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Reproductive System > Contraception > Flashcards

Contraception Flashcards

1
Q

What are the basic methods of contraception?

A

Hormonal
Non-hormonal
Permanent

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2
Q

In the UK, what percentage of women aged 16-49 currently use the OCP as contraception?

A

25%

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3
Q

In the UK, what percentage of women aged 16-49 currently use the progestogen only pill as contraception?

A

5%

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4
Q

In the UK, what percentage of women aged 16-49 currently use progestogen only implants or injectables as contraception?

A

3%

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5
Q

In the UK, what percentage of women aged 16-49 currently use intrauterine methods of contraception?

A

6%

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6
Q

In the UK, what percentage of women aged 16-49 are sterilised?

A

28%

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7
Q

In the UK, what percentage of women aged 16-49 are not using contraception despite being sexually active and having no wish to become pregnant?

A

12%

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8
Q

What are the features of an ideal contraceptive?

A 
100% Reversible 
100% Effective 
Convenient and unrelated to intercourse
Free of adverse side effects 
Protective against STIs 
Low maintenance 
Non-contraceptive benefits
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9
Q

What methods of contraception are 100% reversible?

A

All except sterilisation

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10
Q

What methods of contraception are 100% effective?

A

None, best option is vasectomy followed by implant

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11
Q

What methods of contraception are convenient and unrelated to intercourse?

A

Most except condoms

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12
Q

What methods of contraception are free of side effects?

A

None - oestrogen containing have the most serious side effects

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13
Q

What methods of contraception are 100% protective against STIs

A

None

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14
Q

What methods of contraception have non-contraceptive benefits?

A

COC and Mirena

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15
Q

What methods of contraception are low maintenance?

A

Implant or coil

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16
Q

What are the ways in which contraception can fail?

A

Method failure - true failure of the contraceptive itself, not related to the woman taking the contraceptive
User failure e.g. missed pill

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17
Q

What is the effectiveness of most methods of contraception if used correctly and consistently?

A

Over 99%

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18
Q

What is the Pearl Index of the combined oral contraceptive pill?

A

0.3-0.4 per HWY

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19
Q

What does the combined OCP contain?

A

Combination of 2 hormones - ethinyl oestragiol and synthetic progesterone

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20
Q

What is the usual dose of the combined OCP? When might this be increased?

A

Usual dose 25-30mcg EE

May be increased to 50mcg if on liver enzyme inducers

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21
Q

What are the hormones contained in the second generation combined OCP?

A

Levonorgestrel and norethisterone

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22
Q

What are the hormones contained in the third generation combined OCP?

A

Gestodene and desogestrel

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23
Q

What is the mode of action of the combined OCP?

A

Exerts negative feedback on anterior pituitary and hypothalamus
Prevents ovulation
Alters FSH and LH so there is no surge
Prevents implantation by providing inadequate endometrium
Inhibits sperm penetration of cervical mucosa by altering quality and character of mucous

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24
Q

When is there contraceptive protection after starting the combined OCP?

A

Immediately if started on day 1-5 of period

If started outwit day 1-5 of period another method of contraception is needed for the first 7 days

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25
Q

When can the combined OCP be started?

A

At any time

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26
Q

Why should condoms still be used by women on the combined OCP?

A

As barrier protection against STIs

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27
Q

When does the combined OCP need to be taken?

A

At the same time every day
Protection will still be provided if it is taken within 12 hours of the usual time, if longer than this then it is classed as a missed pill

28
Q

For how many months can the combined OCP be used without a pill-free week?

A

3 months continuously (3 pill packs)

29
Q

What are the non-contraceptive benefits of the combined OCP?

A

Regular bleed
Potential reduction in painful heavy menstruation and anaemia
Reduction in functional ovarian cysts
50% reduction in ovarian and endometrial cancer
Improvement in acne
Reduction in benign breast disease, rheumatoid arthritis, colon cancer and osteoporosis

30
Q

How is the vaginal ring used?

A

Works in the same way as the combined OCP, inserted for 3 weeks then removed for 1 week

31
Q

When does the progestogen only pill need to be taken?

A

Should be taken at the same time every day
Traditional pills - within 3 hours of the same time every day
Modern pills - within 12 hours at the same time

32
Q

What is the Pearl Index of the progestogen only pill?

A

0.3-3.1

33
Q

What is the mode of action of the progestogen only pill?

A

Renders cervical mucous impenetrable by sperm

Affects ovulation

34
Q

When is the maximum effect of the progestogen only pill?

A

48 hours after ingestion

35
Q

When should the progestogen only pill be started?

A

Can be started at any time, but if started outwith days 1-5 of period then condoms need to be used for 2 days

36
Q

What does DepoProvera contain?

A

Aqueous solution of crystals of the progestogen depomedroxyprogesterone acetate

37
Q

How is DepoProvera administrated?

A

150mg given by deep intramuscular injection into the upper outer quadrant of the buttock every 12 weeks

38
Q

What is the Pearl Index of DepoProvera?

A

0.1

39
Q

What is the mode of action of DepoProvera?

A

Prevents ovulation
Alters cervical mucous, making it hostile to sperm
Prevents implantation by rendering the endometrium unsuitable

40
Q

What is the subdermal implant?

A

Small plastic rod, 4cm in length, 2mm in cross-sectional diameter

41
Q

What does the subdermal implant contain?

A

68mg of the progestogen etonogestrel dispersed in a matrix of ethinylvinylacetate (EVA)

42
Q

How long is the subdermal implant effective for?

A

3 years

43
Q

What is the commonest side effect of the subdermal implant?

A

Irregular bleeding, usually settles

44
Q

What is the mode of action of the subdermal implant?

A

Inhibition of ovulation

Effect on cervical mucous - inhibits sperm entry into reproductive tract

45
Q

How long are intrauterine coils effective for?

A

5-10 years

46
Q

What is the mode of action of the intrauterine coil?

A

Hromonal method - small amount of progestogen released into the uterus making the endometrium lining thinner
Copper coils - copper is toxic to sperm

47
Q

What is the most effective method of emergency contraception?

A

CU-IUD

48
Q

When does emergency contraception need to be used to be effective?

A

Levonogestrel - within 72 hours of unprotected sex

Ella one - within 120 hours

49
Q

What are the barrier methods of contraception?

A

Male and female condoms
Cups
Diaphragms

50
Q

What are the risks associated with COC use?

A

Risk of venous thromboembolism
Breast cancer risk slightly increased
Cervical cancer risk increase

51
Q

What is the increase in risk of VTE in women taking COC?

A

Risk of VTE increases from 5 per 100,000 women years in the general population to;
15 per 100,000 women years with COC use (LNG and NET)
25 per 100,000 women years with COC use (GSD and DSG)
and 60 per 100,000 women years with pregnancy

52
Q

What other factors increase the risk of VTE?

A 
Major surgery and immobility
Thrombophilias
Family history of VTE in those under 45 years of age 
BMI over 30 
Underlying vascular disease 
Within 21 days postnatally
53
Q

What is the increase in risk of myocardial infarction?

A

No increase in non-smokers

Small increase in smokers

54
Q

When does the risk of breast cancer return to normal?

A

10 years after stopping COC

55
Q

What are the advantages and disadvantages of DepoProvera?

A

Good for forgetful pill takers
70% of women are amenorrhoeic
Oestrogen free
No reduction in fertility

Reversible reduction in bone density

Problematic bleeding
Weight gain
Delay in return to fertility - can take up to 1 year

56
Q

What is the failure rate of female sterilisation using laparoscopic tube occlusion?

A

1 in 200 lifetime risk

57
Q

What is involved in a vasectomy?

A

Permanent division of the vas deferens under local anaesthetic

58
Q

What is the failure rate of vasectomy?

A

1 in 2000

59
Q

What are the advantages and disadvantages of vasectomy?

A

No evidence of reduction in testosterone
Semen same colour and volume
No evidence that vasectomy predisposes to testicular or prostatic cancer

Low success rates of reversal
Pain due to sperm granuloma

60
Q

What is the target for termination of pregnancy procedures?

A

70% performed under 9 weeks as there are less complications

61
Q

What percentage of abortions in Grampian are medical?

A

> 80%

62
Q

Up to how many weeks is termination offered in the UK?

A

Up to 20 weeks in Scotland
Up to 24 weeks in England

After 20 weeks, patients in Scotland are referred to England

63
Q

What are the possible reasons for termination of pregnancy?

A

Social reasons
Medical reasons

The pregnancy has not exceeded its 24th week and continuation of the pregnancy would cause greater harm to the physical or mental health of the woman and/or her existing children than if the pregnancy were terminated

64
Q

What needs to be covered in a consultation regarding termination?

A

Information about different methods of contraception
Possibility of prolonged bleeding after termination
Counselling available
Contraception agreement and advice
FBC
Group and screen
Rubella test
Scan
Self-obtained swab for chlamydia and gonorrhoea
STI bloods offered

65
Q

What is used in the medical method of termination and how does it work?

A

Mifepristone
Switches off pregnancy hormone which is keeping the uterus from contracting and allowing the pregnancy to grow
Prostaglandin
Given 48 hours later which initiates uterine contraction, which opens the cervix and expels the pregnancy

66
Q

What are the complications of medical termination of pregnancy?

A

Failure < 5 in 100
Haemorrhage < 5 in 100
Infection
Prolonged bleeding < 5 in 100

Reproductive System (33 decks)

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