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1 - MSRA > Contraception > Flashcards

Contraception Flashcards

1
Q

Mechanism of action COCP

A

Inhibits ovulation

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2
Q

Mechanism of action progesterone only pill (excluding desogestrel)

A

Thickens cervical mucus

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3
Q

Mechanism of action desogestrel-only pill

A

Primary: inhibits ovulation
Also: thickens cervical mucus

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4
Q

Mechanism of action injectable contraceptive (medroxyprogesterone acetate)

A

Primary: inhibits ovulation
Also: thickens cervical mucus

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5
Q

Mechanism of action implantable contraceptive (etonogestrel)

A

Primary: inhibits ovulation
Also: thickens cervical mucus

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6
Q

Mechanism of action IUD

A

Decreases sperm motility and survivalMechanism of action

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7
Q

Mechanism of action IUS (levonorgestrel)

A

Primary: prevents endometrial proliferation
Also: thickens cervical mucus

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8
Q

Mechanism of action levonorgestrel as emergency contraception

A

Inhibits ovulation

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9
Q

Mechanism of action ulipristal as emergency contraception

A

Inhibits ovulation

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10
Q

Mechanism of action IUD as emergency contraception

A

Primary: toxic to sperm and ovum
Also: inhibits implantation

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11
Q

Alternative condoms in latex allergy

A

Polyurethane

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12
Q

When to wear/change combined contraceptive patch (Evra)

A

For first 3 weeks, patch worn every day and needs changing each week
During 4th week, patch not worn - withdrawal bleed

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13
Q

Action if Evra patch change delayed at end of week 1 or 2

A

If less than 48 hours, change immediately and no further action
If greater than 48 hours, change immediate and barrier contraception for 7 days. If UPSI in last 5 days, emergency contraception

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14
Q

Action if Evra patch change delayed at end of week 3

A

Patch removed, new patch applied on usual cycle start date of next cycle, even if withdrawal bleed is occurring. No additional contraception

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15
Q

Action in Evra patch change delayed at end of patch-free week

A

Additional barrier contraception for 7 days

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16
Q

Advantages COCP

A

Contraceptive effects reversible on stopping
Usually makes period light, regular, less painful

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17
Q

Conditions COCP reduces risk of

A

Ovarian cancer
Endometrial cancer
Colorectal cancer
PID
Ovarian cysts
Benign breast disease
Acne

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18
Q

Disadvantages COCP

A

May forget
No protection against STI
Temporary side effects - headache, nausea, breast tenderness

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19
Q

Conditions COCP increases risk of

A

Breast cancer
Cervical cancer
Stroke
Ischaemic heart disease

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20
Q

UKMEC categories

A

UKMEC 1 - no restriction
UKMEC 2 - advantages generally outweigh disadvantages
UKMEC 3 - disadvantages generally outweigh advantages
UKMEC 4 - unacceptable health risk

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21
Q

UKMEC 3 COCP

A
  • More than 35 and smoking less than 15/day
  • BMI >35
  • FHx VTE in first degree relative <45
  • Controlled HTN
  • Immobility, e.g. wheel chair user
  • BRCA1/2
  • Current gallbladder disease
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22
Q

UKMEC 4 COCP

A
  • More than 35 and smoking over 15 cigarettes per day
  • Migraine with aura
  • History of VTE or thrombogenic mutation
  • History of stroke or IHD
  • Breastfeeding <6 weeks postpartum
  • Uncontrolled hypertension
  • Current breast cancer
  • Major surgery with prolonged immobilisation
  • Positive antiphospholipid antibodies
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23
Q

Diabetes and COCP

A

Diabetes mellitus diagnosed >20 years ago UKMEC 3 or 4 depending on severity

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24
Q

Additional contraception when starting COCP

A

If started within first 5 days of cycle, no need for additional contraception
If started at any other point, alternative contraception for 7 days

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25
Q

Causes of reduced efficacy of COCP

A
  • Vomiting within 2 hours of taking
  • Medication that may induce diarrhoea or vomiting, e.g. orlistat
  • Liver enzyme inducing drugs
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26
Q

COCP one missed pill

A

Take last pill, even if means taking 2 pills in one day
No additional contraceptive needed

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27
Q

COCP two missed pills

A

Take last pill even if taking two pills in one day, leave any earlier missed pills
Alternative contraception until taken pills for 7 days in a row

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28
Q

COCP two missed pills emergency contraception week 1 (days 1-7)

A

Emergency contraception should be considered if UPSI in pill free interval or week 1

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29
Q

COCP two missed pills emergency contraception week 2 (days 8-14)

A

No need for emergency contraception

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30
Q

COCP two missed pills emergency contraception week 3 (days 15-21)

A

Finish pills in current pack (1/day) then start a new pack next day - omit pill free interval

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31
Q

Contraception UKMEC 2 in ≥40

A

COCP (≥40)
Depo-provera (>45)

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32
Q

Advantages COCP in perimenopausal period

A

May help maintain bone mineral density
May help reduce menopausal symptoms

Pill containing <30 µg oestrogen may be more suitable

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33
Q

Limitations depo-provera in >40

A

May be delay in return of fertility of up to 1 year for women >40 years
Associated with small loss in bone mineral density which is usually recovered after discontinuation

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34
Q

When to stop non hormonal contraception in menopausal women

A

If <50, after 2 years of amenorrhoea
If ≥50, after 1 year of amenorrhoea

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35
Q

Age to stop COCP

A

50 years - switch to non-hormonal or progesterone-only method if ongoing contraception needed

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36
Q

Age to stop depo-provera

A

50 years - switch to either non-hormonal method and stop after 2 years of amenorrhoea, or switch to progesterone only method and stop after 1 year if FSH ≥30 or at 55 y/o

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37
Q

Age to stop implant, POP, or IUS

A

Can continue beyond 50 years
If amenorrhoeic, check FSH and stop after 1 year if FSH ≥30 or at 55y/o
If not amenorrhoeic, consider investigating abnormal bleeding pattern

38
Q

Contraception with HRT

A

POP (as long as HRT has progesterone component aka POP cant be relied on to protect endometrium)
IUS (can be progesterone component of HRT)

39
Q

Most effective emergency contraception

A

Copper IUD

40
Q

Time limit levonorgestrel as emergency contraception

A

Within 72 hours of UPSI

41
Q

Dose levonorgestrel emergency contraception

A

Single dose 1.5mg

42
Q

Who needs double dose levonorgestrel emergency contraception

A
  • BMI >26 or weight >70kg
  • Taking enzyme inducing drugs
43
Q

SEs levonorgestrel EC

A
  • Vomiting
  • Disturbance in current menstrual cycle
44
Q

Management vomiting after levonorgestrel EC

A

If vomiting within 3 hours, dose should be repeated

45
Q

Can levonorgestrel EC be taken more than once in a cycle

46
Q

When to start hormonal contraception after taking levonorgestrel EC

A

Immediately

47
Q

Dose ullipristal (EllaOne) EC

48
Q

Timeframe ullipristal UC

A

Take ASAP, no later than 120 hours after intercourse

49
Q

When to start hormonal contraceptive after ullipristal

A

5 days after - use barrier contraception in interim

50
Q

Ullipristal caution in which conditions

A

Severe asthma

51
Q

Can ullipristal be used more than once in the same cycle

52
Q

Breastfeeding and UC

A

Should be delayed for 1 week after taking ullipristal
No restrictions levonorgestrel

53
Q

Timeline copper coil EC

A

Within 5 days of UPSI
If more than 5 days, may be fitted up to 5 days after likely ovulation date

54
Q

How long to keep IUD for EC

A

Can be left in long term
If wants to remove, should be kept until next period

55
Q

Contraception UKMEC for women taking lamotrigine

A

UKMEC 3 - COCP
UKMEC 1 - POP, implant, depo-provera, IUD, IUS

56
Q

Contraception UKMEC for women taking other anti-epileptics

A

UKMEC 3 - COCP, POP
UKMEC 2 - implant
UKMEC 1 - depo-provera, IUD, IUS

57
Q

Implanon vs nexplanon

A

Pharmacologically the same

Nexplanon has new applicator to try and prevent deep insertions, i.e. SC/IM
Radiopaque - easier to locate if impalpable

58
Q

How long do implantable contraceptives last

59
Q

Advantages implantable contraceptives

A

Most effective form of contraception
Doesn’t contain oestrogen - can be used if history of VTE, migraine
Can be inserted immediately following termination of pregnancy

60
Q

Additional contraceptive after implantable contraception insertion

A

If inserted day 1-5, no additional contraceptive
If inserted on any other day, needs 7 days of alternative contraception

61
Q

Adverse effects implantable contraception

A
  • Irregular/heavy bleeding
  • Progestogen effects - headache, nausea, breast pain
62
Q

Interactions implantable contraception

A

Enzyme inducing drugs, e.g. antiepileptics, rifampicin - may reduce efficacy

63
Q

UKMEC 3 contraindications for implantable contraceptive

A
  • IHD/stroke
  • Explained suspicious vaginal bleeding
  • Past breast cancer
  • Severe liver cirrhosis
  • Liver cancer
64
Q

UKMEC 4 contraindications implantable contraceptive

A

Current breast cancer

65
Q

Main injectable contraceptive

A

Depo provera

66
Q

What is in depo provera

A

150mg medroxyprogesterone acetate

67
Q

How often depo provera given

68
Q

Adverse effects depo provera

A
  • Delayed return of fertility, up to 12 months
  • Irregular bleeding
  • Increased risk of osteoporosis
69
Q

CIs depo provera

A

Breast cancer (current = UKMEC 4, past = UKMEC 2)

70
Q

How long to be effective IUD

A

Immediately

71
Q

How long effective IUD

A

Majority 5 years
Some (if copper on stem and arms) 10 years

72
Q

How long to be effective IUS

73
Q

How long effective IUD

A

Mirena 5 years
Jaydess 3 years
Kyleena 5 years

74
Q

SE/risks IUD/IUS

A
  • Risk of uterine perf (higher in breastfeeding women)
  • Higher proportion of ectopic preg
  • Small increased risk of PID in first 20 days after insertion
  • Risk of explusion
75
Q

When is contraception required after giving birth

76
Q

When can POP start postpartum

77
Q

Additional contraception when starting POP postpartum

A

If after day 21, additional contraception for 2 days

78
Q

When can COCP start post-partum

A

> 21 days due to risk of VTE
6 weeks if breastfeeding

79
Q

Additional contraception COCP post-partum

A

If starting after day 21, additional contraception for first 7 days

80
Q

When can IUD/IUS be inserted post-partum

A

Within 48 hours of childbirth or after 4 weeks

81
Q

Criteria for lactational amenorrhoea to be effective

A

EBF
Amenorrhoeic
<6 months post-partum

82
Q

Risks of inter-pregnancy interval of less than 12 months

A

Increased risk of preterm birth
Low birth weight
SGA babies

83
Q

Pros POP

A
  • Better when breastfeeding (COCP is UKMEC 2 until 6 months)
  • Can be used in situations COCP is contraindicated, e.g. smokers >35, Hx of VTE
84
Q

Disadvantages POP

A
  • Irregular periods
  • No STI protection
  • Increased incidence of functional ovarian cysts
  • Breast tenderness, weight gain, acne, headaches
85
Q

Additional contraception when starting POP

A

If commenced up to and including D5, immediate protection, otherwise use additional contraception
If swapped from COCP → POP, immediate protection if continued from end of pill packet (D21)

86
Q

Does POP have pill free break

87
Q

When does late POP not need any action

A

If <3 hours late

88
Q

Management POP if taken >3 hours late

A

Take missed pill ASAP
Continue with rest
Extra precautions until pill taking re-established 48 hours

89
Q

Management POP with D&V

A

Continue taking, but assume the pills have been missed (alternative contraception until 48h after D&V stopped)

90
Q

Which POP has more leeway with time of taking

A

Cerazette (12 hours)

1 - MSRA (23 decks)

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