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Obs & Gynae > Contraception > Flashcards

Contraception Flashcards

1
Q

What contraception shouldn’t be used in women with IBD?

A

OCP as malabsorption may occur

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2
Q

What contraception should be used in breastfeeding women?

A

Progesterone-only methods
COCP affects breast milk volume
IUD can be inserted 4 weeks post partum

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3
Q

What contraception should be used in later life?

A

Continue 2 years after last period if less than 50
Continue 1 year after last period if older than 50
Can use COCP if none smoker
IUD, IUS

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4
Q

What hormonal contraception exist?

A

POP - mini pill
Depot
CHC - COC, transdermal, vagina ring

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5
Q

How does the COCP act?

A

Negative feedback on gonadotrophin release
Inhibits ovulation
Thins endometrium and thickens cervical mucus

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6
Q

What are the different oestrogens the COCP contains?

A

Ethinyloestradiol - monophasic

Oestradiol valerate - Qlaira
4 phases of dose over 26 days and 2 pill-free days
Better for lipids, migraines and mood swings

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7
Q

What is the failure rate of COCP?

A

0.2/100 woman years

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8
Q

What are indications for COCP?

A 
Menorrhagia
Pre-menstrual symptoms
Dysmenorrhoea
Acne/hirsutism
Prevention of simple ovarian cysts
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9
Q

When should missed pill instructions be followed?

A

Diarrhoea
Vomiting within 2hrs of taking the pill
Missing a pill in the last 7

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10
Q

What are complications of COCP?

A 
Venous thrombosis
Myocardial infarction
Cerebrovascular accidents
HTN
Cervical and breast carcinoma
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11
Q

What are contraindications for the COCP?

A

BMI>40

Age>35yrs and smokes >15 cigarettes

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12
Q

What are side effects of the COCP?

A

Nausea
Headchaes
Breast tenderness
Suppresses lactation

Change to more potent progesterone

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13
Q

How should the POP be taken?

A

Every day without break

At same time +/- 3 hrs

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14
Q

How does the POP work?

A

Makes cervical mucus hostile to sperm

In 50% women inhibits ovulation

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15
Q

What is the failure rate of POP?

A

1/100 woman years

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16
Q

What are side effects of POP?

A 
Breakthrough bleeding
Weight gain
Mastalgia
PMS
Functional ovarian cysts
17
Q

When is POP better than COCP?

A

Breastfeeding mothers
History of thrombosis
Antibiotic takers

18
Q

How is Cerazette different to other POPs?

A

Higher dose of progesterone
Inhibits ovulation in 95%
Can be taken in 12hr window

19
Q

What is the failure rate of the injection?

A
20
Q

What are side effects of the injection?

A

Irregular bleeding followed by amenorrhoea
Long return to fertility
Decreased bone density - regained after stopping

21
Q

What are contraindications for the injection?

A

Teenagers - peak bone mass hasn’t been acheived

Older women - osteoporosis

22
Q

What are indications for the injection?

A

During lactation

23
Q

What is the failure rate for the implant?

A
24
Q

What are side effects of the implant?

A

Irregular bleeding in first year
No drop in bone density
Easy removal
Rapid resumption of fertility

25
Q

What and when can emergency contraception be given?

A

Levonelle - single dose of levonorgesterel

  • within 72hr
  • can cause vomiting
  • 95% success rate

Ulipristal (EllaOne) - selective progesterone receptor modualtor

  • prevents or delays ovulation
  • within 120hr
  • reduces effectiveness of progesterone containing contraceptions

Copper IUD - prevents implantation

  • within 5 days after unprotected sex or expected day of ovulation
  • give antibiotic prophylaxis
26
Q

What is the failure rate of condoms?

A

2-15/100 woman years

27
Q

What is the failure rate of the diaphragm?

A

5/100 woman years

28
Q

How does the copper IUD work?

A

Copper is toxic to sperm

Blocks implantation

29
Q

How does the IUS work?

A

Changes cervical mucus
Produced uterotubal fluid which impair sperm migration
Reduces menstrual loss and pain

30
Q

What is the failure rate of the IUD?

A
31
Q

What are indications for IUD?

A

IUD can be inserted straight after termination, puerperium and during first half of cycle

IUS can be used for menorrhagia or dysmenorrhoea

32
Q

What are complications of IUD?

A 
Pain or cervical shock
Expelled (within month 1)
Perforation - at insertion or later
Heavier/painful periods
PID from previous STI
Ectopic
33
Q

If threads of IUD have disappeared what do you do?

A

USS to look inside uterus

Abdo XR then laparoscopy

34
Q

What are contraindications to the IUD?

A

Endometrial or cervical cancer
Active PID
Breast cancer (IUS)
Pregnancy

Previous ectopic
Nulliparity

35
Q

What methods are available for female sterilisation?

A

Filshie clips - laparoscopy under GA

Microinserts in proximal part of tubes

36
Q

What is the failure rate of female sterilisation?

A

0.5/100 woman years

37
Q

What are complications of female sterilisation?

A

Pain
Ectopic pregnancy
Reversal request

38
Q

How is male sterilisation done?

A

Ligation and removal of part of vas deferens
Can be done under LA
Sterility is confirmed by two semen analyses and may take up to 6 months

39
Q

What are complications of male sterilisation?

A

Failure
Haematotoma
Chronic pain

Obs & Gynae (20 decks)

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