Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GOSH > Contraception > Flashcards

Contraception Flashcards

1
Q

List some non-hormonal methods of contraception:

A 
IUD and IUS
Male condom
Female condom
Diaphragm and cervical cap
Persona
Withdrawal method
Natural method
Male and female sterilisation
Emergency contraception
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is an IUD?

A

Intra-uterine device. Upper bearing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is an IUS?

A

Intra uterine system progesterone releasing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How long does an IUD last?

A

5-10 years

if fitted over 40, can stay until no longer required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When is an IUD fitted?

A

Normally in first half of menstrual cycle
OR
anytime if patient definitely not pregnant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When does the IUD become effective?

A

immediately

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When would you advise a women on non-hormonal contraception to finish using contraception?

A

over 50: after 1 year of amenorrhoea

under 50: after 2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is an IUD made out of?

A

Copper

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does an IUD work?

A

Primary effect (through copper ions):
toxicity on sperm and ova
decreased sperm motility
decreased sperm survival

Secondly effect (on endometrium):
impedes sperm transfer
sperm phagocytosis
impedes implantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How long does an IUS last for?

A

3-5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the different types of IUS?

A

mirena

jaydess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

when is a mirena coil used?

A

menorrhagia

HRT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does the mirena coil contain? How long does it last for?

A

52mg levonorgestrel

5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does the jayvees coil contain? How long does it last for?

A

13.5mg levonorgestrel

3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is a benefit of Jaydess over mirena?

A

Jaycees has smaller frame and narrower insertion tube

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When does an IUS become effective?

A

Depends when inserted.

days 1-7 = effective at once

after day 7 = additional precautions needed for one week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does an IUS work?

A

Thickening of cervical mucus, inhibiting passage of sperm

Prevention of endometrial proliferation

Prevention of ovulation in some women’s cycles

Local effect of foreign body on uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are some contraindications for using intra-uterine devices?

A 
Pregnancy
Undiagnosed bleeding
Cervical/uterine pre-treatment 
active PID or PID in last 3 months
Current chlamydia, GC or cervicitis
Uterine abnormality
Gestational trophoblastic disease
Long QT syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How can you exclude a possible implanted pregnancy (to ensure you can insert IUD)?

A

Menstruating (NOT WITHDRAWAL BLEED)
No sex since menstruation
Using another reliable method (CONDOMS DO NOT COUNT)
No sex in last 3 weeks and PT negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What bleeding pattern occurs with hormonal IUD?

A

Irregular bleeding
Eventual amenorrhoea (in some women)
Bleeding much lighter in most

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What bleeding pattern occurs with non-hormonal IUD?

A

Heavier periods but regular bleeding

Intermenstrual spotting initially

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What should you be aware of in an established IUD used? What could this be indicative of?

A

Change of bleeding pattern in an established user

Carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When is expulsion most likely to occur? What can this cause?

A

Most common: in first 3 months after fitting
with heavy menstruation

IUD failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are women asked to do to prevent undetected expulsion?

A

check their threads after every period, to ensure they can feel threads, but not the device, protruding from the cervix.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

In what women is perforation more likely to occur?

A

Early post natal period in lactating women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

When, within the fitting process and the IUD being present, is perforation most likely to occur?

A

at time of fitting - usually painful at this time

or over time - may not be painful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are some risks of IUDs?

A

Expulsion

Perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is it essential to check in a woman who has become pregnant using an IUD? Why?

A

Assess whether ectopic

1 in 20 IUD contraceptions are ectopic (but there is still reduced number of total ectopic pregnancies compared to general population)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Can a woman using and IUD continue with her pregnancy if it is uterine?

A

Yes
BUT
higher rate of miscarriage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what can be done to reduce the risk of miscarriage in a woman who is pregnant and using an IUD?

A

Remove it if threads can be seen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Can IUDs cause pelvic infection?

A

NO (risk is only higher in three weeks post-insertion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What should you do before inserting and IUD to prevent risk of infection?

A

Screen for STIs - offer if high risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

When might you give prophylactic antibiotics while inserting and IUD? What should you give?

A

If it is an emergency fitting and cannot be delayed for STI results

Azithromycin 1g PO
Metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What should you include when counselling a woman about IUDs?

A

E and 6Ps:

Explosion
Pregnancy (failure rates and ectopic)
Perforation
Periods
PID
Procedure
Preogestogenic side effects (IUS)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

When should an emergency IUD be fitted? Why?

A

within 5 days of potential conception or ovulation

implantation can definitely NOT occur earlier than 5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the failure rate of emergency IUD?

A

<1:1000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Which type of coil is given as emergency IUD?

A

Copper

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How does a copper coil act as an emergency contraception?

A

Toxic to ovum and sperm

effective immediately after insertion

works mainly by inhibiting fertilisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

If a patient chooses an emergency IUD and you need to refer on for it, what should you do?

A

Give oral method first - lose valuable time (therefore efficacy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are the side effects of an emergency IUD?

A

Same as routine use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is ulipristal? How long can it be used for after risk?

A

Emergency contraception

30mg ulipristal acetate - selective progesterone receptor modulator

licensed for up to 120 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How does ulipristal work?

A

delays or inhibits ovulation

efficacy sustained to 5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

how does ulipristal compare to levonorgestrel in terms of efficacy and IUD?

A

at least as effective as levonorgestrel <72 hours

No studies comparing to IUD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what things might limit efficacy of ulipristal?

A

Enzyme INDUCERS may reduce efficacy

Progestogens (uliprsital has no effect on hormonal contraception, but hormonal contraception may interfere with ulipristal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

When should you not give ulipristal?

A

Hypersensitivity
Pregnancy
Severe asthma (uncontrolled with oral glucocorticoids)

not ideal if on enzyme INDUCERS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What advice should you give to a woman who is breast feeding and needs to take ulipristal?

A

Should express and scared milk for 7 days after use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What advice would you give to a woman on hormonal contraceptive/wanting hormonal contraceptive who needs to take ulipristal?

A

Leave taking hormonal method for 5 days after ulipristal administration before starting another hormonal method

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is levonelle? What does it contain?

A

Progesterone only emergency contraceptions (POEC)

1500 micrograms levonorgestrel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What influences the failure rate of levonorgestrel (morning after pill)?

A

Timing - ideally take within 72 hours of intercourse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

How does levonorgestrel work?

A

delays ovulation (prevent follicular rupture or cause luteal dysfunction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

How can levonelle (levonorgestrel) be acquired by women?

A

Available over counter £25, if certain criteria are fulfilled

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

How long does levonelle act for, if taken before LH surge? What happens to the effect if it is taken closer to ovulation?

A

5-7 days

(by which time, any sperm in reproductive tract will be non-viable)

Less likely to interfere with ovulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

When might you not want to give a woman levonorgestrel (levonelle)?

A

Enzyme inducers (but can double dose of this drug in this case - NOT the case for ultiprel)

Displace warfarin from binding site - increase INR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What are common side effects with oral emergency contraceptives?

A

nausea and vomiting

breast tenderness

disturbance of menstruation (menstrual delay - advise to do PT in there weeks if there is any doubt)

dizziness, tiredness and headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What does the sympto-thermal method rely on?

A

Temperature, which rises after ovulation

Mucus, presence, absence and characteristics

Cervix, position and degree of opening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is persona?

A

Measures fertility by predicting ovulation

assists in symptom-thermal method?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

When is persona most reliable?

A

sexual intercourse is restricted until after ovulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is the symptom-thermal method?

A

method of family planning - avoid sex on days when woman is most fertile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is the lactational amenorrhoea method (LAM)?

A

family planning method relying on:

being completely amenorrhoeic after child birth

fully breast feeding (through night)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

How long does LAM generally last for?

A

6 months in western countries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

How effective is LAM?

A

Can be very effective IF ALL CRITERIA ARE FULFILLED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What is important to tell women who are considering using/currently using LAM for contraception?

A

1) have to have all three criteria to minimise risk

2) first period follows ovulation, so they won’t know that they’re ovulating until after first period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

How is female sterilisation carried out?

A

Laparoscopically - clips, rings or diathermy

Newer method: ensure - inserts in fallopian tube. performed hysteroscopically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What is the risk of failure of female sterilisation? Who is the risk higher in?

A

1 in 200 lifetime risk

younger women
sterilisation immediately postpartum or termination of pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Can sterilisation be reversed?

A

can be attempted, success depends on method used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

How is a vasectomy usually performed?

A

Local anaesthetic

single incision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

How long do patients need to wait before they can rely on their vasectomy?

A

two negative specimens

2 months post-procedure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What is the lifetime failure rate of vasectomies?

A

1:2000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Is reversal of vasecomty possible?

A

possible BUT

even if vas ability returned, development of ANTI-SPERM antibodies may prevent fertility returning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

How does a diaphragm work? how does this compare to a cap?

A

diaphragm: covers anterior wall of vagina and cervix
caps: covers only cervix

71
Q

What are caps and diaphragms usually used with?

A

spermicide

72
Q

What are caps/diaphragms made out of? are they single or multiple use?

A

latex or silicone

some single, some reusable if washed

73
Q

What are female condoms made out of?

A

polyurethane

74
Q

Are female condoms single or multiple use?

A

single use only

75
Q

How does a vaginal sponge act as contraception? what is the problem with these?

A

Contains spermicide

have a higher failure rate than female condoms, diaphragms and caps

76
Q

Are vaginal sponges single or multiple use?

A

single use

77
Q

What are different methods of combined hormonal contraception?

A

Pills
Patch
Ring

78
Q

What is the difference between COC and CHC?

A

COC (combined oral contraception ie pills)

CHC (combined hormonal contraception ie pills, patch and ring) in the subsequent slides.

79
Q

When does pregnancy begin?

A

When implantation has occurred (according to UK law)

80
Q

What does contraception do?

A

prevent pregnancy

81
Q

What are the hormonal methods of contraception?

A 
Implants
Intrauterine system
Injectables
Pills
Patches
Vaginal Rings
Emergency contraception
82
Q

What are the non-hormonal methods of contraception?

A 
Intrauterine devices
Sterilisation
Barrier methods
Natural methods
Withdrawal
83
Q

What does LARC stand for?

A

long-acting reversible contraception

84
Q

What are the different LARC methods?

A

Implant
Injectable
IUD (intrauterine device)
IUS (intrauterine system – Mirena®)

85
Q

What are the failure rates for different contraceptive methods (assuming perfect use)?

A 
Chance: 85%
Condom: 2%
Pill: 0.3%
Depp provera (injection): 0.6%
Copper IUD: 0.6%
Female sterilisation: 0.5%
Mirena IUS: 0.2%
Implanon: 0.05%
86
Q

What is UK-MEC and what does it mean?

A

UK medical eligibility criteria

UKMEC 1 (no restriction)- always use
UKMEC 2 (advantages outweigh risks) - benefits outweighs the risks
UKMEC3 (risks outweigh advantages) - caution
UKMEC4 (unacceptable health risk) - DO NOT use

87
Q

What do combined hormone contraceptions contain?

A

Ethanol oestrodiol (oestrogen) - levels stay relatively the same

Progesterone - levels and types differ

88
Q

What things are women often interested in when discussing contraception options?

A

S/E: bleeding (more/less etc.)
Weight gain
Pain

Risks: fertility

Efficacy

How it works

89
Q

What are the three different types of pills?

A

monphasic, biphasic and triphasic

90
Q

What things should make sure you discuss with women when deciding on contraceptives?

A

Risks with dangerous women (any risks eg. inducers, clots etc.)

Compliance

Understanding

91
Q

What progestogens are commonly contained in older pills? What are the side effects of these? What are the benefits of these pills?

A

2nd generation progestogens:
levonorgestrel and norethisterone

S/E: androgenic - hair growth and acne

Reduced VTE risk compared to newer pills

92
Q

What do the terms: monophasic, biphasic or triphasic

mean?

A

monophonic - hormonal levels in pill stays same throughout cycle

biphasic - hormonal levels in pill course changes once in cycle (two different types of tablets)

triphasic - hormonal levels in pill course changes twice in cycle (three different types of tablets)

93
Q

Which pills are most commonly used currently: monophasic, biphasic or triphasic?

A

Monophasic

94
Q

What types of progestogens are used in newer pills? what is the benefit of this?

A

3rd generation progestogen

weak androgenic/anti-adndrogenic activity - therefore less side effects

95
Q

How do combined pills work?

A

Inhibition of ovulation

EE inhibits FSH secretion, follicles do not develop

Progestogen inhibits LH surge so no ovulation

Cervical mucus effects

Atrophic endometrium

96
Q

What are some UKMEC 1 conditions for the COCP?

A 
Age - menarche to 40Y
Benign breast disease
Past ectopic
Endometrial or ovarian Ca
Pelvic surgery 
PID
STI
HIV/AIDS
Non-migrainous headaches
Epilepsy (if not on enzyme inducers)
97
Q

What are some UKMEC 2 conditions for the COCP?

A 
Age - menarche to 40Y
Benign breast disease or ovarian tumour
Past ectopic
Endometrial or ovarian Ca
Pelvic surgery 
PID
STI
HIV/AIDS
Non-migrainous headaches
Epilepsy (if not on enzyme inducers)
Endometriosis
Cervical ectropion
ABX
98
Q

What are some UKMEC 3 conditions for the COCP?

A

Breastfeeding 6wks - 6m Postpartum

Postpartum <21d

Smoking <15 cigs/d & >35y

BP140/90 - 159/99
or if cannot measure

Non-focal Migraine > 35y

History of Breast Ca

Gallbladder Disease
symptomatic or on medical treatment

Cirrhosis (mild compensated)

Taking Enzyme Inducers

99
Q

What are some UKMEC 4 conditions for the COCP?

A

Breastfeeding <6wks Postpartum

Cirrhosis (severe)

Smoking >15cigs/d & >35y

Liver Tumours

Multiple risk factors for Arterial CVD

BP >160/100

Current or past VTE

Major Surgery with Immobilisation

IHD

CVA

Valvular Heart Disease
- complicated by
Pulm.HT,AF, or SBE

Focal Migraine

Breast Ca

Complicated DM

100
Q

If you start a COCP at any time (when not pregnant), how long does protection take to kick in - what should you tell the patient?

A

can take up to 7 days

advice them to use condom

101
Q

If you start a COCP on days 1-5, how long does protection take to kick in - what should you tell the patient?

A

Protection should start straight away, no need for condoms

UNLESS

short cycle (23 days or less) = condoms for 7 days

102
Q

If you start a COCP postpartum, how long does protection take to kick in - what should you tell the patient?

A

up to day 21 postpartum, - should start straight away, no condoms needed

day 22-28 postpartum- should use condom for 7 days

After 28 days - must exclude pregnancy

103
Q

If you start a COCP post TOP or miscarriage <24 weeks, how long does protection take to kick in - what should you tell the patient?

A

cover starts straight away, no need for condoms

104
Q

If you have TOP of miscarriage at >24 weeks, how long does protection take to kick in - what should you tell the patient?

A

up to day 21 since - no condoms

after day 21, condoms for 7 days

105
Q

If you start a COCP by changing from a POP, how long does protection take to kick in - what should you tell the patient?

A

Can change any time
Cover continues
No condoms

106
Q

If you start a COCP by changing from Implanon, how long does protection take to kick in - what should you tell the patient?

A

Any time prior to removal or on day of removal = no condoms

107
Q

Does the location of one missed pill in the cycle matter?

A

ONE missed pill anywhere in pack is not a problem (even if first pill)

108
Q

Where is the worst place in the cycle to miss more than one pill?

A

Start or end of pack

109
Q

Where is the least-risky place in the cycle to miss pills?

A

in the middle (after 7 days)

110
Q

What are some common enzyme inducers?

A

ABX: rifampicin, rifabutin

anti-depressants: St John’s wart

Anti-epileptics: carbamazepine, phenytoin, primidone, topiramate, phenobarbitol

Antifungals

Anti-retrovirals

111
Q

What should you prescribe and advise for women who are on long term enzyme inducers and choose to have CHC?

A

CHC containing 50mcg EE (or mestranol)

Also to consider to continue to use condoms

112
Q

What should you prescribe and advise for women who are on long term enzyme inducers and choose to have CHC?

A

CHC containing 50mcg EE (or mestranol)

Also to consider to continue to use condoms

113
Q

What should you prescribe and advise for women who are on short term enzyme inducers and choose to have CHC?

A

use condom in addition to CHC whilst on enzyme-inducers and for 4 weeks afterwards

114
Q

What should women do if they vomit within 2 hours of taking pill?

A

Take another or follow rules for missed pills

115
Q

What should women do if they have severe diarrhoea for > 24 when taking pill?

A

Keep taking pills
BUT
follow missed pill instructions for each day of diarrhoea

116
Q

What are the non-contraceptive benefits of COC?

A

Can reduce dysmenorrhoea and PMS

Prevents irregular bleeding

Decreased menorrhagia - decreased iron-deficiency

Reduced incidence of functional ovarian cysts

Reduced problems with benign breast disease

Reduced PID

Reduced ovarian, uterine and colon cancer

117
Q

What are the benefits of general CHC?

A 
Reduction in menstrual disorders: 
functional ovarian cysts
menorrhagia
irregular bleeding 
dysmenorrhoea 
PMS

Reduced iron deficiency anaemia

Reduced PID

Reduced ectopic pregnancy

Reduced fibroids

Reduced benign breast disease

Symptomatic relief/treatment of endometriosis

Reduced climacteric symptoms

Increased osteoporosis protection

Reduced rheumatoid arthritis

Reduced endometrial, ovarian and colorectal cancer

118
Q

What are some risks associated with combined hormonal contraceptive?

A

VTE (low) - obesity is most significant risk factor

Stroke (ischaemic)

Acute MI (safe, unless other risk factors present)

Breast cancer risk is extremely small

Cervical cancer

119
Q

If a woman wants to take the pill but has MI or VTE risk factors, what can you recommend instead of COCP?

A

POP

120
Q

What are some side effects of COCP caused by oestrogen?

A

Breast enlargement/tenderness

Bloating

Nausea

Non-infective vaginal discharge

Headaches

Chloasma

Photosensitivity

(not usually a problem with modern low dose pills)

121
Q

What are some side effects of COCP caused by progesterone?

A 
Acne 
Greasy hair
Hirtuitism
Depression
Loss of libido
Vaginal dryness

(less likely in newer pills, if there is a problem, select a third generation pill)

122
Q

What is an Evra patch?

A

A hormone-releasing contraceptive patch.

Approximately 2in x 2in in size

Realeases synthectic oestrogen and progestrone

123
Q

When does an Evra patch begin to be effective once it is stuck on?

A

immediately effective

124
Q

What hormones does an evra patch contain?

A

Synthetic oestrogen and progesterone

125
Q

How is an Evra patch used?

A

New patch once a week for three weeks

stop using patch for 7 days = patch-free week. Get withdrawal bleed (but this might not always happen)

apply new patch after 7 days (even if still bleeding)

126
Q

Where can an Evra patch be placed?

A

Any clean, hairless, dry area of skin

SHOULD NOT BE:
sore/irritated skin
anywhere it might be rubbed off
breast

127
Q

What is a NUVA ring (aka vaginal ring)?

A

Small plastic ring

5.5cm in diamete and 4 mm thick

128
Q

What does a NUVA ring contain? How does this act?

A

Synthetic oestrogen and progestogen

Prevents ovulation

129
Q

How is a NUVA ring used?

A

Patient inserts ring in to vagina

Left for 21 days

After 21 days, removed and disposed of

Leave out for 7 days

Insert new ring after 7 days and leave in for 21 days

130
Q

What hormone is given in a contraceptive injection?

A

progestogen

131
Q

How does the contraceptive injection work?

A

Prevents the sperm reaching an egg (thickens cervical mucus)

Thins the womb lining

Prevents ovulation.

132
Q

What are the three types of contraceptive injection offered in the UK?

A

Depo-provera

Noristerat

Sayana press

133
Q

Which contraceptive injections are given in to gluteus or in arm?

A

Depo

Noristerat

134
Q

Which contraceptive injection is given under the skin (abdo or thigh_?

A

Sayana

135
Q

How could you describe an IUD to a patient?

A

Small T-shaped device

Plastic or copper

Works by stopping sperm and egg from surviving in womb or fallopian tubes

Prevents fertilised egg from implanting in the womb

Long-acting
Reversible

Different types and sizes

136
Q

What is the implant?

A

small flexible tube about 40mm long

inserted under skin of upper arm

137
Q

How does an implant work?

A

anovulant - slowly realises progestogen (etonorgestrel)

thickens cervical mucus

Endometrial thinning

138
Q

What is the most common implant used in the UK?

A

Nexplanon

139
Q

Which oestrogen is contained in most COCP? What are the exceptions?

A

Ethanol oestrodiol

Norinyl-1 (mestranol)
Qlaira
Zoely

140
Q

Most pills are monophonic 21 day pills - what are the exceptions?

A

Qlaira (26 active, 2 inactive)

Zoely (24 active, 4 inactive)

141
Q

What are ED pills? What are the advantages of these?

A

every day pills - 21 days of active pills, 7 inactive pills.

Aid compliance

142
Q

What is the most common pill to start someone on? What progesterone does it contain? What generation is this?

A

microgynon

Levongestrel

2nd generation

143
Q

What is the action of CHC?

Which of these is the main mode of action?

A

oestrogen and progestogens prevent pituitary release of FSH and LH = prevent ovulation - main mode of action

thin endometrium = prevent implantation

Cervical mucus excludes sperm

144
Q

What are common side effects of COCP?

A

Nausea
mastalgia (breast tenderness)
headache
irregular bleeding initially

145
Q

What are some important contra-indications for CHC?

A 
Smoking, age>35, >15 a day
BMI over 35
BP >= 160/95 (or 90)
Migraine with aura
Vascular disease
Hx of VTE
Complex congenital heart disease
Breast cancer 
Liver disease (abnormal LFTs or tumour)
146
Q

Do broad spectrum antibiotics affect pill efficacy?

A

no

147
Q

What should you advise a girl who has missed 2 pills?

A

Abstain or condoms for 7 days

148
Q

What would you advise a girl who has made some pill mistakes in the last week of her pack?

A

run packs together

149
Q

How many days’ worth of hormones does a patch have?

A

9 days

150
Q

What are some scenarios in which you should you assume cover has been lost when using the a patch?

A

patch on >9 days

Patch has fallen off and not replaced within 24 hours

151
Q

What should you do if your patch comes off?

A

Replace within 24 hours

If not within 24 hours - abstain or condoms for 7 days

152
Q

When is cover by the contraceptive ring lost?

A

If ring out of vagina for >3 hours

Ring-free week extended

153
Q

What happens to a ring that has been used for 3 weeks?

A

take out for a week
wash with tepid water
replace

154
Q

How does progestogen act as contraception?

A

Prevent ovulation
Thicken cervical mucus
Reduces endometrial receptivity

Importance of each varies with method

155
Q

What are some common problems seen with progestogen only contraception?

A

bleeding irregularities - rare to have regular cycles. CAN’T PREDICT WHAT PATTERN WILL BE

General progestogen s/e:
headaches
mood changes
weight gain
acne

Progestogen = pre-menstrual

156
Q

How is taking a POP different to taking a COCP?

A

Taken continuously, no pill free interval.

Packs of 28

Monophonic

157
Q

What is the most common Progestogen in POP currently? Which others may also be included?

A

Most common: desogestrel

Levonorgestrel
Norethisterone

158
Q

What are some contraindications for POP?

A

Breast cancer in the last 5 years (4)

Current enzyme inducers (3)
Continuing use following CVA (3)
Severe cirrhosis, hepatoma (3)

159
Q

What is the window for taking a POP?

A

Used to be 3 hours

Now 12

160
Q

What is the window for taking a COCP?

A

24 hours

161
Q

How do traditional POPs work?

A

Thicken cervical mucus
Reduce endometrial receptivity
May suppress ovulation

162
Q

What is the best known brand of POP? What does it contain?

A

Cerazette

Desogestrel

163
Q

What are the precautions that need to be taken if a POP is missed?

A

Additional precautions for 48 hours

Consider EC if necessary

164
Q

What are import things to cover when counselling someone about taking a POP?

A

Method use

REGULAR DAILY PILL TAKING (shorter window than COCP)

Side effects: bleeding pattern

Reasons for failure and enzyme inducer interaction (as with COCP)

165
Q

What are some contraindications of the implant?

A

Breast cancer in last 5 years (4)

Current enzyme inducers (3)

Continuing use following a CVA (3)

Severe cirrhosis, hepatoma (3)

166
Q

What should you include when counselling a patient on use of an implant?

A

Lasts 3 years

Irregular bleeding pattern (can be controlled, some people are amenorrhoeic)

Other progestognenic SEs

Affected by enzyme inducers

Fitting and removal

Deep implants (harder to remove, US used)

167
Q

What can be done if bleeding is a problem for a patient with an implant?

A

COC

168
Q

What are deep provera contraindications?

A

Breast cancer (4)

Multiple risk factors for cardiovascular disease (3)

CVA (3)

Diabetes with vascular complications (3)

Severe cirrhosis, hepatoma (3)

169
Q

How often is the injection given? By what route? Which injection is the exception to this?

A

IM injection every 12 weeks (effective for up to 14 weeks)

(Noristerat - every 8 weeks)

Sayana = S/C

170
Q

What are the side effects of the injection?

A

Weight gain (3kg by 2 years) - only contraceptive with proven weight gain

Fertility delay (6-12 months after stopping)

Bone mineral density

171
Q

What is a benefit of the injection?

A

amenorrhoea

172
Q

What are the interactions for the injection?

A

NONE.

Effective even with strong enzyme inducers

Ideal for patients with HIV or epilepsy

173
Q

Which contraceptive might be good for a patient with HIV or epilepsy? Why?

A

Deep injection

No interactions

GOSH (33 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions