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OBGYN CP2 > Contraception > Flashcards

Contraception Flashcards

1
Q

List the long acting reversible contraceptives

A

Depo Provera injection

Nexplanon implant

Mirena coil IUS

Copper coil IUD

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2
Q

List the long acting irreversible contraceptives

A

Female sterilisation

Male sterilisation (vasectomy)

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3
Q

List the short acting reversible ostrogen containing contraceptives

A

Combined oral contraceptive

Evra contraceptive patch

Nuvaring

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4
Q

List the short acting reversible contraceptives that only contain progerstone

A

Progesterone only pill

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5
Q

List contraceptive barrier methods

A

Diaphragm

Female and male condoms

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6
Q

List emergency contraception

A

Levonelle pill

ellaOne

Copper IUD

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7
Q

List the natural methods of contraception

A
  • Coitus interuptus (pullling out)
  • Body temp
  • Cervical mucus monotoring
  • Urinary LH levels (home hormone tests)
  • Calendar techniques
  • Breastfeeding
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8
Q

List ostrogen and progesterone containign contraceptives

A

COC

Evra Patch

Nuvaring

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9
Q

MoA of ostrogen containing contraceptive

A

Anovulation

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10
Q

MoA progesterone containing contraception

A
  1. Cerval mucus becomes hostile to sperm
  2. Endometrial lining remains thin and therefore imprenetrable to blastocyst
  3. Sometimes causes anovulation (implant, POP) but not may stay MoA of progesterone
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11
Q

MoA copper containing contraceptive (IUD)

A
  1. Toxic to sperm and ova
  2. Mucus becomes hostile
  3. Generalised inflammatory response is induced in genital tract making pregnancy less suitable
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12
Q

Main MoA of IUS

A

Prevents implanation through enodmetrial changes

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13
Q

Contraindications to ostrogen containing contraception

A

General contraceptive

  • Pregnancy
  • Undiagnosed genital bleeding
  • Breast Cancer
  • Liver disease esp tumours
  • Aversion to SEs

Specific

  • VTE/PE history esp. cardiovascular in general stroke, cerebrovascular disease, HTN
  • Migraine/aura
  • High BMI (patch can’t be used >90kg)
  • Smoking and being over 35 (not an absolute contraindication but don’t give them ostrogen)
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14
Q

Contraindications to progesterone containing contraception

A

General ones contraceptive

  • Pregnancy
  • Undiagnosed genital bleeding
  • Breast cancer
  • Liver disease
  • Aversion to SEs
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15
Q

Contraindications to copper contraceptives IUD

A

General contraceptives

  • Pregnancy (unless for emergency in later slides)
  • Undiagnosed genital bleeding
  • Aversion to SEs

Copper

  • Copper allergy
  • Wilsons disease
  • Dysmenarrhoea and menorhagia (not contra indications but don’t give)

General for IUD

  • Malformed genital tract (fibriods, cancer of peliv tract)
  • Pelvic infection
  • STIs (risk of PID)
  • Ectopic pregnancy
  • Aversion/contraindication to fitting process
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16
Q

Contraindications of IUS

A

General contraceptives

  • Pregnancy (unless for TOP in later slides)
  • Undiagnosed genital bleeding
  • Breast cancer
  • Liver disease
  • Aversion to SEs

General for IUD

  • Malformed genital tract (fibriods, cancer of peliv tract)
  • Pelvic infection
  • STIs (risk of PID)
  • Ectopic pregnancy
  • Aversion/contraindication to fitting process

Specific Mirena

  • Aversion to irregular bleeding
17
Q

Negatives of barrier methods

A

General

  • Not the most effective 90% if used properly

Femidon

  • Not user friendly

Cap/diaphragm

  • Fitted by trained health professional
  • need spermicide
  • not ideal for women with prolapse/ recurrent UTI’s
  • Reassess size if weight changes.
18
Q

Counselling points for coil fitting

A
  • Pain - cramp like 24hrs after, use OTC analgesia
  • Dizzy if clamp on cervix
  • Infection
  • Bleeding
  • Uterine perforation
  • Explusion - check strings
19
Q

Side effects of hormonal contraception

A
  • Irregular bleeding / no periods
  • Weight gain
  • Mood swings / depression
  • Headaches
  • Skin problems – mainly acne
  • Breast tenderness / enlargement (occasionally galactorrhoea)
  • Nausea/dizziness (oestro)
  • Vaginal discharge(oestro), vaginal dryness(prog)
  • Decrease libido
20
Q

Who is the copper coil good for

A
  • Long acting (10yrs)
  • Can stay in till menopause in put in age 40
  • Non hormonal ergo no hormonal SEs
  • Most effective emergency
  • Highest efficacy (same as sterilisation)
21
Q

Who is the IUS good for

A
  • Long acting (5yrs)
  • Women with heavy and painful periods (bleeding issues e.g. anaemia)
  • Can double as progesterone component of HRT
  • High efficacy same as sterilisation
22
Q

Who are barrier methods good for

A
  • Protection against STIs and pregnancy
  • Aversion to hormones SEs
  • Averson to IUD fitting
  • Aversion to periods affected

Femidon

  • Not erection dependent
23
Q

Who is the COC good for

A
  • Short acting take a pill every day organised
  • Regular bleed pattern
  • Protects against endometrial and ovarian cancers
  • Treats menstrual disorders, PCOS and acne
  • Depo>COC>patch
24
Q

Who is the Evapatch for

A
  • Semi comitment, change weekly
  • Regular periods
  • Not oral good for people with GI/absorption problems
  • COC>patch>ring
25
Q

Who is the Nuvaring for

A
  • Semi comitment, change monthly
  • Regular periods
  • Not oral good for people with GI/absorption problems
  • Less ostreogen consider with SEs to COC
  • patch>ring>diaphragm
26
Q

Who is the POP for

A
  • Short acting take a pill every day organised
  • No ostrogen
  • Cerazette (constantly taking progesterone) can dercrease periods
  • Depo>POP>Patch
27
Q

Who is the Depo for and negatives

A
  • Long acting + no IUD fitting (12wks)
  • No ostrogen
  • possible amenorrhoeic
  • Good for women taking enzyme inducers
  • Highly effective IUD>Depo>Patch

Negatives

  • Slow return to fertility
  • Concern about bone density long term
  • May get irregular bleeding to start with
  • Irreversible for 3 months
28
Q

Who is the implant for

A
  • Long acting (3yrs)
  • No ostrogen
  • No IUD fitting, discrete in arm
  • Same efficacy as IUD
29
Q

Rank the contraceptives into 4 categories based on effectiveness

A
30
Q

Assessing the best contraception

A

EXCLUDE PREGNANCY ask about un+protected sex

Emergency?

  1. Ideas about what they want and why
  2. Previously tried any other contraception? Thoughts
  3. Period history
  4. Sexual history
  5. Previous STIs
31
Q

When are the different types of pills late?

A
  • POP 3hrs
  • Cerazette 12hrs also (POP)
  • COC 48 hrs
32
Q

Indications for emergency contraception

A
  • UPSI
  • Failure of barrier methods
  • Use of withdrawal method
  • Missed pill for significant amount of time (applied to patches and rings too)
  • IUD expulsion/mid cycle removal
  • Late Depo 2 weeks after it ran out
33
Q

Levonelle pill: contents, MoA, time after UPSI, efficacy, draw backs

A
  • 1 pill
  • Progesterone only
  • Stops/delays ovulation
  • Liscenced 3 days after UPSI
  • 2.2% Failure rate

Drawbacks

  • Has to be given before LH surge (ovulation)
  • Dose doubled if taking enzyme inducers
  • Pill therefore malapsorption
  • BMI >30 dec efficacy
34
Q

ellaOne: contents, MoA, time after UPSI, efficacy, draw backs

A
  • 1 pill
  • Ulipristal Acetate 30mg (UPA)
  • Stops/delays ovulation
  • Liscenced 5 days after UPSI
  • Failure 1.28%

Draw backs

  • Pill therefore malapsorption
  • Can only use once per cycle
  • Caution in severe asthma, antacids/PPI/H2 antagonists, breastfeeding, hepatic dysfunction, enzyme inducing drugs
  • Interferes with hormonal contraceptives
35
Q

IUD as an emergency: contents, MoA, time after UPSI, efficacy, draw backs

A
  • Coil
  • Copper
  • Toxic to sperm and ova, mucus becomes hostile and generalised inflammatory response is induced in genital tract making pregnancy less suitable
  • 5 days after ovulation (no matter how many UPSI) or 5 days after single UPSI anytime in the cycle
  • Failure <1%

Draw backs

  • Fitting not fun
  • Menorraghia
  • Dysmenorrhia
  • Not suitable for Malformed genital tract (fibriods, cancer of peliv tract), STIs (risk of PID)
  • Ectopic pregnancy increased risk of ectopic
  • Needs trained fitter
36
Q

Emergency contraception assess and manage

A

Assess which EC

  • Time of UPSI + dets (with who, how many, use of natural contraception)
  • LMP
  • Current contraception + thoughts going forward
  • Ideas about methods

Follow up

  • Pregnancy test 3-4 wks after UPSI
  • STI screen
  • Ongoing contraception
37
Q

Post partum contraception

A
  • An IUD can be fitted <48hrs after birth or >4 wks
  • COC is not recommended in breast feeding women (not contraindicated) or <21 days pp
  • POP and condoms are always okay (unless infection other birth stuff)
  • Depo can be given immediately after birth

OBGYN CP2 (10 decks)

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