Contraception Flashcards
What are the release rates of etonogestrel in Nexplanon vs DMPA?
Nexplanon- 68mg/3years
DMPA - 150mg/12 weeks
What is the release rate of levonorgestrel from the LNG-IUS?
Mean 14mcg/day over 5 years
Initially 20, reduced to 11 at end of 5 years
What is the amenorrhoea rate/regular periord rate and erratic bleeding rate for POP (Cerazette)?
Amenorrhoea 20%
Regular 40%
Erratic 40%
How many women achieve complete cessation of menstruation at 1 year with DMPA?
50%
What is the amenorrhoea rate and erratic bleeding rate with Nexplanon?
Amenorrhoea 20%
Erratic bleeding 50%
How many women achieve 5 years of reduced blood loss or amenorrhoea using LNG-IUS?
90%
Which cancers are at increased/decreased risk with COCP use?
- Protective - ovarian and endometrial (15 years or more after stopping)
- Decrease in colorectal cancer
- Small additional risk of breast cancer, decreased to no risk after 10 years of stopping use (UKMEC 3 BRCA)
- Small increase cervical - to no risk after 10 years cessation
What is the age cut off for smokers where risk outweighs benefit of COCP?
35
When is the recommended maximum age for DMPA (depo)?
How often should women be reviewed?
No upper limit but generally recommend 50 - UKMEC 2 >45
Caution with cardiovascular risk factors
Review every 2 years
When can non-hormonal contraception be stopped peri-menopausally?
After 1 year amenorrhoea if >50
After 2 years amenorrhoea if <50
55 if still bleeding
Cu-IUD if inserted over age of 40 can stay in until menopause or until contraception not required
When can hormonal contraception be stopped peri-menopausally?
FSH only if >50 and progesterone only method
6/52 apart and if both >=30 stop contraception after 1 year
If LNG-IUS inserted >=45 for 7 years if amenorrhoeic or until menopause
(If used as P component of HRT change at 5 years)
COCP - not reliable doing FSH
What is the rate of abortion in women >40 in England & Wales?
4/1000
What is the risk of cancer with progesterone only methods of contraception?
Breast - inconclusive
Cervical - slight increase with length of use but
How did LNG-IUS compare to other methods in Cochranre review for menorrhagia?
More effective than cyclical norethisterone
Smaller mean reduction in blood loss compared to ablation
QOL measures similar to ablation/hysterectomy but more progestogenic side effects
Which progestogenic contraception has the greatest effect on lipid metabolism (ie increase in vascular risk)
DMPA injectable
Which spermicide should not be used with condoms due to increased HIV transmission 2dry to mucosal irritation?
Nonoxinol-9 (N9)
What are the methods of emergency contraception. how long after UPSI can they be used and which is most effective?
CuIUD - 5/7 after earliest expected ovulation regardless of no UPSI - 99% effective
Progesterone only (POEC) - levonorgestrel - licenced 3/7
P-receptor modulator ullipristal
What is the probability of menstration (and ovulation) after 1 year amenorrhoea in women >45?
2-10%
How many women continue to ovulate with LNG-IUS?
Up to 75%
Sequential HRT inhibits ovulation in how many women with regular cycles (age 42-52)?
40%
what contraception to be avoided in 30yr old nullip, with SLE
all hormonal contraceptives including mirena.
UKMEC=4 for CHC
UKMEC=3 for prog contraception
what contraception to avoid in 33y/o woman with FHx VTE in 1st degree relative under age 45. pt has normal thrombophilia screen
all CHC (COCpill/ ring/ patch). UKMEC=3
what contraception to avoid n 22 yr old with T1DM, neuropathy and microvascular disease
CHCs & DMPA
UKMEC=3/4 with CHCs
UKMEC=3 for DMPA
What are the methods of emergency contraception in the UK and how long after UPSI can they be given?
Copper coil - 5/7
Levenorgestrel - 72 hours - can be given more than once a cycle
Ullipristal - Up to 5/7 but efficacy reduces after 72 hrs
What % of 18-49 year olds who are married/in a partnership are using Fertility Awareness Method for contraception?
2%
