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O&G > contraception > Flashcards

contraception Flashcards

1
Q

patch - how is it used?

A

wear daily for 3 weeks
change weekly
4th week patch-free - bleed

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2
Q

what happens if you delay changing patch at end of week 1 or 2?

A

<48h delay - change + that’s it

>48h - change + condoms for 1 week. if sex in last 5d consider emergency cc

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3
Q

what happens if you delay changing patch at end of week 3?

A

remove + put new one on usual start day next week + that’s it

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4
Q

what happens if you delay starting new patch at end of week 4?

A

condoms for 1 week

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5
Q

COCP - pros

A

> 99% effective
quickly reversible
periods regular, lighter, < painful
< risk ovarian, endometrial, colorectal ca

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6
Q

COCP - cons

A

forget
no STI protection
> risk VTE / stroke / IHD, breast + cervical ca
SEs - headache, nausea, breast tender

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7
Q

COCP - contraindications to check

A 
smoking
obesity
migraine
epilepsy
hx VTE/stroke
breastfeeding <6wk
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8
Q

UKMEC criteria for smoking for COCP

A

2 - <35y
3 - >35y + <15/d
4 - >35y + >15/d

progesterone only are all 1

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9
Q

progesterone-only contraceptives - CV risks?

A

none - UKMEC1 even if smoker

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10
Q

obesity - UKMEC criteria for COCP

A

increased VTE risk

2 - BMI 30-34
3 - BMI 35+

all other cc are UKMEC1 for obesity

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11
Q

migraine - UKMEC criteria for COCP

A

4 - migraine with aura
3 - migraine without aura, continued prescribing
2 - migraine without aura, initiation

2 - progesterone only methods eg POP, implant, injection

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12
Q

epilepsy - contraception

A

consistent condom use as teratogenicity of meds

injection, IUD + IUS are all UKMEC 1 regardless of meds

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13
Q

COCP - UKMEC 3 criteria

A 
> 35 + smoke < 15
BMI > 35
FH VTE in 1° relatives < 45y
HTN - controlled
immobility
BRCA gene
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14
Q

COCP - absolute contraindications

A 
> 35 + smoke > 15
migraine + aura
clot hx / predisposition
breastfeeding < 6 wk PP
HTN uncontrolled
breast cancer
post-op + prolonged immobilisation
~diabetes
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15
Q

COCP - advice on contraception when pill is started for first time. other advice?

A

started in 1st 5d - no need for extra cc
after - condoms for 7 days

sex in break is only safe if next pack started on time
beware vomiting
STI risk

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16
Q

COCP - missed pill

A

1 pill - take asap, no extra cc
2+ - take one asap, condoms 7d. emergency cc indications:
week 1 - if UPSI in pill free interval or week 1
week 2 - no need
week 3 - no need but b2b next pack

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17
Q

how does COCP work

A

inhibits ovulation

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18
Q

how does POP work

A

thickens cervical mucus

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19
Q

POP - common SE

A

irregular bleeding

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20
Q

progesterone injection - how does it work

A

inhibits ovulation

also thickens cervical mucus

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21
Q

implant - how does it work

A

inhibits ovulation

also thickens cervical mucus

22
Q

implant - common SE

A

irregular bleeding

23
Q

IUD - mechanism

A

decreases sperm motility + survival

24
Q

IUS - mechanism

A

prevents endometrial proliferation

also thickens cervical mucus

25
Q

IUS - SEs + complications

A

irregular bleeding
initial frequent light bleeding
later - intermittent light menses, poss amenorrhoea

26
Q

emergency contraception - mechanism

A

levonorgestrel/ulipristal - inhibit ovulation

IUD - toxic to sperm + ovum, inhibits implantation

27
Q

young people + contraception - advice

A

STI test 2 + 12 weeks after UPSI
long acting poss better in case forgetful
implant best - injection poss not good for BMD + IUD/D = UKMEC2 < 20y

28
Q

levonorgestrel (morning after pill) - how effective? SEs? key piece of counselling?

A

84% effective
repeat if vomit in 2h

SEs rare - occasional disturbance of menses, 1% vomit

29
Q

ulipristal acetate (ellaone) - how does it work? anything to be aware of?

A

inhibits ovulation
poss reduces efficacy of hormonal contraception - re/start 5d after + use condoms in between
don’t breastfeed for a week

30
Q

IUD as emergency contraception - when to insert? how effective? method of action?

A

99% effective
~inhibits fertilisation / implantation
in 5d. if > 5d, can give up to 5d after ovulation date.
~prophylactic abx if ++risk STI
if not wanted long term then keep til next period

31
Q

implant - cc after insertion

A

if inserted after day 5 - condoms for a week

32
Q

implant - SEs

A 
irregular / heavy periods
progestogen effects:
headache
nausea
breast pain
33
Q

implant - contraindications

A

UKMEC 2 - initiation if IHD/stroke
UKMEC 3 - continuation if IHD/stroke, suspicous vaginal bleeding, hx BC, liver problems
UKMEC 4 - current BC

34
Q

the injection - where’s it given?

A

IM into bottom

35
Q

the injection - disadvantages + SEs

A

irreversible
can take 1y to return to fertility

irregular bleeding
weight gain
~osteoporosis

36
Q

the injection - how long last?

A

12wk but next dose can be given at 14wk without need for condoms

37
Q

IUD + IUS - how effective?

A

> 99%

38
Q

IUS - when can it be relied upon after insertion?

A

7 days

39
Q

IUD - when can it be relied upon after insertion?

A

immediately

40
Q

intrauterine devices (IUS + IUD) - risks

A

2/1000 perforation
small increased risk of PID in first 20 days
expulsion risk 1 in 20

41
Q

post partum contraception - when needed?

A

day 21

emergency cc not needed before this

42
Q

post partum contraception - POP - when start? extra precautions?

A

can start whenever
use condoms 2d after d21
fine to breastfeed

43
Q

postpartum contraception - COCP - contraindications, things to be aware of, when to start

A

if start d21 - works immediately
if start >d21 - condoms 1wk

UKMEC4 - <6wk pp + breastfeeding (UKMEC2 - 6wk-6mo)
may ↓ milk

44
Q

POP - starting

A

day 1-5 - no condoms needed

day 6+ - condoms 2 days

45
Q

POP - missed pills

A

<3h - fine
>3h - take asap, condoms 2 days

same apply for D+V
12h not 3 if cerazette (deogestrel)

46
Q

emergency cc history - structure

A 
UPSI - who, when, consensual
Cc - why failed
Menses - LMP, cycle length
Pregnancy - any chance (as ecc CI)? had ecc this cycle?
STI - symptoms
Smears
ROFS
Reasons - why wanted, impact of baby
Options
Future cc - can start asap but condoms 14d
STI risk - advise test

ice, leaflet, return in 3w for preg test

47
Q

levonelle - when, drug, method, effectiveness, SEs, CIs, extra info

A

72h
levonorgestrel
inhibits ovulation + disrupts implantation
1d 95%, 2d 85%, 3d 58%
SEs - N, V (3h - repeat + domperidone OR IUD), breast pain, bleed (now, later, period), headache, breast/pelvic pain
CI - less effective if enzyme drugs
extra - abstain till bleed/7d COCP/2d POP/ideal 2w. if period >1w late/light/concerned - preg test 3wk post pill

48
Q

ellaone - when, drug, method, effectiveness, SEs, CIs, extra info

A

5d
ulipristal acetate
inhibits ovulation + thins endometrium
98%
CI - <18y, already used this cycle, asthma/liver disease ++, less effective if enzyme drugs
SEs - N, V (3h - repeat + domperidone OR IUD), bleed (now, later, period), headache, breast/pelvic pain
extra - abstain till bleed/7d COCP, 2d POP, ideal 2w. period >1w late/light/concerned - preg test in 3w

49
Q

IUD as emergency cc - when, method, effectiveness, SEs, CIs, extra info

A

5d
prevents fertilisation
99%
SEs - dysmenorrhoea/menorrhagia, pain on insertion (ibuprof), infection, 1/1000 perf, 1/10 - vasovagal, 5% expulsion
CIs - pelvic infection, PID in last 3mo, copper allergy
extra info - can remove in 4w. check up in 6w

50
Q

contraception counselling - structure

A

person, periods, STI, health + baby

PPBC
partner - who, age
periods - regularity, pain, heavy, length
breastfeeding + pregnancy
contraception hx

PMH - BP, BMI, STIs, VTE/stroke/MI
DH - allergies
FH - ov/br ca, VTE, migraine + aura
SH - smoke

describe a type:
ICE + preference - memory, reversibility
mode, course, +ves and -ves

extras:
OCP - review 3mo. no protection STIs

O&G (22 decks)

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