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Gynae > contraception > Flashcards

contraception Flashcards

1
Q

what is the pearl index ?

A

number of contraceptive failures per 100 women per year

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2
Q

mechanism of action of depot injection (IM progesterone)??

A

inhibits ovulation

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3
Q

depo injection lasts how long?

A

12-14 weeks

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4
Q

pearl index of depot injection (IM progesterone)??

A

0.2%

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5
Q

absolute CI to depot injection??

A

pregnancy
breast cancer
severe cardiac disease
undiagnosed vaginal bleeding

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6
Q

starting depot injection- must rule out what??

A

pregnancy

risk factors for osteporosis

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7
Q

depot injection can be started without need for further contraception if ??
what day in cycle?
when after TOP?
when post partum?

A

up to and including day 5 of cycle

up to day 5 after TOP

up to day 21 post partum

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8
Q

if depot injection started outwith first 5 days of cycle, after 5 days TOP or after 21 days post partum - need what?

A

additional cover with condoms for 7 days

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9
Q

side effects of depot injection??

A

weight gain
risk of osteoporosis
ectopic
delay in return of fertility of about 10 months
irregular bleeding (usually settles with time)

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10
Q

non hormanl intrauterine device (copper IUD) mechanism of action??

A

prevention of fertilization (toxic to sperm and ovum)

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11
Q

Copper IUD effective after how long ?

A

immediately

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12
Q

copper iud can stay in uterus for how long?

A

5-10 years

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13
Q

pearl index of copper IUD?

A

0.6-0.8%

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14
Q

CI to having copper IUD?

A

peptic ulcer disease
current pelvic infection
abnormal uterine anatomy (need to do PV before inserting)
Hx/current endometrial/cervical cancer
pregnancy (increased risk of ectopic and second trimester miscarriage)

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15
Q

when is copper IUD suitable for insertion?

can be used up to when post UPSI for EC?

A

anytime if reasonably certain not pregnant

up to 5 days post UPSI

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16
Q

copper coil normally inserted when?

copper coil can be inserted when post partum??

A

within first 7 days of period

post partum:
either <2 days or >4weeks

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17
Q

problems/side effects with copper coil??

A

heavy prolonged periods

insertion issues - pain, increased risk of infection, uterine perforation, expulsion of device

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18
Q

IUS (mirena coil) is impregnated with what?

A

a synthetic progesterone

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19
Q

mechanism of action of IUS?

A

prevention of implantation

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20
Q

IUS can stay in for how long ?

A

3-5 years

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21
Q

pearl index for mirena coil??

A

0.2%

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22
Q

CI to using mirena??

A 
peptic ulcer disease
current pelvic infection
abnormal uterine anatomy
Hx/current endometrial/cervical cancer
pregnancy (ectopic risk and 2nd trimester miscarriage)
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23
Q

Suitable time for insertion of mirena coil??

anytime if not pregnant but if outwith first 7 days of cycle cover with??

A

within first 7 days of period

7/7 condoms

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24
Q

mirena coil can be inserted when following TOP?

A

immediately

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25
Q

mirena coil can be inserted when post partum ?

A

< 2 days or

>4 weeks

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26
Q

problems/side effects of mirena coil??

A

irregular menstrual bleeding, usually becomes lighter and most women become amenorrhoeic
insertion issues as per IUD

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27
Q

implant is what?

A

non-degradable rod implanted into arm thats impregnanted with progesterone

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28
Q

MofA of implant??

A

inhibition of ovulation

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29
Q

implant lasts how long in arm?

A

3 years

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30
Q

pearl index for implant ??

A

0.05% (most effective form of contraception)

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31
Q

insertion of implant:
no additional cover needed if inserted when in cycle?
when post partum?
when after TOP?

A

within first 5 days of cycle

on or before day 21 post partum

up to day 5 days post TOP

can also start the impant with no additional cover if starting it after last active pill taken

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32
Q

When would cover with 7/7 condoms be needed when starting implant ??

A

starting any other time in cycle outwith first 5 days

if used as a quick start after emergency contraception

if switching from POP, mirena or IUD

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33
Q

problems/side effects with implant ?

A

irregular bleeding, acne

insertion issues - nerve damage and pain on insertion

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34
Q

short acting combined hormonal contraception contains what?

works how?

A

oestrogen and progesterone

inhibition of ovulation

35
Q

transdermal patch - regimen?

A

applied for one week at a time for 3 weeks then patch free week for withdrawl bleed

36
Q

patch can be worn for how many days before efficacy lost?

A

9 days

37
Q

patch can be removed for up to how many days before efficacy lost?

A

2 days

38
Q

problems with patch?

A

obesity reduces efficacy
breast pain nausea and painful periods
increased thrombotic risk

39
Q

vaginal ring regimen?

A

ring inserted for 21 dyas then 7 day ring free period for bleed

40
Q

COCP regimen?

A

pill taken for 21 days

first 7 days prevent ovulation and next 14 maintain an anovulatory state

41
Q

how can COCP regimen be altered to induce bleed free periods ??

A

tricycling of packs

42
Q

pearl index for the pill??

A

0.3% (if used completely properly)

9% if typical usage

43
Q

starting the COCP - if starting in first 5 days of cycle??

starting anytime after day 5 of cycle?

A

fine. no additional cover needed

7/7 condom cover

44
Q

when can COCP be started after TOP?

A

immediately

45
Q

COCP can be started when post partum? only if?

if breastfeeding - rules about COCP?

A

3 weeks
only if NOT breastfeeding

completely CI

46
Q

starting COCP after EC: can start it when after having levonelle ??

when can u start it after having EllaOne?

A

immediately

5 days

47
Q

if vomiting within 2 hours of taking pill ?

if >24 hours of diarrhoea?

A

take again

take again

48
Q

COCP - missed pills:

if 1 pill missed (>24 hours but <48 hours without a pill) what must be done?

A

take missed pill and continue rest of pack as normal (no need for EC or additional cover)

49
Q

If 2 COCP pills missed (>48 hours without a pill)

1) If in week 1 - do what?
2) If in week 2 - do what?
3) If in week 3 - do what?

A

1) take most recent pill, use 7/7 condoms and consider EC if UPSI
2) take most recent pill, 7/7 condoms
3) take most recent pill, 7/7 condoms + omit the pill free break

50
Q

If >2 missed COCP pills - do what?

1) if in 1st week?
2) if in any other week?

A

1) Emergency contraception

2) continue with rest of the pack and omit the pill free break

51
Q

benefits of COCP??

A

improves acne, premesntrual symptoms, protects against ovarian, endometrial and colorectal cancer

52
Q

minor side effects of COCP?

A

increased BP
mood swings
N & V
irregular bleeding - should settle with time

53
Q

major side effects of COCP?

A

increased VTE risk
increased CVD and stroke risk
increased risk of breast and cervical cancer

54
Q

other risk factors that would increase VTE risk along with COCP?

A 
>35 y/o
smoking
immobility
long haul flights
6 weeks post partum
high altitudes for > 1 week
55
Q

have cautions when giving COCP if ?

A

> 2 risk factors for VTE/arterial disease
GI conditions that would affect absorption
Use of enzyme inducing drugs

56
Q

UKMEC 4 CI to using the COCP???

A 
BP >160/95
Breast feeding
Migraine with aura
Smoking >15 a day if >35 y/o
IHD
Hx breast cancer
APLS
Hx stroke or thrombotic disease 
advanced DM with signs of complications
57
Q

POP (progesterone only pill) (etonogestrel, levenogestrel) - MofA??

A

thickens cervical mucus + suppresses ovulation

58
Q

regimen for POP??

A

pill taken everyday for 28 days and pill taken at the same time everyday

59
Q

missed POP’s rules:
if 1 missed pill and no UPSI ??
if 1 missed pill and UPSI ?

A

7/7 condom cover

EC + 7/7 condoms

60
Q

if <3 hours late in taking POP ?

A

continue as normal

61
Q

if >3 hours late in taking POP ?

A

take missed pill ASAP, continue with the rest of pack, extra precaution (condoms) used until pill taking has been re-established for 48 hours

62
Q

2 different types of progestogen-only pill

A

3-hour progestogen-only pill (traditional progestogen-only pill) – must be taken within 3 hours of the same time each day

12-hour progestogen-only pill (desogestrel progestogen-only pill/Cerazette) – must be taken within 12 hours of the same time each day

63
Q

missed POP rules, 12 hour window rather than 3 hour window allowed if ?

A

using desogestrel (cerazette) type of POP

same rules apply but as if <12 hours and >12 hours since missing taking the pill

64
Q

POP generally used as an alternative to the COCP in women where COCP is CI - eg??

A

breast feeding

>35 and smoking > 15 a day

65
Q

side effects of POP?

A

DUB (irregular bleeding - main SE)
weight gain
headaches

66
Q

CI to POP?

A

active breast cancer

67
Q

UPSI in context of lack of contraception, barrier failure, missed pills, expulsion of coil, late injections etc - need what?

A

EC

68
Q

Oral EC used up to 3 days post UPSI and can be used multiple times in cycle?

mechanism of action?

A

Levonelle (levonogestrel - high dose of progesterone)

suppresses ovulation

69
Q

efficacy of Leonelle at day 1 ?

day 3?

A

98%

80%

70
Q

cautions with levonelle?

A

obesity

use of enzyme inducers

71
Q

Oral EC used up to 5 days after UPSI and only once per cycle?

MofA?

A

EllaOne (ulipristal acetate - anti-progesterone)

inhibition or delay of ovulation

72
Q

efficacy of ellaone?

A

> 99%

73
Q

cautions with EllaOne?

A

use of antacid meds or uncontrolled asthma

74
Q

considered most effective form of EC, can be inserted up to 5 days post UPSI??

A

Copper coil

75
Q

IUD can also be inserted up to how many days after the likely ovulation date in women presenting when after UPSI who want EC??

A

up to 5 days after likely ovulation date in women presenting >5 days after UPSI

76
Q

before use of copper IUD (in EC) need to screen for what?

A

chlamydia (test for this)

if high risk - can give prophylactic azithromycin

77
Q

EC not required before what time post partum?

A

before day 21 post partum

78
Q

contraception is required from what day post partum onwards??

why?

A

day 21 onwards

(earliest time of ovulation in non-breastfeeding woman thought to be day 28 post partum and sperm can survive up to 7 days)

79
Q

Perl index of implant ??

A

0.05%

80
Q

pearl index of vaectomy?

A

0.1%

81
Q

pearl index of IUS?

A

0.2%

82
Q

pearl index of depot injection? (depo provera)

A

0.2%

83
Q

pearl index of pill if used perfectly and typical use?

A

0.3% and 9% (typical use)

84
Q

pearl index of IUD?

A

0.6-0.8%

Gynae (2 decks)

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