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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
What is a condition required when using caps?
Spermicide reapplied for reused caps or in-situ caps for >3hours
26
How does the combined oral contraceptive pill work?
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
What are the SE of the combined oral contraceptive pill?
``` Nausea, headache, irregular bleeding initially, mastalgia X3-5 VTE risk X2 ischaemic stroke risk Inc breast Ca X2 Cervix Ca at 10years ```
28
How long does the hormone given by the Evra combined Patch last for?
7 days Changed weekly for 3weeks 4th week = withdrawal bleed If same patch is used for >9 days assume cover is lost
29
How do progestogen only pills work?
``` Monophasic 28 pills No pill free interval Thickens cervical mucus Reduce endometrial receptivity May suppress ovulation ```
30
When should POP be taken?
Continuously | Within 3hours every day
31
How long do extra precautions need to be taken if a POP is missed?
48hours
32
Who is an injectable contraception (Depo Provera) ideal for?
Not affected by enzyme inducers so patients with HIV or epilepsy
33
What are the side effects of the Depo contraceptive injection?
amenorrhoea Weight gain Fertility delay (6-12months) Reduced bone mineral density
34
How often is the Depo contraceptive injection given?
Every 12weeks
35
How long does the Nexplanon implant last for?
3years
36
What are the side effects of the Nexplanon implant?
80% irregular bleeding 20% amenorrhoeic Fitting/removal under LA
37
What are the contraindications to fitting an IUD/IUS?
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
What is the number system for UKMEC classification for a method of contraception?
``` 1= No restriction 2= Advantages outweigh risks 3= Risks outweigh advantages 4= Unacceptable health risk ```
39
What are the potential SE of an IUD/IUS?
- 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
What are the indications for emergency contraception?
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
What are the possible SE of emergency contraception?
Nausea & vomiting (20%) Breast tenderness Dizziness, tiredness, headache Disturbance of menstruation- common
42
What happens if someone vomits after taking emergency contraception?
If patient vomits within 2hours of Ulipristal or Levonorgestrel the dose should be repeated or IUD considered
43
What do most combined oral contraceptives contain?
Ethinyl Oestradiol
44
What are the different generations of progestogens?
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
What are the contraindications to taking the COCP? (Include the UKMEC numbers)
``` 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
What are the drug interactions associated with the COCP?
Enzyme inducers (Cytochrome p450) Rifampicin St John’s Wort Some anti-retrovirals used in HIV (ritonavir) Some anti-epileptics (Phenytoin, Carbamezepine, Phenobarbitone)
47
How is the absorption of the COCP reduced?
- 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
What are the contraindications to the Depo Provera injection including UKMEC numbers?
``` CVA [3] Diabetes with vascular complications [3] Severe cirrhosis, hepatoma [3] Multiple RF for CVD [3] Breast cancer [4] ```
49
For how long is Levonelle effective for?
72hours | Efficacy starts decreasing after first 24hours
50
For how long is EllaOne effective for?
120hours | Efficacy the same from first to last hour
51
What are the restrictions for giving Levonelle
Cannot give if another form of hormone treatment has been given 3days before Cannot start a hormonal form of contraception for 5days afterwards
52
Including the UKMEC numbers what are the contraindications to the POP & Nexplanon?
- 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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