Contraception Flashcards
1
Q
How long until IUD effective?
A
Instant
2
Q
How long until POP effective?
A
2 days
3
Q
How long until COCP effective?
A
7 days
4
Q
How long until implant effective?
A
7 days
5
Q
How long until injection effective?
A
7 days
6
Q
How long until IUS effective?
A
7 days
7
Q
How effective is COCP if taken correctly?
A
99%
8
Q
Risks of COCP?
A
- Blood clots
- Heart attacks and strokes
- Breast cancer and cervical cancer
9
Q
Advice on taking COCP?
A
- If started within first 5 days of cycle then no need for additional contraception. If started at any other point, use condom for 7 days
- Should be taken at same time everyday
- Usually taken for 21 days and stopped for 7 days. However tailored regimes also possible. Options = pill-free interval or tricycling (3x21 packs back to back to back before having a 4 or 7 day break)
- Intercourse during pill-free period only safe if next pack started on time
10
Q
When may COCP be less effective?
A
- Vomiting within 2h of taking COCP
- Medications that induce diarrhoea or vomiting e.g. orlistat
- Taking liver-enzyme induce drugs
11
Q
What drug do condoms need to be used with whilst on COCP?
A
Rifampicin (enzyme inducing)
12
Q
3 methods of emergency contraception?
A
- Levonorgestrel
- Ulipristal
- IUD
13
Q
Levonorgestrel MOA?
A
Not fully understood, stops ovulation and inhibits implantation
14
Q
When should levonorgestrel be taken?
A
Within 72h of UPSI
15
Q
Levonorgestrel dose?
A
1.5mg (should be doubled if BMI >26 or weight over 70kg)
16
Q
Levonorgestrel mushkies?
A
- 84% effective if used within 72h of UPSI
- Disturbance of menstrual cycle seen in a minority, vomiting occurs in 1%
- If vomiting occurs within 3h, dose should be repeated
- Can be used more than once in a menstrual cycle if clinically indicated
- Hormonal contraception can be started immediately after
17
Q
Levonorgestrel brand name?
A
Levonelle
18
Q
Ulipristal MOA?
A
Selective progesterone receptor modulator –> inhibits ovulation
19
Q
Ulipristal brand name?
A
EllaOne
20
Q
Ulipristal when to take and dose?
A
30mg ASAP, no later than 120h after intercourse
21
Q
Ulipristal mushkies?
A
- May reduce the effectiveness of hormonal contraception. Contraception with the pill, patch or ring should be started, or restarted, 5 days after having ulipristal. Barrier methods should be used during this period
- Caution exercised in pts with severe asthma
- Can be used more than once in the same cycle
- Breastfeeding should be delayed for one week after taking ulipristal
22
Q
Most effective method of emergency contraception?
A
Copper IUD
23
Q
Emergency IUD mushkies?
A
- Within 5d of UPSI, if presents after more than 5d than may be fitted up to 5 days after the likely ovulation date
- May inhibit fertilisation or implantation
- Prophylactic Abx may be given if the pt is considered to be at high risk of STI
- 99% effective regardless of where it is used in the cycle
- May be left in-situ to provide long-term contraception, if pt wants IUD to be removed should be kept in until the next period
24
Q
COCP contraindication guide name?
A
UKMEC
25
UKMEC Classes?
1. No restriction
2. Advantages generally outweigh disadvantages
3. Disadvantages generally outweigh advantages
4. Unacceptable health risk
26
UKMEC 3 conditions?
1. >35 y/o and smoking <15 a day
2. BMI >35
3. FHx in 1st degree relatives < 45 y/o
4. Controlled HTN
5. Immobility e.g. wheelchair use
6. BRCA1/BRCA2 or known mutations associated with breast cancer
7. Current gallbladder disease
27
UKMEC 4 conditions?
1. > 35 y/o and smoking >15 cigarettes/day
2. Migraine with aura
3. History of thromboembolic disease or thrombogenic mutation
4. Hx of stroke or IHD
5. Breastfeeding <6 weeks postpartum
6. Uncontrolled HTN
7. Current breast cancer
8. Major surgery with prolonged immobilisation
9. Positive antiphospholipid antibodies e.g. in SLE
28
DM diagnosed >20 y/o UK MEC class?
3 or 4 depending on severity
29
Breastfeeding 6 weeks - 6 months postpartum UK MEC?
2
30
Switching COCP mushkies?
Miss pill free interval if progestogen changes according to BNF, but some say no need
31
When do women require contraception from after giving birth?
21 days after
32
Postpartum and POP?
1. Can start POP anytime postpartum
2. After day 21 additional contraception should be used for first 2 days
3. Small amount of progestogen enters breast milk but this is not harmful to the infant
33
Postpartum and COCP?
1. UKMEC 2 6 weeks-6 months postpartum
2. COCP may reduce breast milk production in lactating mothers
3. Should not be used in first 21d due to VTE risk
4. After Day 21, additional contraception should be used for the first 7 days
34
When can IUD/IUS be inserted after childbirth?
Within 48h or after 4 weeks
35
LAM?
Lactational amenorrhoea method = 98% effective providing woman is fully breastfeeding, amenorrhoeic, and <6m post-partum
36
Inter-pregnancy interval of <12m between childbirth and conceiving again associated with?
Increased risk of preterm birth, LBW, and SGA babies
37
POP advantages?
1. Highly effective = failure rate of 1 per 100 woman years
2. Doesnt interfere with sex, can be used whilst breastfeeding
3. Contraceptive effects reversible upon stopping
4. Can be used when COCP C/I
38
POP disadvantages?
1. Irregular periods
2. Increased incidence of functional ovarian cysts
3. Common s/e include breast tenderness, weight gain, acne and headaches. Usually subside within the first few months
39
When is copper coil C/I?
Active STI or pelvic inflammatory disease
40
COCP increased risk of which cancers?
Breast and cervical
41
COCP protective against which cancers?
Ovarian, endometrial and colorectal cancer
42
COCP advantages?
1. Highly effective (failure rate <1 per 100 woman years)
2. Usually makes periods regular, lighter, less painful
3. Reduced risk of ovarian and endometrial cancer (effect may last for several decades after cessation)
4. May protect against PID
5. May reduce ovarian cysts, benign breast disease, acne
43
COCP disadvantages?
1. Increased risk of VTE
2. Increased risk of breast and cervical cancer
3. Increased risk of stroke and IHD esp. in smokers
4. Temporary s/e of headache, nausea, breast tenderness may be seen
44
Weight gain whilst taking COCP?
Cochrane review did not support a causal relationship
45
POP AKA?
Mini-pill
46
Most common POP s/e?
Irregular vaginal bleeding
47
Starting the POP advice?
1. If commenced up to and including day 5 of the cycle it provides immediate protection, otherwise additional contraceptive methods (e.g. condoms) should be used for the first 2 days
2. If switching from a COCP gives immediate protection if continued directly from the end of a pill packet
48
Taking the POP?
Same time every day without a pill-free break
49
Missed POP pills advice?
1. <3 hours late = continue as normal
2. >3 hours late = take missed ASAP, continue with rest of pack, condoms until pill taking re-established for 48 hours
50
What POP provides 12h window rather than 3h window?
Cerazette (desogestrel)
51
Depo provera mushkies?
1. Medroxyprogesterone acetate 150mg
2. IM Injection every 12w (can be given up to 14 w after last dose without need for extra precautions)
52
Depo provera MOA?
Inhibiting ovulation (secondary effects include cervical mucus thickening and endometrial thinning)
53
Depo provera s/e?
1. Potential delayed return to fertility (up to 12m)
2. Irregular bleeding, weight gain
3. May increase risk of osteoporosis
54
Depo provera C/I?
Breast cancer (current UKMEC4, past UKMEC3)
55
How often is depo provera given?
Every 12w
56
IUD MOA?
Decreased sperm motility and survival as an effect of copper ions
57
IUS MOA?
Levonorgestrel prevents endometrial proliferation and causes cervical mucous thickening
58
IUD counselling?
1. Immediately effective after insertion
2. Copper on stem 5y, Copper on stem and arms 10y
59
IUS counselling?
1. Can be relied upon after 7d
2. Mirena levonorgestrel 20mcg/24h effective for 5y
3. If used as endometrial protection for women taking oestrogen-only hormone replacement therapy are only licensed for 4y
60
IUD and IUS potential problems?
1. IUDs make periods heavier, longer and more painful
2. Uterine perforation 2/1000 and higher in breastfeeding women
3. Proportion of ectopics increased but absolute number decreased
4. Infection = small PID risk 20d after insertion
5. Expulsion = 1/20, most likely to occur in first 3m
61
New IUS systems?
1. Jaydess® IUS is licensed for 3 years. It has a smaller frame, narrower inserter tube and less levonorgestrel (LNG) than the Mirena® coil (13.5 mg compared to 52 mg). This results in lower serum levels of LNG
2. Kyleena® IUS has 19.5mg LNG and is also smaller than the Mirena® but is licensed for 5 years. It also results in lower serum levels of LNG. The rate of amenorrhoea is less with Kyleena® compared to Mirena®
62
Absolutely no contraindication for migraine with aura?
Copper IUD
63
CYP450 inducers or inhibitors reduce COCP efficacy?
Inducers
64
POP MOA?
Thickens cervical mucus
65
Desogestrel only pill MOA?
Inhibits ovulation
66
Implantable contraceptive (etonogestrel) MOA?
Inhibits ovulation
67
IUS MOA?
Prevents endometrial proliferation
68
Levonorgestrel and Ulipristal MOA?
Inhibits ovulation
69
Implantable contraceptive name?
Nexplanon (Implanon was old one)
70
Nexplanon insertion and MOA?
1. Proximal non-dominant arm, just overlying tricep
2. Main MOA prevents ovulation, also thickens cervical mucus
71
Nexplanon mushkies?
1. Most effective form of contraception, failure rate 0.07/100 woman years
2. Long-acting = lasts 3 years
3. Doesnt contain oestrogen so can be used if Hx of VTE, migraine etc.
4. Can be inserted immediately post ToP
72
Nexplanon disadvantages?
1. Need for a trained professional to insert and remove device
2. Initial contraception methods are needed for the first 7 days if not inserted on day 1 to 5 of a woman's menstrual cycle
73
Nexplanon s/e?
1. Irregular/heavy bleeding (sometimes managed using co-prescription of COCP, perform speculum exam/STI check if bleeding continues)
2. Progestogen effects = headache, nausea, breast pain
74
Nexplanon interactions?
1. Enzyme-inducing drugs such as certain antiepileptic and rifampicin may reduce the efficacy of Nexplanon
2. Switch to a method unaffected by enzyme-inducing drugs or to use additional contraception until 28 days after stopping the treatment
75
Nexplanon UKMEC 3?
1. IHD/Stroke (for continuation, if initiation then UKMEC 2)
2. Unexplained suspicious vaginal bleeding
3. Past breast cancer
4. Severe liver cirrhosis
5. Liver cancer
76
Nexplanon UKMEC 4?
Current breast cancer
77
2nd generation POP pills?
1. Norethisterone
2. Levonorgestrel
3. Ethynodiol diacetate
78
3rd generation POP?
1. Desogestrel = Cerazette
2. Inhibits ovulation in majority of women
3. Users can take the pill up to 12h late rather than 3h like other POPs
79
Contraceptives time until effective?
1. Instant = IUD
2. 2 days = POP
3. 7 days = COCP, injection, implant, IUS
80
COCP 1 missed pill at any time in the cycle?
1. Take last pill even if it means taking 2 pills in one day and then continue taking pills daily, one each day
2. No additional contraceptive protection required
81
COCP 2 or more pills missed?
1. Take last pill, leave any earlier missed pills, continue taking pills OD
2. Condoms/abstain until taken pills for 7d in a row
2. If pills missed in Days 1-7 = emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1
2. If pills missed days 8-14 = after seven consecutive days of taking the COC there is no need for emergency contraception
3. If pills missed days 15-21 = she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval
82
Theoretically women would be protected if they took the COC in a pattern of?
7 days on, 7 days off
83
Classification of methods of contraception?
1. Barrier = condom
2. Daily = COCP, POP
3. LARCs = Implantable, injectable, IUS, IUD
84
LARC?
Long acting method of reversible contraception (LARCs)
85
Nexplanon drug?
Etonogestrel
86
Contraceptive unaffected by enzyme inducing drugs (EIDs)?
1. Copper IUD
2. Mirena IUS
3. Depo-provera
87
Depo-provera weight gain?
2-3kg over 1 year
88
UKMECs for pts taking enzyme inducing antiepileptics (basically all of them)?
1. UKMEC 1 = IUD, IUS, Depo-provera
2. UKMEC 2 = Implant
3. UKMEC 3 = COCP and POP
89
UKMECs for lamotrigine?
1. UKMEC 1 = IUD, IUD, Depo-provera, Implant
2. UKMEC 3 = COCP
90
Combined contraceptive patch name
Evra
91
Combined contraceptive patch mushkies?
Patch cycle lasts 4 weeks, for the first 3 weeks the patch is worn everyday and needs to be changed each week, during the 4th week the patch is not worn and during this time there will be a withdrawal bleed
92
Combined contraceptive patch change delayed at the end of week 1 or week 2?
1. Delay <48h = changed immediately, no further precautions
2. Delay >48h = changed immediately, condom 7d, consider emergency contraception
93
Combined contraceptive patch change removal delayed at the end of week 3?
1. Patch removed ASAP and new patch applied on usual cycle start day for next cycle, even if withdrawal bleeding occurring, no additional contraception needed
94
Combined contraceptive patch application delayed at end of a patch-free week?
1. Condom for 7d
95
COCP > 40 y/o?
1. COCP in perimenopausal period may help to maintain BMD
2. COCP may help reduce menopausal symptoms
3. Pill containing <30mcg ethinyloestradiol may be more suitable for women > 40 y/o
96
Depo-provera > 40 y/o?
1. May be delay in fertility of up to 1 year
2. Use is associated with a small loss in BMD which is usually recovered after discontinuation
97
Stopping non-hormonal contraception (e.g. IUD, condoms, natural family planning)?
1. < 50 y/o = Stop contraception after 2y of amenorrhoea
2. > 50 y/o = Stop contraception after 1 year of amenorrhoea
98
Stopping COCP age mushkies?
1. < 50 y/o = Can be continued to 50 years
2. > 50 y/o = Switch to non-hormonal or progestogen-only method
99
Stopping depo-provera age mushkies?
1. < 50 y/o = can be continued to 50 years
2. Switch to either a non-hormonal method and stop after 2 years of amenorrhoea OR switch to a progestogen-only method and follow advice below
100
Implant, POP, IUS mushkies?
1. < 50 y/o = Can be continued beyond 50 years
2. > 50 y/o = Continue, if amenorrhoeic check FSH and stop after 1 year if FSH >30 or stop at 55 years. If not amenorrhoeic consider investigating abnormal bleeding pattern
101
HRT and contraception?
1. HRT cannot be relied upon for contraception
2. POP may be used in conjunction with HRT as long as HRT has a progestogen component (POP cannot be relied upon to protect the endometrium)
102
Children under 13 y/o contraception consultation?
Unable to consent to sex --> automatically trigger child protection measures
103
Fraser guidelines?
1. Understands
2. Cant be persuaded to tall parents
3. Likely to begin or continue sex
4. Physical and mental health will suffer unless they have contraception
5. Best interests
104
When to have STI check after UPSI?
2 and 12 weeks after
105
Young people choice of contraceptive?
LARC advantageous --> Nexplanon is LARC of choice (Depo-provera may have an effect on BMD)
106
Breast cancer pt contraception?
Copper IUD, all hormonal forms of contraception are Category 4
107
Which contraception is associated with weight gain?
Depo-Provera
108
Latex free condom?
Polyurethane condom
109
What should not be used with latex condoms?
Oil based condoms
