smoking more than 15 cigarettes per day
Major surgery with prolonged immobility
Vascular disease or stroke
Ischaemic heart disease, cardiomyopathy or atrial fibrillation
Liver cirrhosis and liver tumours
Systemic lupus erythematosus (SLE) and antiphospholipid syndrome

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23
Q

when do you start the COCP.

A

Start first day of the cycle.
if you start after 5 days of the cycle then additional protection might be needed for the first 7 days but up to 5 days safe.

24
Q

what type of COCP requires no additional contraception

A

Destrogel you can switch immediately as desogestrel inhibits ovulation

25
Q

when you switch from POP to COCP what additional measures should be taken

A

When switching from a traditional progesterone-only pill (POP), they can switch at any time but 7 days of extra contraception (i.e. condoms) is required.

26
Q

what is the theoretical theory of starting COCP

A

you will be protected if you take the pill in a cycle of 7 days on and 7 days off

27
Q

What does missing one pills mean

A

Missing one pill is when the pill is more than 24 hours late (48 hours since the last pill was taken).

28
Q

what is management for Missing one pill (less than 72 hours since the last pill was taken):

A

If is less than 72 hours then take the dose even if it means taking 2 pills for the 2 days you missed so that is the missed and the scheduled one.
Protection: no protection required if this is the only pill missed.

29
Q

what happens if you miss more than one pill (more than 72 hours).

A
  1. Take the most recent pill alongside scheduled pill
  2. use additional contraception- condoms for the next 7 days
  3. consider emergency contraception if you missed pill in the first week of the cycle and had unprotected sex
    4.In week 2 or 3 emergency contraception is not required but follow up protection for next 7 days
30
Q

what medication but also symptoms should be considered when you are on COCP

A

Rifampicin: Additional contraception may be required
Diarrhoea and vomiting: reduces absorption rate

31
Q

what are contraindications for COIL

A

Contraindication

PID or immunosupression

Pregnancy

Unexplained bleeding

Pelvic cancer

Fibroids

32
Q

What is the choice of treatment for UPSI

A

Coil can be put immediately or up to 5 days after ovulation.
Levonogestrel: is progesterone only and it will delay ovulation and can be taken up to 72 hours- protection needed for. 7 days.

Ellone- ulipristal: up to 120 hours and protection needed for 5 days

If NV happens within 3 hours of taking the. Repeat dosing.

33
Q

Which type of contraception needs to be stopped after 50 and what is the reason for this

A

Some COCP needs to be stopped and progesterone depo injection as it can cause osterperosis.

34
Q

What type of contraception is beneficial if you have high risk of VTE or not advised in obesity or breast cancer risk

A

Levonongestrel or norethisterone - microgynon and leostrin

COCP

35
Q

What type of contraception is beneficial if you have high risk of VTE or not advised in obesity or breast cancer risk

A

Levonongestrel or norethisterone - microgynon and leostrin

COCP

36
Q

Which type of contraception is prone or active for breast cancer

A

Estrogen ans progesterone combined such as COCP or progesterone only

37
Q

Name the types which requires protection for 7 days before having UPSI if not started within 5 days

A

IUS, Nexplanon, COCP, DEPO
So if you start within 5 days the COCP and progesterone only works immediately however if started after 5th day then 72 hours required for COCp and 48 hours required for progesterone only

38
Q

If you have a young woman under 20s that is sexually active with Mennegorrhia what is the choice of contraception if there is no contraindications such as VtE obesity and what would be given if there are risks.

A

IUS
; merinea coil is the first line.
However if they are under 20s then mirena isn’t given and. COCP or POP is given if there is no contraindications such as obesity vte or smoking.

39
Q

If you are sexually inactive and is young what medication is given for menerroghea

A

iUS first line And also tranexamic acid
And for dysmenorrhea give mefanic acid.

40
Q

What type of infection associated with fishy vaginal discharge? Can you give some risk factors?

A

Bacterial vaginosis and a risk factors are multiple sexual partners recent antibiotics smoking copper coil and excessive vaginal cleaning

41
Q

What type of infection associated with fishy vaginal discharge? Can you give some risk factors?

A

Bacterial vaginosis and a risk factors are multiple sexual partners recent antibiotics smoking copper coil and excessive vaginal cleaning

42
Q

What is the main cause of bacterial vaginosis and what is the investigation and investigation findings?

A

It’s to do with the loss of lactose villi which is friendly bacteria that helps to leave the pH as acidic. The loss of the bacteria caused the vagina to be an anaerobic and alkaline the main common cause.
Investigations shows ‘Clue Cells’

43
Q

What is the choice of management for asymptomatic and symptomatic bacterial vaginosis.

A

If it’s asymptomatic then no requirement for treatment however if they are symptomatic, then stop them on metronidazole which is specifically targeting anaerobic bacteria and Clinda in as an alternative

44
Q

Why is progesterone given for mennogorrhea

A

So the there will be too much of the oestrogen which causes the thickening of the endometrium and so the progesterone would balance the thickening and thin the lining so that there is less shedding and therefore less bleeding

45
Q

What are the common cause for candidiasis

A

Increased oestrogen, higher in pregnancy, low pre- puberty and post menopausal
Poorly controlled diabetes
Immuniosupression with corticosteroids
Broad spectrum abx

46
Q

What is the presentation for candidasis

A

Thick white discharge
Vulvak ans vaginal itching, irritation or discomfort

47
Q

What is the choice of investigation for candidiasis

A

Test vaginal PH: exclude BV or trichomonas but they > PH and candidiasis have PH< 4.5

48
Q

What is the management option for thrush

A

Anti-fungal cream or pessary: clotrimazole
Oral antifungal tablets: flucanazole

Canesten duo: over the counter treatment. Contains single flucanazole tablet and clotrimazole cream.

49
Q

What are the two type of swabs involved in sexual health testing

A

-Charcoal swabs
- Nucleic acid amplification testt NAAT

50
Q

What test does NAAT test for

A

Chlamydia and gonorrhea and not useful for pelvic infections.

51
Q

What is chlamydia trachomatis

A

Gram negative bacteria.

52
Q

What is chlamydia trachomatis

A

Gram negative bacteria.

53
Q

What are the symptoms of chlamydia in women and in men

A

-abnormal vaginal discharge
-pelvic pain
- abnormal vaginosis bleeding
-dyspareunia
-dysuria

-urethral discharge or discomfort
-painful urination
-epidemics-orchid is
-reactive arthiritis

54
Q

What are the examination findings for chlamydia

A

Pelvic or abdominal tenderness
Cervical excitation
Inflamed cervix
Ourulent discharge

55
Q
A

obs and gynae (3 decks)

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