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Obstetrics and Gynaecology > Contraception > Flashcards

Contraception Flashcards

1
Q

What is the likelihood of getting pregnant within the first year of intercourse, with no contraception?

A

85%

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2
Q

What are the 6 broad categories of contraceptive methods?

A
  1. Physiological
  2. Barrier methods
  3. Hormonal - piils vs injection vs implanon
  4. IUD
  5. Surgical - tubal ligation, vasectomy
  6. Emergency contraception
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3
Q

How is ovulation detected best?

A

Basal body temperature rise

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4
Q

How does lactational amenorrhoea work as a contraceptive method?

A

Breastfeeding suppresses GnRH secretion via prolactin (compare anovulation due to hyperprolactinaemia in prolactinomas)

Must be exclusively breastfeeding

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5
Q

In which population is using the progestin-only pill most effective?

A

If also post-partum breastfeeding

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6
Q

How is the minipill taken?

A

Taken daily at same time of day to ensure reliable effect

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7
Q

How does the minipill work?

A

Inhibition of ovulation + cervical mucous changes

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8
Q

What is the mechanism of action of the OCP? (3)

A

Stops ovulation (through LH and FSH suppression)

Changes lining of uterus to prevent implantation

Thickens cervical mucous resulting in decreased sperm penetration

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9
Q

What are the advantages of using the combined OCP? (7)

A
  1. Highly effective if used properly
  2. Reversible
  3. Decreased dysmenorrhoea and menorrhagia
  4. Decreased benign breast disease and ovarian cyst development
  5. Decreased risk of ovarian cancer
  6. Improved acne
  7. Possible osteoporosis protection
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10
Q

List 7 oestrogen-related side effects when taking the OCP.

A
  1. Nausea
  2. Breast changes (tenderness, enlargement)
  3. Fluid retention/bloating/oedema
  4. Weight gain (rare)
  5. Migraine, headaches
  6. Thromboembolic events
  7. Breakthrough bleeding - occurs in the first few months after starting, usually resolves after three cycles
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11
Q

List 9 progestin-related side effects when taking the OCP.

A
  1. Amenorrhoea/breakthrough bleeding - breakthrough bleeding usually occurs in the first few months after starting, usually resolves after three cycles
  2. Headaches
  3. Breast tenderness
  4. Increased appetite
  5. Decreased libido
  6. Mood changes
  7. Hypertension
  8. Acne/oily skin
  9. Hirsutism
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12
Q

List 9 absolute contraindications to taking the OCP

A
  1. Known/suspected pregnancy OR less than 6 weeks postpartum
  2. Undiagnosed abnormal vaginal bleeding
  3. Prior thromboembolic events OR thromboembolic disorders
  4. Current or past history of cerebrovascular or coronary artery disease
  5. Current oestrogen-dependent tumours
  6. Impaired liver function associated with acute liver disease
  7. Migraines with focal neurological symptoms
  8. Uncontrolled hypertension
  9. Smoker age more than 35 years and smoking more than 15 cigarettes a day
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13
Q

List 4 relative contraindications to taking the OCP

A
  1. Migraines - non-focal
  2. Currently symptomatic gallbladder disease
  3. Controlled hypertension
  4. Medications: rifampin (might affect absorption) or anti-epileptics e.g. phenytoin, carbamezapine (hepatic enzyme-inducing drugs (increase metabolism and therefore decreases hormone levels)
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14
Q

What advice is given to women taking OCP and is on rifampicin?

A

Advice to use condoms concurrently and 28 days after stopping

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15
Q

What advice is given to women who misses pills while on OCP? (3)

A

Depends on which part of pill pack is missed and how many in a row

  1. If miss one pill at any point - take missed pill as soon as you remember, take next pill at normal time, condom use not required
  2. 7 subsequent pills required for sufficient suppression of ovulation - a back-up method of contraception or abstinence should be used if a pill is more than
    24 hours late, until 7 consecutive pills have been
  3. If the missed pills are in week 3, the pill-free interval should be missed
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16
Q

What advice is given if woman on progestin-only pills misses dose?

A

If more than 3 hours, use back-up contraceptive methods for at least 48h. continue to take remainder of pills as prescribed

17
Q

Describe the use of the contraceptive ring

A

Thin flexible plastic ring inserted into vagina that releases oestrogen and progesterone - works for 3 weeks than removed for 1 week. As effective of OCP in preventing pregnancy

18
Q

What is the mechanism of action of a copper IUD?

A

mild foreign body reaction in endometrium toxic to sperm and alters sperm motility

19
Q

What is the mechanism of action of a Mirena?

A

Progesterone-releasing IUD

Decidualisation of endometrium and thickening of cervical mucous; minimal effect on ovulation

20
Q

When are IUDs suitable to use as a contraceptive?

A

In women with contraindications to OCPs or wanting long-term contraception

21
Q

When are progestin-only methods suitable to be used as contraception? (3)

A

Suitable for postpartum women (does not affect breast milk supply)

Women with contraindications to combined OCP

Women intolerant of oestrogenic side effects of combined OCPs

22
Q

How does a Depo-Provera work?

A

Injectable progesterone IM (MDPA) every 12 weeks - can have irregular spotting at first but can progress to complete amenorrhoea.

  1. Thins lining of uterus - no implantation
  2. No ovulation
  3. Thickens cervical mucous - decreases sperm penetration
23
Q

What options are there for female sterilisation?

A

Usually permanent/irreversible

Laparoscopic or hysteroscopi tubal occlusion - does not prevent ovulation therefore will still get period.

24
Q

How effective are the following hormonal forms of contraception?

  • OCP
  • contraceptive ring
  • progestin only pill
  • depo-provera
  • IUD
A

All except progestin-only pill have >99% effectiveness

Progestin-only pill = slightly less (1.1-13% failure rate with typical use)

25
Q

What is the effectiveness of the pill?

A

99.7% with perfect use, 92% with typical use

26
Q

Resumption of normal periods on the pill

A

80% resume normal periods within 3 months of ceasing use of pill

95%-98% resume normal ovulation within 1 year

27
Q

What should be done if a woman falls pregnant while on the IUD?

A

Should be removed to decrease infection, abortion

28
Q

What are the absolute contraindications of having an IUD inserted? (5)

A

Both copper and progesterone IUD:

  1. . Known or suspected pregnancy
  2. Undiagnosed genital tract bleeding
  3. Acute or chronic PID

Copper: known allergy to copper, Wilson’s disease

29
Q

List 6 relative contraindications to having an IUD inserted.

A
  1. Valvular heart disease
  2. Past history of PID or ectopic pregnancy
  3. Presence of prosthesis
  4. Abnormalities of uterine cavity
  5. Cervical stenosis
  6. Immnosuppressed individuals e.g. HIV
30
Q

Male vs female sterilisation - is the contraceptive effect immediate?

A

In female sterilisation, yes (tubal ligation)

Not in male sterilisation

31
Q

When should the combined OCP be initiated for it to be effective?

A

Day 1 of the first day of bleeding in normal menstrual cycle to day 5 - effective immediately

Any other time provided pregnancy is excluded - effective within 7 days (use other forms of contraception until then)

32
Q

What is the disadvantage of using a Depo-Provera?

A

Disadvantage - restoration of fertility may take up to 1-2 years

33
Q

What are the two forms of emergency contraception?

A

Hormonal - levonorgestrel (first-line), Yuzpe method (combined oestrogen and progestogen, second-line, rarely used)
Non-hormonal - copper IUD

34
Q

How does levonorgestrel work?

A

Hormonal emergency contraception - primarily acts to prevent or delay ovulation by interfering follicular, taken within 72h

35
Q

What is the Yuzpe method?

A

Hormonal emergency contraception - used if levonorgestrel unavailable

Essentially taking 2 doses of particular OCPs (100mcg of ethinyloestradiol and 500mcg of LNG) taken 12 hours apart

Obstetrics and Gynaecology (10 decks)

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