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Gynaecology > Contraception > Flashcards

Contraception Flashcards

1
Q

Types of progestogen only contraceptive pill

A

Levonorgestrel 30mcg/day

Norethisterone 350mcg/day

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2
Q

Effectiveness of progestogen only pill

A

3per 100 failure

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3
Q

Side affects of progestogen only pill

A 
Lack of compliance
Irregular cycle
Irregular bleeds
Breast tenderness 
Increase appeptite
Breast tenderness
Depression
Acne
N and V
Headache
Dizziness
Lethargy
Cholestatic Jaundice
Reduced libido
Androgenic - Hirsutism, greasy hair
Hypersensitivity
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4
Q

Indications for progestogen only pill

A

> 45 yr
smokers aged >45
Pt who are contraindicated to or intolerance of oestrogen’s e.g. DM, migraine, chasm, lactation and well controlled HTN

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5
Q

Contraindication for progesterone only pill

A 
Pregnancy
Undiagnosed genital tract bleeding
Absolute if PmHx or increase risk of ectopic pregnancy and concomitant use of enzyme-inducing drugs.
Liver failure
SLE
Anticonvulsant
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6
Q

What is Depo Provera

A

Medroxyprogestreone acetate IM injection

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7
Q

Dose of Depo Provera

A

150mg deep IM in 1st 5 days of cycle and repeat every 12 week.

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8
Q

Failure rate Depo Provera

A

1 per 1000

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9
Q

Adverse effects of Depo Provera

A

Disrupted menstrual cycle e.g. irregular or prolonged, 70% amenorrhoea
Wt gain
Breast tenderness
Depression
Delay in return to fertility about 6 months
Long term use = decrease in bone

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10
Q

Contraindication of Depo Provera

A

No absolute

Not for >2yr or as 1st line in

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11
Q

Types of emergency contraception

A

Within 72hrs
- Postinor 1 (one dose of 1500mg)- 2 - ( 2 doses of 750mcg levonorgestrel 12hr apart . 80-85%
- Ulipristal acetate 30mg as a single dose.
Copper - IUCD within 5 days - 99%

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12
Q

Implanon MOA

A

Etonogestrel implant 68mg (25-30micg/day)

Inhibits ovulation and antimucus effect

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13
Q

Implanon AE

A

Irregular bleeding most common. Requires minor surgery to insert and remove.

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14
Q

Implanon failure rate

A
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15
Q

IUCD efficacy

A

96-99%

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16
Q

IUCD contraindication

A

Absolute - pregnancy, active PID, undiagnosed abnormal genital bleeding tract. Previous ectopic pregnancy, severe uterine cavity distortion
Relative - Menorrhagia, dysmenorrhoea, lesser uterine cavity distortion, very large or very small uterus, anaemia, defective immune system, impaired clotting mechanism, valvular heart disease, acutely anteverted or retroverted uterus, increase risk of PID e.g. multiple sex partners

17
Q

IUCD AE

A

If pregnant 40-50% risk of abortion/sepsis, 10 times higher risk of pregnancy vs COCP. Increase risk of PID in first 30 day. extrusion, perforation, translocation, bleeding for 2-3m and pain.
increase risk of ectopic

18
Q

Side effects of COCP

A 
Advice to patient
- Peroids become shorter, regular and lighter
- No break from the pill is necessary
- Drugs that effect the pill are - antacids, purgatives, vitamin C, antibiotics(griseofulvin and rifampicin) and anticonvulsants except sodium valproate.
- Warfarin and oral hypoglycaemic may need adjustment
- Acne
- Amenorrhoea
- brake through bleeding
- Breast fullness/tenderness, mastalgia
- Chloasma (tan skin)
- Depression
- Dysmenorrhea/menorrhagia
-Libido loss
- Headache - focal migraine
- N and V
- Wt gain
Bloating
Clot: DVT, PE, Stroke, MI, 
HTN
Increase choleesterol and stasis = Gallbladder
Breast and Cervical cancer
19
Q

Types of contraception and their effectiveness

A 
Physical
- Withdrawal 77%
- Rhythm method/calender/mucus/temp 98-76%
- Lactational amenorrhea 98% 1st 6 m
- Chance - no method 10%
- Abstinence 100%
Barrier method
- Condom 98-85%
- Spermicide 82-71%
- Sponge parous 80-65%, nulliparous 91-84%
- Diaphragm with spermicide 94-79%
- female condon 95-79%
- cervical cap 68-91%
Hormonal 
- OCP 99.7-92%
- Nuva Ring 99.7-92%
- Transdermal 99.7-92%
- Depo provera 99.7-97%
- progestin only pill 90-99%
- Mirena IUD 99.9%
- Subnormal implant 99.9%
Others
- Copper IUD 99.5%
- Surgical tubal ligation 99.65%, vasectomy 99.9%
- emergency postcoital contraception- Yuzpe method 98%
20
Q

Contraindications for COCP

A 
Absolute
- pregnancy
- 1st 6 wk postpartum
- Hx thromboembolic or thrombophilia
- CVD
- Focal migraine
- CAD
- Oestrogen dependent tumor
- active liver disease
- Polycythaemia
Relative
- Heavy smoker
- >35yr and smoking or other risk of CAD
- Undiagnosed abnormal vaginal bleeding
- Breast feeding
- 4 wks after surgery
- HTN
- Gall bladder or liver disease
- DM
- Long term immobilisation
- complicated valvular heart disease
- hyperlipidaemia
- Chloasma
- severe depression
21
Q

Serious AE of COCP

A

CVS
- venous - DVT, PE, rarely mesenteric, hepatic and kidney thrombosis
- Arteries - MI, stroke, retinal and mesenteric thrombosis
Cancer - ↑ risk cervix, breast
Protective against endometrial and epithelial
Liver cancer

22
Q

Counsel a patient only COCP

A

Contains Ethinyl estradiol 20-35mg and progestin
Failure rate is 0.03%
MOA - inhibits hypothalamic and pituitary function leading to anovulation
Component
- Estrogens - mestranol and ethingloestradiol
- Progesterone - Nor testosterone derivative, levonorgestrel, 3rd gen gestogens
Starting- lowest effective dose, 1st line is monophasic pill(levonorgestrel or norethisterone, 30mcg ethinyloestradiol)
Contraindications
AE

23
Q

Counseling for emergency contraception

A

take ASAP within 72 hrs of sex
If vomiting less then 2 hours take again
It shouldn’t change your period but you may get intermensual spotting.
Come back if your period is light or late be a week
You may experience N/V, breast tenderness, spotting and headache.

24
Q

Precautions with COCP

A 
Unexplained bleeding
Breast Cancer
Migraine - stroke
Diabetes - clot
Smoking - clot
BMI over 30 - clots
Antiphospholipid syndrome
Postpartum until day 42
Hx of CVS
Age greater then 40
Liver disease
Surgery
25
Q

Indications for COCP use

A 
Contraception
Acne
Menstral Disorder
Endometrosis
Prementrual syndrome

Gynaecology (15 decks)

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