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Contraception Flashcards

1
Q

What are the types of intrauterine devices?

A
  • Intrauterine device copper bearing

- Intrauterine system progestogen releasing

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2
Q

What is the mode of action of the IUD?

A

Primary effect through copper ions- Direct toxic effect on sperm & ova, dec sperm motility, dec sperm survival
Secondary effect on endometrium: Impedes sperm transfer, sperm phagocytosis, impedes implantation

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3
Q

What are the disadvantages of an IUD?

A

Heavier periods but regular bleeding

Intermenstrual spotting initially

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4
Q

What is the mode of action of an IUS?

A

Thickening of cervical mucus inhibiting the passage of sperm
Prevention of endometrial proliferation
Local effect of foreign body on uterus
Prevention of ovulation in some women’s cycles

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5
Q

What are the disadvantages of an IUS?

A

Irregular bleeding & eventually amenorrhoea in some women
Much lighter in most women

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6
Q

Other than as contraception when else can an IUS be used?

A

Use in HRT & menorrhagia (Mirena 5years)

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7
Q

What substance is released by an IUS?

A

Levonorgestrel

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8
Q

In an emergency which intrauterine device is fitted?

A

Copper IUD

Must be done before implantation to ensure it is not causing abortion-5day rule. Works by inhibiting fertilisation

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9
Q

When must an emergency IUD be fitted?

A

Within 5days of risk OR ovulation

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10
Q

When can an emergency IUD not be fitted?

A

Not after day 19 in a 28day cycle.

Must avoid possible implanted pregnancy

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11
Q

How does the emergency pill Ulipristal work?

A

Selective progesterone receptor modulator. Delays/inhibits ovulation. Given immediately before ovulation it suppresses growth of lead follicles delaying follicular rupture until up to 5days later.

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12
Q

How long is Ulipristal licensed for?

A

Licensed for up to 120hours

As effective as Levonorgestrel <72hours

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13
Q

When is Ulipristal not recommended?

A

Enzyme inducers & progestogens may reduce efficacy
Not recommended in women w/ s.asthma
BF- discard milk for 7days

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14
Q

What are the brand names of Ulipristal?

A

EllaOne

Ulipristal Acetate

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15
Q

How does progestogen only emergency contraceptive work?

A

Levonorgestrel:

Delays ovulation- appears to prevent follicular rupture or cause luteal dysfunction.

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16
Q

What are the brand names of the progestogen only emergency contraceptive?

A

Levonelle 1500

Levonelle One Step

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17
Q

When should the progestogen only emergency contraceptive be taken?

A

Ideally within 72hours of intercourse

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18
Q

What are the issues with the progestogen only emergency contraceptive?

A

May displace Warfarin from binding sites & increase INR

Reduced efficacy of enzyme inducers

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19
Q

When is persona most reliable?

A

If sexual intercourse is restricted to after ovulation

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20
Q

Name a natural type of contraception

A

Lactational amenorrhoea method

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21
Q

How does male & female sterilisation work?

A

M:Vasectomy performed under LA through single incision.
Reversal possible but even if patent vas, development of anti-sperm antibodies may prevent fertility.

F: Laparoscopically using clips/rings/diathermy
Reversal may be attempted but success depends on the original method used

22
Q

After male sterilisation what must happen before the method can be relied upon?

A

Wait approx 2months post procedure & have 2 negative specimens

23
Q

Where are caps & diaphragms placed?

A

C: Cover the cervix
D: Covers the anterior wall of the vagina & cervix
Normally used with spermicide, made of latex/silicone

24
Q

When is a diaphragm or cap unsuitable?

A

<6weeks postpartum

25
Q

What is a condition required when using caps?

A

Spermicide reapplied for reused caps or in-situ caps for >3hours

26
Q

How does the combined oral contraceptive pill work?

A

Monophasic 21pills with pill free interval
Synthetic oestrogen & progestogen prevent pituitary release of FSH &LH-prevent ovulation.
Cervical mucus changes to exclude sperm
Endometrial effects prevent implantation

27
Q

What are the SE of the combined oral contraceptive pill?

A 
Nausea, headache, irregular bleeding initially, mastalgia
X3-5 VTE risk
X2 ischaemic stroke risk
Inc breast Ca
X2 Cervix Ca at 10years
28
Q

How long does the hormone given by the Evra combined Patch last for?

A

7 days
Changed weekly for 3weeks
4th week = withdrawal bleed
If same patch is used for >9 days assume cover is lost

29
Q

How do progestogen only pills work?

A 
Monophasic 28 pills
No pill free interval
Thickens cervical mucus
Reduce endometrial receptivity
May suppress ovulation
30
Q

When should POP be taken?

A

Continuously

Within 3hours every day

31
Q

How long do extra precautions need to be taken if a POP is missed?

32
Q

Who is an injectable contraception (Depo Provera) ideal for?

A

Not affected by enzyme inducers so patients with HIV or epilepsy

33
Q

What are the side effects of the Depo contraceptive injection?

A

amenorrhoea
Weight gain
Fertility delay (6-12months)
Reduced bone mineral density

34
Q

How often is the Depo contraceptive injection given?

A

Every 12weeks

35
Q

How long does the Nexplanon implant last for?

36
Q

What are the side effects of the Nexplanon implant?

A

80% irregular bleeding
20% amenorrhoeic
Fitting/removal under LA

37
Q

What are the contraindications to fitting an IUD/IUS?

A

Pregnancy [4]
Undiagnosed bleeding [4]
Cervical/uterine cancer pre-treatment [4]
Active PID (or in last 3months) [4]
Current chlamydia, GC, Cervicitis [4]
Uterine abnormality (fibroids, bicornuate uterus) [3]
Gestational trophoblastic disease [4]
Long QT syndrome (increased risk of collapse during fitting) [3]

38
Q

What is the number system for UKMEC classification for a method of contraception?

A 
1= No restriction
2= Advantages outweigh risks
3= Risks outweigh advantages
4= Unacceptable health risk
39
Q

What are the potential SE of an IUD/IUS?

A
  • Expulsion: Most common in first 3 months after fitting & with heavy period (check threads)
  • Perforation: Very rare, more common in early postnatal period in lactating women
  • Pregnancy: 1/20 ectopic, can continue pregnancy if uterine but high risk of miscarriage, remove device if threads seen
  • Infection: Risk of pelvic infection higher in 3 weeks post-insertion, screen for STIs before insertion
40
Q

What are the indications for emergency contraception?

A

Diaphragm/cap is dislodged/removed within 6hours of sex
Diaphragm has been left in >3hours before sex & no additional spermicide applied
Condom splitting/breaking/slippage
Failure to use condom as advised when starting/switching contraception
If enzyme-inducing drugs being used alongside hormonal contraception and condoms are not being used

41
Q

What are the possible SE of emergency contraception?

A

Nausea & vomiting (20%)
Breast tenderness
Dizziness, tiredness, headache
Disturbance of menstruation- common

42
Q

What happens if someone vomits after taking emergency contraception?

A

If patient vomits within 2hours of Ulipristal or Levonorgestrel the dose should be repeated or IUD considered

43
Q

What do most combined oral contraceptives contain?

A

Ethinyl Oestradiol

44
Q

What are the different generations of progestogens?

A

1st: Norethisterone
2nd: Norgestrel, Levonorgestrel (Microgynon 30)
3rd: Gestodene, Desogestrel, Norgestimate
4th: Drospirenone, Dienogest
Newer Progestogens tend to have less androgenic side effects but are more expensive. Later generations have an increased risk of VTE.

45
Q

What are the contraindications to taking the COCP? (Include the UKMEC numbers)

A 
Smoking >age35 >15/day [4]  <15/day [3]
BMI >35 [4]
BP >160/95 [4]   >160/90 [3]
Migraine with aura [4]
Vascular disese (inc CVA) [4]
History of VTE [4]
Complex congenital heart disease [4]
Breast Cancer [4]
Liver disease (abnormal LFTs/tumour) [4]
46
Q

What are the drug interactions associated with the COCP?

A

Enzyme inducers (Cytochrome p450)
Rifampicin
St John’s Wort
Some anti-retrovirals used in HIV (ritonavir)
Some anti-epileptics (Phenytoin, Carbamezepine, Phenobarbitone)

47
Q

How is the absorption of the COCP reduced?

A
  • Taking the pill accurately (missed pill) >24hours late, if in first week/>2 pills use additional contraception, mistake in last week run packs together
  • Vomiting within 3hours of taking the pill
  • GE
  • Other drugs causing diarrhoea (Orlistat)
48
Q

What are the contraindications to the Depo Provera injection including UKMEC numbers?

A 
CVA [3]
Diabetes with vascular complications [3]
Severe cirrhosis, hepatoma [3]
Multiple RF for CVD [3]
Breast cancer [4]
49
Q

For how long is Levonelle effective for?

A

72hours

Efficacy starts decreasing after first 24hours

50
Q

For how long is EllaOne effective for?

A

120hours

Efficacy the same from first to last hour

51
Q

What are the restrictions for giving Levonelle

A

Cannot give if another form of hormone treatment has been given 3days before
Cannot start a hormonal form of contraception for 5days afterwards

52
Q

Including the UKMEC numbers what are the contraindications to the POP & Nexplanon?

A
  • Breast cancer in last 5 years [4]
  • Current enzyme inducers [3]
  • Continuing use following a CVA [3]
  • Severe cirrhosis, hepatoma [3]

GOSH (17 decks)

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