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afsha Pre- Reg > Contraception > Flashcards

Contraception Flashcards

1
Q

What are the advantages of combined hormonal contraceptives?

A

Reliability and Reversibility: Effective contraception that can be discontinued when pregnancy is desired.

Reduced Dysmenorrhea and Menorrhagia: Alleviates painful periods and heavy menstrual bleeding.

Decreased Premenstrual Tension: Reduces symptoms associated with premenstrual syndrome (PMS).

Risk Reduction:
Lowers the risk of:

  • Symptomatic fibroids
  • Functional ovarian cysts
  • Benign breast disease
  • Ovarian and endometrial cancer
    Lower Risk of Pelvic Inflammatory Disease: Provides protective effects against infections in the reproductive tract.
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2
Q

How is the choice of combined hormonal contraceptive determined?

A

selecting a preparation with the lowest estrogen and progestogen content

that provides good cycle control

and minimal side effects.

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3
Q

Is it recommended to continue combined hormonal contraceptives beyond the age of 50?

A

No

more suitable alternatives exist at that age

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4
Q

What types of combined hormonal contraceptive preparations are suitable for women with risk factors for circulatory disease?

A

Low-strength preparations (20mcg ethinylestradiol, not 30-35)

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5
Q

What is a risk of standard- strength preparations of hormonal contraceptives?

A

deep vein thrombosis (DVT)

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6
Q

Which progestogens may be considered for women experiencing side effects with other progestogens?

A

Desogestrel, drospirenone, and gestodene (in combination with ethinylestradiol)
may be considered for women experiencing side effects such as acne, headache, depression, breast symptoms, and breakthrough bleeding with other progestogens.

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7
Q

What symptoms or conditions warrant the immediate cessation of combined hormonal contraceptives or hormone replacement therapy (HRT)?

A
  • sudden severe chest pain
  • sudden breathlessness
  • cough with blood
  • unexplained swelling or severe pain in one leg
  • severe stomach pain
  • serious neurological effects
  • hepatitis
  • jaundice
  • liver enlargement
  • blood pressure above systolic 160 mmHg or diastolic 95 mmHg
  • prolonged immobility after surgery or leg injury
  • or detection of a risk factor that contraindicates treatment.
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8
Q

What neurological symptoms should prompt the immediate discontinuation of combined hormonal contraceptives or HRT?

A
  • severe, prolonged headache
  • sudden partial or complete loss of vision
  • sudden disturbance of hearing
  • bad fainting attack
  • unexplained epileptic seizure or weakness
  • motor disturbances
  • very marked numbness suddenly affecting one side or one part of the body
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9
Q

What precaution should be taken for individuals traveling for long periods while using combined hormonal contraceptives?

A

Increased risk of deep-vein thrombosis during travel involving long periods of immobility (over 3 hours)

may be reduced by appropriate exercise and possibly by wearing graduated compression hosiery

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10
Q

What factors should be considered when assessing the risk of venous thromboembolism with combined hormonal contraceptives?

A
  • family history of venous thromboembolism in a first-degree relative aged under 45 years
  • history of superficial thrombophlebitis
  • obesity (avoid if BMI ≥ 35 kg)
  • long-term immobilization (avoid if bed-bound)
  • age over 35 years (avoid if over 50 years)
  • smoking

They should be used with caution if any of the mentioned factors are present, but they should be avoided if two or more factors are present

Superficial thrombophlebitis is an inflammation of a vein just below the surface of the skin, which results from a blood clot.

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11
Q

What factors should be considered when assessing the risk of arterial disease with combined hormonal contraceptives?

A
  • a family history of arterial disease in a first-degree relative aged under 45 years
  • diabetes mellitus (avoid if diabetes complications present)
  • hypertension (avoid if blood pressure above systolic 160 mmHg or diastolic 95 mmHg)
  • smoking (avoid if smoking 40 or more cigarettes daily)
  • age over 35 years (avoid if over 50 years)
  • obesity (avoid if BMI ≥ 35 kg),
  • migraine without aura (avoid if migraine with aura).
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12
Q

What is the association between combined hormonal contraceptives and breast cancer?

A

There is a small increase in the risk of benign breast cancer in women taking the combined pill.

However, the risk diminishes after stopping

and disappears by about 10 years.

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13
Q

How does long-term use of combined hormonal contraceptives relate to cervical cancer risk?

A

Use for 5 years or longer is associated with a small increased risk of cervical cancer

however, the risk diminishes after stopping

and disappears by about 10 years.

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14
Q

When is a pill considered missed, and what should be done if only one pill is missed?

A

A missed pill is one that is 24 or more hours late.

If only one pill is missed, the woman should take an active pill as soon as she remembers and then resume normal pill-taking, even if this means taking 2 pills together.

No additional precautions are necessary.

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15
Q

What should be done if two or more pills are missed, especially from the first 7 in a packet?

A

If two or more pills are missed, especially from the first 7 in a packet, the woman may not be protected.

She should take an active pill as soon as she remembers and then resume normal pill-taking.

Additionally, she must either abstain from sex or use an additional method of contraception such as a condom for the next 7 days.

If these 7 days run beyond the end of the packet, the next packet should be started at once, omitting the pill-free interval.

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16
Q

What is recommended if 2 or more combined oral contraceptive tablets are missed from the first 7 tablets in a packet and unprotected intercourse has occurred?

A

Emergency contraception is recommended in this scenario.

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17
Q

What action should be taken if vomiting occurs within 2 hours of taking a combined oral contraceptive pill?

A

Another pill should be taken as soon as possible.

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18
Q

When should additional contraception be used if vomiting or severe diarrhea persists?

A

If vomiting or severe diarrhea lasts for more than 24 hours, additional contraception should be used during and for 7 days after recovery.

19
Q

What should be done if vomiting and diarrhea occur during the last 7 tablets of the pill pack?

A

: If vomiting and diarrhea occur during the last 7 tablets, the next pill-free interval should be omitted.

20
Q

When are progestogen-only contraceptives considered suitable alternatives to combined hormonal contraceptives?

A

when estrogens are contraindicated, such as in individuals with:

  • venous thrombosis or a past history of it
  • heavy smokers (>40 a day)
  • hypertension above systolic 160 mmHg or diastolic 95 mmHg
  • valvular heart disease
  • diabetes mellitus with complications
  • migraine with aura
21
Q

What are the two types of hormonal emergency contraceptives mentioned?

A

levonorgestrel and ulipristal

22
Q

Within what time frame is levonorgestrel effective if taken after unprotected intercourse?

A

if taken within 72 hours (3 days) of unprotected intercourse.

23
Q

Within what time frame is ulipristal effective if taken after unprotected intercourse?

A

within 120 hours (5 days) of unprotected intercourse.

24
Q

Within how many hours after unprotected sex can an intra-uterine device (IUD) be inserted?

A

It can be inserted up to 120 hours (5 days) after unprotected sex.

25
Q

What should be done if intercourse has occurred more than 5 days previously? Can an intra-uterine device (IUD) still be inserted?

A

If intercourse has occurred more than 5 days previously, the device can still be inserted up to 5 days after the earliest likely calculated ovulation.

26
Q

What factors increase the risk of infection after IUD insertion?

A
  • women under 25 years old
  • over 25 years old with a new partner
  • have had more than one partner in the past year
  • if their regular partner has other partners

Risk of infection occurs in the first 20 days after insertion and is believed to be related to existing carriage of a sexually transmitted infection.

27
Q

What symptoms may indicate uterine perforation after IUD insertion? (4)

A

Symptoms such as

  • severe pelvic pain
  • increased bleeding
  • period changes
  • pain during intercourse

may require medical attention

28
Q

What does COCs stand for?

A

Combined Oral Contraceptives

29
Q

What are monophasic COCs?

A

Combined Oral Contraceptives

that contain a fixed amount of estrogen and progestogen in each active tablet

30
Q

What are phasic COCs?

A

Combined Oral Contraceptives (COCs)

contain varying amounts of estrogen and progestogen

31
Q

What can reduce the effectiveness of COCs?

A

if they are if taken with enzyme inducers

such as carbamazepine, phenytoin, phenobarbital, ritonavir, St. John’s wort, and rifampicin.

32
Q

When should patients take progestogen-only contraceptives or intrauterine devices instead of COCs? (2)

A
  • if they are taking enzyme inducers
  • if experiencing vomiting and diarrhea
33
Q

What makes progestogen-only pills (POP) more suitable for patients with a history of venous thromboembolism (VTE)?

A

do not interact with enzyme inducers

making them more suitable for patients with a history of VTE.

34
Q

What is the most effective form of emergency contraception?

A

The insertion of a copper intrauterine device (IUD)

35
Q

How long after unprotected sexual intercourse (UPSI) can a copper IUD be inserted?

A

up to 5 days after UPSI.

36
Q

What factors may reduce the effectiveness of oral emergency contraception, particularly Levonorgestrel?

A

A higher body weight or BMI
(especially if BMI is greater than 26 kg/m² or body weight is greater than 70 kg)

it is recommended that either ulipristal or a double dose of levonorgestrel (unlicensed) is given.

37
Q

When should Levonelle not be taken? (4)

A
  • already taken emergency contraception once before in that cycle )(small chance it was unsuccessful and pt is pregnant)
  • if the woman’s period is overdue
  • if they have severe hepatic dysfunction
  • if they have severe acute porphyria ( abnormal metabolism of the blood pigment haemoglobin.)
38
Q

What should women do after taking emergency contraception, and what symptoms should they watch for?

A

Women should use condoms until their next period

and seek medical attention if they experience lower abdominal pain (could indicate ectopic pregnancy) or if their next period is unusually light, heavy, or missing

39
Q

What may be necessary if a patient is taking enzyme- inducing drugs and needs to take emergency contraceptive pills? what risk does this increase

A

A double dose (3 mg) of Levonelle can be given (unlicensed) if necessary

but this may increase the chances of nausea and unusual bleeding.

40
Q

What are some drawbacks of progestogen-only pills (POP)?

A

require more strict dosing times

and do not provide protection if missed by just 3 hours.

41
Q

Pt switching from POP to COC

A

Addition precautions for 7 days until it becomes effective

42
Q

EHC can be used more than once in the same cycle, but how many days between?

A

If levonorgestrel has been used first, ulipristal acetate should be
avoided for the next 7 days, and if ulipristal acetate has been used first, levonorgestrel should
be avoided for the next 5 days.

43
Q

Patient has had UPSI 2 days ago. They are breastfeeding. Which EHC is suitable?

A

Levonorgestrel is safe to take while breastfeeding, and there is no need to delay
breastfeeding. The patient can resume breastfeeding immediately after taking the
medication.

Ulipristal: Avoid for 7days

afsha Pre- Reg (24 decks)

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