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Gynaecology > Contraception > Flashcards

Contraception Flashcards

1
Q

% unintended pregnancy - female sterilisation

A

0.5%

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2
Q

% unintended pregnancy - vasectomy

A

0.1%

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3
Q

% unintended pregnancy - progesterone only implant

A

0.05%

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4
Q

% unintended pregnancy - mirena

A

0.2%

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5
Q

% unintended pregnancy - Copper coil

A

0.8-0.6%

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6
Q

% unintended pregnancy - Depo injection

A

0.2 - 6%

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7
Q

% unintended pregnancy - COCP and POP

A

0.3- 9%

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8
Q

% unintended pregnancy - male condom

A

18 - 2%

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9
Q

% unintended pregnancy - female diaphragm

A

12 - 6%

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10
Q

UKMEC category 1

A

no restriction

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11
Q

UKMEC category 2

A

advantages outweigh theoretical risk

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12
Q

UKMEC category 3

A

theoretical or proven risks outweigh advantage

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13
Q

UKMEC category 4

A

unacceptable health risk

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14
Q

Which conditions contraindicate the use of certain contraceptives postpartum/breastfeeding (UKMEC 4)?

A

postpartum sepsis contraindicates the use of intrauterine devices
1-3 week postpartum + VTE risk - no cocp

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15
Q

Which contraceptives can be safely used postpartum and breastfeeding?

A

Progesterone only pill/depo/implant

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16
Q

When should cocp be avoided (UKMEC 3) postpartum/breastfeeding?

A

0-3 weeks post partum without VTE risk factors

3-6 weeks with risk factor of VTE

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17
Q

When should IUDs be avoided postpartum/breast feeding (UKMEC 3)

A

48-4weeks post partum (can be inserted in first 48 hours)

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18
Q

Regarding BMI, when should COCP be avoided?

A

BMI >/= 35

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19
Q

Which contraceptions are UKMEC 2 for organ transplant?

A

If uncomplicated - all are
If complicated it is not advisable to start IUD or COCP but progesterone only is UKMEC 2 and IUD can be continued if already present

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20
Q

Which contraceptives should be avoided (UKMEC 3) in patient with multiple cardiac risk factors?

A

Depo injection and COCP

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21
Q

Which contraception is contraindicated with impaired cardiac function?

A

COCP, the rest are fine to use

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22
Q

Which contraception is contraindicated in AF?

A

COCP, the rest are fine to use

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23
Q

Which contraceptions are best avoided in long QT and why?

A

Advisable not to start an IUD, risk of vasovagal due to cervical excitation leading to bradycardia and risk of cardiac event

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24
Q

Which contraceptions are UKMEC 3/4 with gestational trophoblastic disease?

A

All fine if BHCG levels not detectable
IUDs should be avoided if BHCG levels present and falling
IUDS contraindicated if BHCG levels elevated or there is malignant disease

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25
Q

Which contraceptions are UKMEC 3/4 with cervical cancer?

A 
Awaiting treatment UKMEC 4 - do not start IUD
Radical cervicectomy (Trachelectomy) - UKMEC 3 IUD
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26
Q

In active breast cancer, which contraceptions are contraindicated?

A

Everything except copper coil

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27
Q

In past breast cancer, which contraceptives are UKMEC 3?

A

everything except the copper coil

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28
Q

Regarding breast conditions, when should COCP be avoided?

A

starting in an undiagnosed breast lump/mass/symptoms

BRCA1/BRCA2 carriers

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29
Q

What is the UKMEC guidance on contraception in ovarian cancer?

A

All contraceptions safe to use

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30
Q

Which contraceptions are contraindicated with certain STIs?

A

UKMEC 4 IUD insertion of IUD in a symptomatic chlamydia or active gonorrhoea or in cervicitis or active PID, UKMEC 3 for insertion of IUD in asymptomatic chlamydia

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31
Q

When should you not insert an IUD in a HIV positive patient?

A

If CD4 count <200

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32
Q

Which contraceptive is UKMEC 3 in diabetes?

A

COCP if associated cardiovascular disease or diabetic retinopathy

33
Q

In viral hepatitis, which contraceptive should be avoided?

A

Don’t start COCP in an acute flare

34
Q

What dose difference between the progesterone IUD that lasts for 3 years and theIUD that lasts for 5 years?

A

3 years - 13.5mg

5 years - 58mg

35
Q

What is the risk of having an IUD at <20 years?

A

Increased risk of expulsion

36
Q

What are highest risk factors for IUD expulsion?

A

lactation and insertion within 36 weeks of birth

37
Q

Decompensated liver disease - IUD

A

copper coil safe

mirena should be avoided as liver will find it difficult to metabolise progesterone

38
Q

What dose is the progesterone only implant?

A

68mg

39
Q

When should an IUD be avoided in liver disease?

A

copper coil safe

UKMEC3 for mirena in decompensated liver disease, hepatocellular adenoma and carcinoma

40
Q

What dose of progesterone is in the POP?

A

350micrograms norehisterone

75micograms desogestrel

41
Q

progesterone only contraception and bone mineral density

A

depo has slight increased risk of reduced bone mineral density, in women under 18 other methods should be considered first

42
Q

Progesterone only contraception post abortion/breastfeeding/postpartum

A

All safe to use straight away

Although, non-breastfeeding women don’t require contraception until 21 days

43
Q

Progesterone only contraception in smokers and high BMI

A

safe to use

44
Q

Vascular disease (CHD/TIA/PVD/angina) which progesterone only contraception should be avoided?

A

DEpo injection, otherwise all fine to use in patients with uncomplicated hypertension

45
Q

Which contraception is safe to use in ischaemic heart disease and stroke?

A

Copper coil

46
Q

Which contraceptions should be avoided in IHD/stroke?

A

avoid continuing mirena/POP/implant if stroke or IHD develops
avoid depo UKMEC 4 with stroke/IHD

47
Q

Which progesterone only contraception is UKMEC3 with unexplained vaginal bleeding?

A

implant and depo

POP = UKMEC 2

48
Q

Active or past breast cancer - progesterone only contraceptives

A

Active - UKMEC 4 for all including mirena

Past- UKMEC 3 for all including mirena

49
Q

STIs- progesterone only contraceptives

A

safe to use except mirena

50
Q

HIV - progesterone only contraceptives

A

safe to use except mirena if CD4 count <200

51
Q

Liver disease- progesterone only contraceptives

A

avoid (UKMEC3) if decompensated liver disease or hepatocellular adenoma or carcinoma (including mirena)

52
Q

Cervical/endometrial/ovarian cancer - progesterone only contraceptives

A

safe to use whilst awaiting treatment
mirena is ukmec 4 for starting in endometrial cancer and ukmec 2 for continuing
Do not start mirena whilst awaiting cervical treatment
theoretical risk of POC with cervical cancer and prognosis

53
Q

Oestrogen in COCP

A

Ethinylestradiol

54
Q

When is COCP contraindicated postpartum?

A

0-6 weeks breastfeeding
0- <3 weeks with VTE risk factors
Should be avoided if additional VTE risk factors 0-6 weeks postpartum (UKMEC 3)
Safe to use after 6 weeks

55
Q

COCP post abortion

A

safe to use

56
Q

smoking and COCP

A

ukmec 4 - >35 years and smoking >15/d

ukmec 3 - >35 years and smoking <15/d or quit within the last year

57
Q

BMI and COCP

A

> 35 = UKMEC 3

58
Q

Complicated organ transplant + COCP

A

UKMEC 3

59
Q

Multiple risk factors for CVD + COCP

A

UKMEC 3 (also depo - other POP incl. mirena = UKMEC 2)

60
Q

HTN + COCP

A

UKMEC 3

Except BP >160/>100 or vascular disease = UKMEC 4

61
Q

IHD or Stroke + COCP

A

UKMEC 4!

62
Q

History of vte or current vte + COCP

A

UKMEC 4

63
Q

First degree relative <45 years had VTE + COCP

A

UKMEC 3

64
Q

Major surgery + prolonged immobilisation + COCP

A

UKMEC 4

65
Q

Immobility + COCP

A

UKMEC 3

66
Q

Thrombogenic mutations + COCP

A

UKMEC 4

67
Q

complicated heart disease/impaired cardiac function/AF + COCP

A

UKMEC 4

68
Q

Migraine + COCP

A 
with aura (at any age) = UKMEC 4
5 years ago with aura = UKMEC 3
Migraine without aura starts whilst on COCP = UKMEC 3 to continue
69
Q

Breast cancer + COCP

A

Active = UKMEC 4
Past = UKMEC 3
BRCA1/BRAC 2= UKMEC 3
Undiagnosed breast lump - can continue UKMEC 2 but shouldnt start UKMEC3

70
Q

STIs + COCP

A

Safe

71
Q

HIV + COCP

A

safe

72
Q

Diabetes + COCP

A

UKMEC 3 if diabetic retinopathy or other cvd risk factors

73
Q

Gallbladder disease + COCP

A

UKMEC 3 if medically treated or current symptomatic disease

74
Q

Viral hepatitis + COCP

A

UKMEC 3 for starting COCP if active infection

75
Q

Liver disease + COCP

A

UKMEC 4 for hepatocellular adenoma and carcinoma and for decompensated liver disease

76
Q

SLE + COCP

A

UKMEC 4 if anti-phospholipid antibodies present

77
Q

When can copper IUD be used for emergency contraception?

A

0-120hours

Or within 5 days of ovulation

78
Q

When can oral emergency contraception be used?

A

Ullipristal acetate within 120 hours

Levenorgesterel within 72 hours 1.5mg

Gynaecology (10 decks)

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