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GP > Contraception > Flashcards

Contraception Flashcards

1
Q

What are some methods of contraception?

A

Natural family planning (“rhythm method”)
Barrier methods (i.e. condoms)
Combined contraceptive pills
Progestogen-only pills
Coils (i.e. copper coil or Mirena)
Progestogen injection
Progestogen implant
Surgery (i.e. sterilisation or vasectomy)

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2
Q

What is the UKMEC?

A

UK Medical Eligibility Criteria

to categorise the risks of starting different methods of contraception in different individuals

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3
Q

What are the levels of UKMEC?

A

UKMEC 1: No restriction in use (minimal risk)
UKMEC 2: Benefits generally outweigh the risks
UKMEC 3: Risks generally outweigh the benefits
UKMEC 4: Unacceptable risk (typically this means the method is contraindicated)

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4
Q

What contraception should be avoided if there’s a risk factor of breast cancer?

A

Hormonal contraceptives

Copper coil or barrier methods should be used instead

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5
Q

What contraception should be avoided if cervical or endometrial cancer is a risk factor?

A

Intrauterine system e.g. Mirena coil

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6
Q

What contraception should be avoided if patient has Wilson’s disease?

A

Copper coil

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7
Q

What are some specific risk factors that makes you avoid combined contraceptive pill?

A

-Uncontrolled hypertension (particularly ≥160 / ≥100)
-Migraine with aura
-History of VTE
-Aged over 35 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 and antiphospholipid syndrome

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8
Q

How long is contraception still required after a woman’s last period due to menopause?

A

2yrs if under 50
1yr over 50

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9
Q

What contraception advice should be given to perimenopausal women starting HRT

A

HRT does not prevent pregnancy

Added contraception is required

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10
Q

What age should the progesterone injection be stopped and why?

A

Before 50yrs due to osteoporosis risk

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11
Q

What contraceptive can be used to treat perimenopausal symptoms?

A

Combined contraceptive pill

Up to 50yrs

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12
Q

When does fertility return after childbirth?

A

21days after

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13
Q

What is lactational amenorrhea?

A

Women who are fully breastfeeding become amenorrhoeic
Effective contraception for up to 6 months

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14
Q

What contraceptions are safe and what should be avoided in breastfeeding?

A

Progesterone only pill and implant are safe

Combined contraceptive pill should be avoided

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15
Q

What is the mechanism of action for the combined oral contraceptive pill?

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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16
Q

What hormones does the COCP contain?

A

Oestrogen
Progesterone

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17
Q

How does the COCP prevent ovulation?

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.

18
Q

What are the two types of 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

19
Q

What are some examples on 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

20
Q

What are some side effects of COCP?

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

21
Q

What are the 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

22
Q

What are the missed pill rules for COCP?

A

Missing one pill (less than 72 hours since the last pill was taken):

-Take the missed pill as soon as possible (even if this means taking two pills on the same day)
-No extra protection is required provided other pills before and after are taken correctly

Missing more than one pill (more than 72 hours since the last pill was taken):

-Take the most recent missed pill as soon as possible (even if this means taking two pills on the same day)
-Additional contraception (i.e. condoms) is needed until they have taken the pill regularly for 7 days straight
-If day 1 – 7 of the packet they need emergency contraception if they have had unprotected sex
-If day 8 – 14 of the pack (and day 1 – 7 was fully compliant) then no emergency contraception is required
-If day 15 – 21 of the pack (and day 1 – 14 was fully compliant) then no emergency contraception is needed. They should go back-to-back with their next pack of pills and skip the pill-free period.

23
Q

What is the mechanism of action for the traditional progesterone only pill?

A

-Thickening the cervical mucus
-Altering the endometrium and making it less accepting of implantation
-Reducing ciliary action in the fallopian tubes

24
Q

What’s the mechanism of action for the Desogestrel only pill?

A

-Inhibiting ovulation
-Thickening the cervical mucus
-Altering the endometrium
-Reducing ciliary action in the fallopian tubes

25
Q

What are some Sid’s effects of the POP?

A

Changes to bleeding schedule:
-20% have no bleeding (amenorrhoea)
-40% have regular bleeding
-40% have irregular, prolonged or troublesome bleeding

Breast tenderness

Headaches

Acne

26
Q

What is there an increased risk of when taking POP?

A

-Ovarian cysts
-Small risk of ectopic pregnancy with traditional POPs (not desogestrel) due to reduce ciliary action in the tubes
-Minimal increased risk of breast cancer, returning to normal ten years after stopping

27
Q

What are the missed pill rules for POP?

A

-take a pill as soon as possible
-continue with the next pill at the usual time (even if this means taking two in 24 hours)
-use extra contraception for the next 48 hours of regular use

28
Q

What is the progesterone only injection also known as?

A

depot medroxyprogesterone acetate (DMPA)

29
Q

What’s a contraindication for starting POP?

A

Breast cancer

30
Q

How is the progesterone only injection given, and how frequently?

A

intramuscular or subcutaneous injection
12-13wk intervals

31
Q

What are the two versions of the progesterone only injection given in UK?

A

Depo-Provera: given by intramuscular injection

Sayana Press: a subcutaneous injection device that can be self-injected by the patient

32
Q

What are some contraindications for progesterone only injection?

A

Active breast cancer
Ischaemic heart disease and stroke
Unexplained vaginal bleeding
Severe liver cirrhosis
Liver cancer

33
Q

Whats the mechanism of the progesterone only injection?

A

-inhibit ovulation by inhibiting FSH secretion
-Thickening cervical mucus
-Altering the endometrium and making it less accepting of implantation

34
Q

What are some side effects of the progesterone only injection?

A

-Changes in bleeding schedule
-Weight gain
-Acne
-Reduced libido
-Mood changes
-Headaches
-Flushes
-Hair loss (alopecia)
-Skin reactions at injection sites
-Osteoporosis
-Small increased risk of breast and cervical cancer

35
Q

What can be done to help problematic bleeding when taking the progesterone only injection?

A

taking the combined oral contraceptive pill (COCP) in addition to the injection for three months
OR
short course (5 days) of mefenamic acid to halt the bleeding.

36
Q

What are some benefits of the progesterone only injection?

A

-Improves dysmenorrhoea (painful periods)
-Improves endometriosis-related symptoms
-Reduces the risk of ovarian and endometrial cancer
-Reduces the severity of sickle cell crisis in patients with sickle cell anaemia

37
Q

When should progesterone only injection be started?

A

Day 1-5 of cycle gives immediate protection

After day 5, 7 days of extra contraception required

38
Q

When should POP be started?

A

Day 1-5 of cycle gives immediate protection.
If started at other time, 48hrs of additional contraception required

39
Q

What if the progesterone only implant?

A

a small (4cm) flexible plastic rod that is placed in the upper arm, beneath the skin and above the subcutaneous fat. It slowly releases progestogen into the systemic circulation

40
Q

How long does the progesterone only implant last for before it needs replacing?

A

3 years

41
Q

What’s a contraindication of the progesterone only implant?

A

Active breast cancer

42
Q

What does the progesterone only implant contain?

A

Nexplanon is the implant used in the UK. It contains 68mg of etonogestrel

GP (8 decks)

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