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GP, obstetrics, psych, paeds > Contraception > Flashcards

Contraception Flashcards

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1
Q

what are four things you must consider as a GP prior to prescribing contraception?

A
  1. Obtain history including sexual history etc
  2. Establish contraindications
  3. Are the patient likely to adhere?
  4. Does the patient require permanent contraception?
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2
Q

how does the COCP work as a contraception

A

prevents ovulation; E suppresses FSH and P suppresses LH (primary mechanism) and thickens cervical mucus (secondary mechanism)- less hospitable environment

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3
Q

what is the failure rate for COCP amongst adults and teenage women?

A
  1. 09 realistically for adults (9%)

0. 15 for teenagers (15%)

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4
Q

how would you advise a female patient how to begin taking the COCP?

A

Start first day on menses or you can start on any day of the pack if you exclude pregnancy and use barrier contraception for first 7 days

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5
Q

what would be your advice for a patient who has missed a COCP pill?

A

Missing a pill less than 24 hrs- take the pill that you missed.

If more than 24 hrs, then take 2 pills but also use barrier contraception for 7 days.

If you are on the placebo pills (sugar pills) and you miss a 2 placebo pills, and have been having intercourse in the last 5 days, then you need to take the morning after pill as they may be pregnant.

If you are still on active pills and are near the sugar pills and miss a pill for more than 24 hrs, take 2 pills, skip sugar pills and start the next pack.

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6
Q

what are some advantages for COCP?

A

convenient, rapidly reversible, independent of intercourse, can also be used for dysmenorrhoea, reduces PID/ovarian cysts/ovarian cancer and endometrial cancer.

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7
Q

what are some disadvantages for COCP?

A

nausea, breast tenderness, mood changes, libido changes, fluid retention, adherence

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8
Q

what are the contraindications for COCP?

A
  • High risk of VTEs/DVTs/PE
  • High risk factors for CVD, obesity, over 35, high BP, smoking
  • Past history of stroke or TIA
  • Undiagnosed vaginal bleeding- ?cancer
  • Focal migraines + aura
  • History of breast cancer- clarify which receptor positive?
  • Active liver disease
  • Think about drug interactions

No COCP for breastfeeding if less than 6 months after birth of baby

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9
Q

what is the COCP?

A

oestrogen + progesterone pill

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10
Q

what are the options for emergency contraception?

A

morning after pill and copper ring

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11
Q

what is the benefit of a vaginal ring over OCP?

A

don’t get the hepatic first pass metabolism hence no drug interaction/no GI absorption hence no problem with malabsorption

better compliance as no daily pill required

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12
Q

How do we use the vaginal nuvaring for contraception?

A

3 weeks you insert a vaginal ring, and you then remove for 1 week to induce a withdrawal bleeding.

Immediately effective from insertion on the first day of period. If inserted at any other time–> requires back up contraception for 7 days

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13
Q

what progesterone only option forms of contraception can you prescribe?

A

mini pill
depo provera
implanon
mirena

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14
Q

general SE of progesterone only forms of contraception

A

irregular bleeding, weight gain, mood lability, reduced libido, drug interactions (rifampicin if mini pill and implanon) and hormone dependent cancer

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15
Q

specific SE of implanon you should inform patients before insertion?

A

irregular bleeding

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16
Q

what are some practice points about the minipill?

A

Mini-pill is generally used whilst breastfeeding.

Must take at the same time every day. within 3 hr time period.

If more than 3 hrs missed pill- need to use extra contraception.

Also need extra contraception when first starting the mini-pill (2 days) unless starting Day 1-5 of menstrual cycle.

Increased risk of functional ovarian cysts.

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17
Q

what are the general mechanisms of progesterone only containing contraception?

A

endometrial atrophy and thickened cervical mucus.

Implanon and depo provera also inhibit ovulation but not mirena or minipill

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18
Q

what form is depo provera and how often do we give it?

A

IM

every 12 weeks (not three months)

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19
Q

what are some advantages of depoprovera?

A

convenient
not interfered by other drugs
some protection against uterine cancer and PID

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20
Q

what are the disadvantages of depo-provera

A

cannot be immediately reversed- need to wait out the 3 month period

reduces bone density

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21
Q

what is the most effective form of contraception for young women?

A

implanon

22
Q

what are some SE of implanon

A

Minor side effects reported include headache, abdominal pain, breast tenderness, decrease in libido, acne and hair loss (rare).

main side effect is irregular bleeding

23
Q

how do we manage breakthrough/irregular bleeding with implanon?

A

use additional OCP

24
Q

what is so good about condoms?

A

only form of contraception that protects against STIs

25
Q

how long does mirena stay in for?

A

5 years

26
Q

What are some practice points of mirena?

A

Need to check for STIs prior to insertion. Increased risk of PID with new insertion.

Last for 5 yrs. 99% efficacy.

Arrange for follow up 4-6 weeks later to check if the strings are still there.

If the strings are missing- it has been expelled or it could have perforated into the pelvis. If they have an IUD and they are pregnant- there is a risk of miscarriage.

Increased risk of infection in the first 20 days (STIs and actinomyses).

Less systemic side effects because of local hormonal effect.

27
Q

what group of female patients would you opt not to prescribe copper ring IUD?

A

patients who experience dysmenorrhoea and severe cramping

28
Q

what are the options for permanent sterilisation in women?

A

essure coils(using hysteroscopes and plugging the fallopian tubes) –> tubal occlusion

filchie clips (using laparoscope to clip the fallopian tubes, potentially reversible)= tubal ligation

salpingoectomy/hysterectomy (but less commonly offered unless there are other indications)

29
Q

tell me about emergency contraception?

A
  • Levonorgestrol 1.5mg (morning after pill)
  • The mode of action is to prevent or delay ovulation by disrupting follicular development.
  • Needs to be taken as soon as possible up to 4 days after unprotected sex

or copper IUD up to 120-hours post-unprotected intercourse; The Cu-IUCD interferes with sperm passage, inhibits fertilisation by direct toxic action and may prevent implantation.

30
Q

what are some considerations for a teenager wanting implanon for contraception?

A
  • Implanon- consent for a surgical procedure with anaesthetic
  • Encourage to use condoms for STI prevention
  • Mature minor? Can they remember the information?
31
Q

what are some contraindications for implanon?

A 
breast cancer active within last 5 years
severe liver disease including liver tumours
other hormone sensitive cancers
acute thromboembolism
undiagnosed vaginal bleeding
32
Q

when should you review/follow up after implanon insertion?

A

3 months

33
Q

what do we mean by ‘quick start’ for contraception?

A

quick start refers to commencing hormonal contraception outside the recommended time e.g. after day 5 of menstrual cycle. Often suits patients who cannot wait for monthly period to start contraception.

Advise the patient that they will need extra barrier protection/contraception during the first 7 days if they choose the quick start method

34
Q

what hormone is used in implanon?

A

etonogestrel

35
Q

what do we mean by monophasic vs polyphasic COCP?

A

monophasic constant dose of estrogen

polyphasic- varying dose of progesterone or estrogen depending on cycle

36
Q

what component of COCP may be considered for a woman with acne?

A

cyproterone acetate

37
Q

what is the first line option for prescribing COCP to a woman of childbearing age for the first time?

A

monophasic 2nd gen COCP

38
Q

what hormones are used in a nuvaring?

A

etonogestrel and ethinylestradiol

39
Q

how exactly does the nuvaring work?

A

suppresses ovulation = primary mechanism of the nuvaring

40
Q

what hormone is used in depo provera injection?

A

methoxyprogesterone acetate

41
Q

how does implanon work as a contraception?

A

primary mechanism= inhibits ovulation by reducing LH surge

also reduces sperm motility and increases viscosity of cervical mucus

42
Q

what is the main contraindication for implanon?

A

Breast cancer, current or within the last 5 years, is an absolute contraindication (WHO MEC 4)

43
Q

how do IUDs work as contraception?

A

inhibits sperm transport

44
Q

at what age should we cease giving depo provera injections to women?

A

at 50 yrs

45
Q

what hormone is in depo-provera?

A

Depo-Provera is depot medroxyprogesterone acetate (DMA)

46
Q

what is the difference between regaining fertility between depo-provera and implanon?

A

depo-provera- may take a while to regain fertility

implanon- rapid regain of fertility after its removal so good for family planning

47
Q

what are some advantages of using intrauterine device Mirena for contraception?

A

high efficacy- almost similar to sterilisation
rapid return to fertility upon removal

cost effective long term option

amenorrhoea is often achieved within 6 months of insertion and Mirena is overall very well tolerated

48
Q

what is the mechanism of action of Mirena?

A

Main mechanism- inhibits sperm transport, endometrial atrophy, increased cervical mucus.

49
Q

absolute contraindication for mini-pill?

A

Having breast cancer active within 5 years is an absolute contraindication for the mini-pill

50
Q

what type of contraceptive method (other than withdrawal) has the highest failure rate?

A

use of vaginal diaphragms as contraception

51
Q

what are the conditions of using breastfeeding as a relatively effective contraception?

A
  1. breastfeeding woman must be amenorrhoeic
  2. woman must be fully/exclusively breastfeeding her infant
  3. less than 6 months postpartum

GP, obstetrics, psych, paeds (55 decks)

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