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Reproduction SB > Contraception > Flashcards

Contraception Flashcards

1
Q

what does the natural family planning method take in to account to work as contraception

A

1) Basal body temperature
2) Cervical mucous
3) Cervical position
4) “Standard” days
5) Breast feeding

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2
Q

what does the cervical mucous tell you about ovulation

A

Thick and sticky post ovulation

3 days after thinner, watery, stretchy mucous

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3
Q

what does the cervical position tell you about ovulation

A

when fertile, cervix is high, soft and open

when less fertile, cervix is low in vagina, firm and closed

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4
Q

what days tend to be most fertile in a 28 day cycle

A

day 8 to 18

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5
Q

what criteria is needed to know that breast feeding is working as contraceptive

A

1) exclusively breast feeding
2) less than 6/12 post natal
3) amenorrhoeic

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6
Q

what does the pearl index represent

A

no. of contraceptive failures per 100 women users/year

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7
Q

what is LARC and examples

A

long acting reversible contraception

Depo Provera IM ( medroxyprogesterone acetate)
Sayana press (SC version)
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8
Q

what are VLARC and examples

A

very long acting reversible contraception

IUD
IUS
Implant

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9
Q

how does the Depo provera/ Sayana press [LARC] work

A

inhibits ovulation

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10
Q

when is Depo provera/ Sayana press [LARC] given

A

every 13 weeks

lasts 14 weeks

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11
Q

what else does Depo provera/ Sayana press [LARC] have an effect on

A

thickens cervical mucus

endometrium

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12
Q

what are side effects of Depo provera/ Sayana press [LARC]

A

irregular bleeding

weight gain

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13
Q

what hormones are present in Depo provera/ Sayana press [LARC]

A

progesterone only

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14
Q

what needs to be done before first prescription of Depo provera/ Sayana press [LARC]

A

BP
BMI
risk factors for osteoporosis

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15
Q

what are risk factors for osteoporosis

A 
Underweight
Anorexia
Prolonged steroid use
XS alcohol intake
Immobility
Family history
Smoking
Low trauma fracture
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16
Q

when do you start Depo

A

can be started up to and including Day 5 of the cycle without the need for any additional contraception

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17
Q

when do you start Depo after day 5

A

any other time provided she is ‘reasonably certain’ she is not pregnant and needs to use condoms/abstain for 7 days

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18
Q

what criteria is there to be reasonably certain a women is not pregnant

A

No sex since last period

Consistently using reliable contraception

< 7 days since last normal period

< 4 wks post partum (not breast feeding)

Fully breastfeeding, amenorrhoeic and < 6m post partum

Negative preg test AND > 3 wks since UPSI

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19
Q

side effects of Depo

A

weight gain
delay in return of fertility
irregular bleeding
risk of osteoporosis

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20
Q

what is different about the IUD compared to other devices

A

it is non-hormonal

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21
Q

how does IUD’s work

A

prevent fertilisation

decreases sperm motility and survival

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22
Q

what are side effects of IUD

A

Periods may be heavier, longer and more painful

Small chancer of getting infection in first 20 days
perforation 1-2/1000
Expulsion 1/20, most in first 3/12

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23
Q

when can an IUD be started

A

up to 5 days after UPSI
[it is immediately protective]

Up to 5 days after predicted date of ovulation (I.e. day 19 of 28 day cycle)

Either within 48 hrs or > 4 weeks post partum

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24
Q

what hormones do IUS contain

A

progesterone only

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25
Q

how does IUS work

A

Prevents endometrial proliferation (implantation)

Also thickens cervical mucus

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26
Q

what is side effects of IUS

A

Irregular bleeding/lighter+less frequency bleeding and spotting in first 6 months
Can get infection in first 20 days

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27
Q

when can an IUS be started

A

Within first 7 days of period
If after first 7 days use additional contraception
Either with in 48 hrs or > 4 weeks post partum

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28
Q

what are contraindications to IUD and IUS

A 
Current pelvic infection
Abnormal uterine anatomy
Pregnancy
Sensitivity to any of the constituents
Gestational trophoblastic disease when BHCG levels are abnormal/persistently elevated
Endometrial ca
Cervical ca awaiting treatment
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29
Q

what should be checked before fitting IUD/IUS

A

PV to check uterine size/position

BP and pulse if you think necessary

30
Q

what is the implant

A

single, non biodegradable, subnormal rod

31
Q

how does the implant work

A

inhibition of ovulation

32
Q

when can the implant be fitted

A

Within first 5 days of cycle

Up to day 5 post first/second trimester abortion

On or before day 21 postpartum

33
Q

what hormone does the implant release

A

progesterone only

34
Q

how long does the implant last for

A

3 years

35
Q

S.E of implant

A

irregular bleeding
weight gain
acne

nerve damage/vascular injury on insertion

36
Q

what are the types of short acting contraception

A

Combined Hormonal Contraception (CHC)

Progestogen Only Pill (POP)

Emergency Hormonal Contraception (EHC)

37
Q

what does the COC contain

A

estrogen and progesterone

38
Q

how does the COC work

A

inhibits ovulation
thickens cervical mucous
makes endometrium unfavourable for implantation

39
Q

COC packet contains 21 pills - how does the system work

A

first 7 pills inhibit ovulation

remaining 14 maintain anovulation

40
Q

side effects of COC

A

Increases risk of venous thromboembolism

Increases risk of breast and cervical cancer

Small risk of increase in BP > systemic hypertension

41
Q

what should a person be advised to do if they miss 1 pill

A

Over 24 hours and less than 48 hours
Take the missed pill as soon as it is remembered
Remaining pills are taken at the normal time
EC is not required

42
Q

what should a person be advised to do if they miss 2 or more pills

A

More than 48 hrs without pills
Take the most recent missed pill
Take the remaining pills at the correct time
Use condoms or abstain until 7 pills have been taken consecutively

43
Q

through what mechanism does COC stop ovulation

A

action on hypothalmic-pituitary-ovarian axis to reduce LH and FSH

44
Q

how does CTP work - contraceptive patch

A

One patch is applied and worn for 1 week to suppress ovulation.

The patch is reapplied weekly for a further 2 weeks

The 4th week is patch-free to allow a withdrawal bleed

New patch is applied after 7 patch-free days

45
Q

how does CVR work - vaginal ring

A

A ring is placed into the vagina and left continuously for 21 days.

After a ring-free interval of 7 days to induce a withdrawal bleed, a new ring should be inserted

46
Q

what factors require consideration when prescribing COC

A

absorption - impaired in GI conditions

metabolism - increased in liver enzyme induction, drug interaction

metabolic effects

forgetting

47
Q

what is Cyproterone acetate

A

works as COC

used in the Tx of acne and hirsutism

48
Q

when is COC contraindicated

A

patient suffers migraine ith aura

49
Q

why is migraine with aura a contraindication of COC

A

Migraine with aura increases the risk of ischaemic stroke

CHC further increases thi risk

50
Q

what is ‘aura’ with migraine

A

A ‘change’ occurring 5 – 20 minutes before the onset of headache

May be visual, typical scotoma

Altered sensation

Smell or taste

Hemiparesis

51
Q

what is COC protective against

A

ovarian and endometrial cancers
beneficial effect on acne
can decrease bleeding

52
Q

side effects of COC

A

Unscheduled bleeding - usually settles with time, don’t change before 3 months
Mood changes
WEight gain

53
Q

side effects of CTP - the patch

A

more breast pain, nausea, painful periods than COC/CVR

54
Q

side effects of CVR - vaginal ring

A

less bleeding problems, acne, irritability/mood changes

55
Q

why is CHC useful along side emergency contraception [EC]

A

as a quick start and can be used as riding if the new contraception that patient wants has a delayed started

56
Q

what types of progesterone only pills [POP] are there

A

Older POP - levonorgestrel, norethisterone

Newer POP – etonorgestrel

57
Q

how does POP work

A

primary = Thickening of cervical mucous

secondary = Suppression of ovulation, decreased endometrial receptivity to blastocyst, reduction in cilia activity in fallopian tube

58
Q

what does POP interact with

A

Liver enzyme inducers - Cytochrome P450

59
Q

how are POP taken

A

older pills

  • Daily at same time
  • No break
  • Within 24 - 27 hours of last dose

newer pills
- Daily at same time within 24 – 36 hours of last dose
No break

60
Q

what happens is a patient is on POP and has = One missed dose plus UPSI

A

emergency contraception plus 2 days extra protection

61
Q

what are complications of vasectomy

A

Anaesthetic complications

Pain

Infection

Bleeding /haematoma

Failure

Post-op testicular, scrotal, penile, lower abdominal pain

62
Q

how soon are people protected on the POP

A

Protected immediately if started on day 1-5 of period

If taken after day 5 then must wait 2 days until protected

63
Q

in terms of legality, when can an abortion happen

A

only if two registered medical practitioners are of the opinion, formed in good faith, that an abortion is justified within the terms of the Act

64
Q

what is the types of methods of abortion that can be done and what time frame can they be done in

A

Surgical termination up to 12 weeks

Medical termination up to 18 weeks and 6 days

65
Q

for medical termination, what are the 3 time frames that affect the treatment

A 
early = up to 9 weeks 
late = 9-12 weeks
mid-trimester = 12-24 weeks
66
Q

what are the 2 steps in the process of medical TOP

A

1) Oral MIFEPRISTONE 200mg

2) 24-48 hours later – Vaginal (or oral) prostagladin e.g. misoprostol, gemeprost

67
Q

what are the methods of surgical treatment and what time frames are they in

A

Vacuum aspiration
= 6-12 weeks

Dilatation and evacuation
= 13-24 weeks

68
Q

what is required before surgical TOP

A

Cervical ‘priming’ – vaginal prostaglandin

69
Q

what are the risks of TOP surgically

A 
Pain, Haemorrhage
Infection
Incomplete/failed procedure
Uterine perforation
Cervical trauma
Anaesthetic complications
Ongoing pregnancy
Uterine rupture
70
Q

what is the follow up of a TOP

A

Urine Pregnancy Test at 2-3 weeks

71
Q

what are the methods of emergency contraception and in what time frame can they be used

A

Oral =
Levonelle – up to 72hrs post UPSI
ellaOne – up to 120hrs post UPSI

Intrauterine =
Copper IUD - up to 120hrs post UPSI

72
Q

what follow should be done after emergency contraception

A

urine pregnancy test after 3 weeks

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