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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
When can the combined OCP be started?
At any time
26
Why should condoms still be used by women on the combined OCP?
As barrier protection against STIs
27
When does the combined OCP need to be taken?
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
For how many months can the combined OCP be used without a pill-free week?
3 months continuously (3 pill packs)
29
What are the non-contraceptive benefits of the combined OCP?
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
How is the vaginal ring used?
Works in the same way as the combined OCP, inserted for 3 weeks then removed for 1 week
31
When does the progestogen only pill need to be taken?
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
What is the Pearl Index of the progestogen only pill?
0.3-3.1
33
What is the mode of action of the progestogen only pill?
Renders cervical mucous impenetrable by sperm | Affects ovulation
34
When is the maximum effect of the progestogen only pill?
48 hours after ingestion
35
When should the progestogen only pill be started?
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
What does DepoProvera contain?
Aqueous solution of crystals of the progestogen depomedroxyprogesterone acetate
37
How is DepoProvera administrated?
150mg given by deep intramuscular injection into the upper outer quadrant of the buttock every 12 weeks
38
What is the Pearl Index of DepoProvera?
0.1
39
What is the mode of action of DepoProvera?
Prevents ovulation Alters cervical mucous, making it hostile to sperm Prevents implantation by rendering the endometrium unsuitable
40
What is the subdermal implant?
Small plastic rod, 4cm in length, 2mm in cross-sectional diameter
41
What does the subdermal implant contain?
68mg of the progestogen etonogestrel dispersed in a matrix of ethinylvinylacetate (EVA)
42
How long is the subdermal implant effective for?
3 years
43
What is the commonest side effect of the subdermal implant?
Irregular bleeding, usually settles
44
What is the mode of action of the subdermal implant?
Inhibition of ovulation | Effect on cervical mucous - inhibits sperm entry into reproductive tract
45
How long are intrauterine coils effective for?
5-10 years
46
What is the mode of action of the intrauterine coil?
Hromonal method - small amount of progestogen released into the uterus making the endometrium lining thinner Copper coils - copper is toxic to sperm
47
What is the most effective method of emergency contraception?
CU-IUD
48
When does emergency contraception need to be used to be effective?
Levonogestrel - within 72 hours of unprotected sex | Ella one - within 120 hours
49
What are the barrier methods of contraception?
Male and female condoms Cups Diaphragms
50
What are the risks associated with COC use?
Risk of venous thromboembolism Breast cancer risk slightly increased Cervical cancer risk increase
51
What is the increase in risk of VTE in women taking COC?
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
What other factors increase the risk of VTE?
``` 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
What is the increase in risk of myocardial infarction?
No increase in non-smokers | Small increase in smokers
54
When does the risk of breast cancer return to normal?
10 years after stopping COC
55
What are the advantages and disadvantages of DepoProvera?
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
What is the failure rate of female sterilisation using laparoscopic tube occlusion?
1 in 200 lifetime risk
57
What is involved in a vasectomy?
Permanent division of the vas deferens under local anaesthetic
58
What is the failure rate of vasectomy?
1 in 2000
59
What are the advantages and disadvantages of vasectomy?
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
What is the target for termination of pregnancy procedures?
70% performed under 9 weeks as there are less complications
61
What percentage of abortions in Grampian are medical?
> 80%
62
Up to how many weeks is termination offered in the UK?
Up to 20 weeks in Scotland Up to 24 weeks in England After 20 weeks, patients in Scotland are referred to England
63
What are the possible reasons for termination of pregnancy?
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
What needs to be covered in a consultation regarding termination?
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
What is used in the medical method of termination and how does it work?
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
What are the complications of medical termination of pregnancy?
Failure < 5 in 100 Haemorrhage < 5 in 100 Infection Prolonged bleeding < 5 in 100

Reproductive System (33 decks)

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