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Y3 OBS AND GYNAE > Contraception > Flashcards

Contraception Flashcards

1
Q

What is the world’s most widely used contraceptive method?

A

Condoms

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2
Q

Fertility awareness involves being able to recognise the signs + symptoms of fertility during a menstrual cycle, so that you can avoid/plan a pregnancy (family planning).
What 5 things in particular can a woman monitor?

A 
Basal body temperature
Cervical mucous
Cervical position
"Standard" days in cycle
Breastfeeding
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3
Q

When must basal body temperature be taken when assessing the menstrual cycle? What is the expected increase in body temperature?

A

Before rising in the morning

Increase greater than 0.2’C sustained for at least 3 days following 6 days of a lower temperature

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4
Q

Describe cervical mucous immediately after a period

A

Low secretion, dry vagina

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5
Q

Describe cervical mucous leading up to ovulation

A

Moist, sticky, cloudy 8 days before

Wet, clear, slippery, stretchy 4 days before

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6
Q

Describe cervical mucous post-ovulation and its significance/relation with fertility

A

Thick and sticky

Fertility usually ended after day 3 of thick sticky mucous

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7
Q

What is the cervical position during fertility compared to when less fertile

A

High in vagina, soft and open when fertile; low in vagina, firm and closed when less fertile

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8
Q

In a 28 day menstrual cycle, which days are women most fertile?

A

Days 8-18

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9
Q

Breastfeeding can be very effective for fertility. What are the 3 criteria?

A

Exclusively breast feeding
Less than 6 months post-natal
Amenorrhoeic

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10
Q

What is the UK medical eligibility criteria (UK MEC)?

A

Summarises various medical conditions and their suitability for different forms of contraception

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11
Q

What is category 1 of the UKMEC?

A

No restriction on use of contraception

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12
Q

What is category 2 of the UKMEC?

A

Advantage of using contraception outweighs theoretical/proven risk to health

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13
Q

What is category 3 of the UKMEC?

A

Risk of using contraception outweighs benefit, thus use is not recommended without expert clinical opinion

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14
Q

What is category 4 of the UKMEC?

A

Unacceptable risk if contraception is used

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15
Q

The Pearl Index estimates failure rates of contraception - what is the formula?

A

[No. of accidental pregnancies x 1200]/total no. of months of exposure

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16
Q

What does LARC stand for?

A

Long-acting reversible contraception

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17
Q

List the main LARC methods used

A 
Injection: Depo Provera (IM)
Sayana press (SC)
Intrauterine device (IUD)
Intrauterine system (IUS)
Implant
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18
Q

How does Depo Provera work? How often is it given?

A

Inhibits ovulation, thickens cervical mucous and thins endometrium
Given every 13 weeks

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19
Q

Depo Provera contains a complex which is a synthetic form of which hormone?

A

Progesterone

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20
Q

What chronic conditions may have implication when Depo Provera is used?

A 
AFFECTS BMD
Hypothyroidism
Coeliac disease
Rheumatoid arthritis
Hyperparathyroidism
IBD
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21
Q

When is conception most likely to occur?

A

Unprotected sex on the day of ovulation or the preceding 24 hours

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22
Q

When should Depo Provera be started without the need for using other contraception?

A

Up to and on day 5 of a normal cycle

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23
Q

When can Depo Provera be started beyond day 5 of a normal cycle?

A

Can be started at any other time provided the woman is reasonably certain she is not pregnant and has been using condoms or abstinent for at least 7 days

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24
Q

When can a woman be “reasonably certain” she is not pregnant?

A

Not had sex since last period
Consistently using reliable contraception
Is within first 7 days of onset of period
Is within 4 weeks post-partum
Is fully breast feeding, amenorrhoeic, <6m post-partum
Negative pregnancy test after 3 weeks since unprotected sex

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25
Q

List the main side effects of Depo Provera

A

Weight gain (increased appetite)
Delay in return of fertility
Irregular bleeding
Osteoporosis

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26
Q

Describe the composition of the LARC IUD

A

Non-hormonal T-shaped device made of copper and plastic

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27
Q

What is the significance of an IUD being made of copper? (how does this relate to its mode of action?)

A

Toxic to sperm and ova, therefore prevents fertilisation and causes inflammatory response in the endometrium

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28
Q

When should an IUD be started?

A

Any time in cycle if no UPSI in last three weeks

Since LMP and ongoing pregnancy excluded

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29
Q

When can an IUD be used as emergency contraception?

A

Up to 5 days after unprotected sex or up to 5 days after predicted date of ovulation
Pregnancy doesn’t implant first 5 days after ovulation

30
Q

Describe the composition of the LARC IUS

A

T-shaped device with elastomere core that secretes progesterone into uterus

31
Q

How does IUS work?

A

Makes implantation harder by thickening mucous and thinning endometrium
N.B. does not prevent fertilisation

32
Q

When should an IUS be started?

A

Any time in cycle if no UPSI in last three weeks

Since LMP and ongoing pregnancy excluded

33
Q

What are the contraindications to using an IUD or IUS?

A 
Current pelvic infection
Abnormal uterine anatomy
Pregnancy
Sensitivity to composition
Gestational trophoblastic disease (molar pregnancy)
Endometrial cancer
34
Q

List some side effects of using an IUD or IUS

A 
Heavy periods (though IUS may have lighter periods)
Pain, infection
Perforation
Expulsion
Failure to work!
Ectopic risk with IUS
35
Q

Describe the composition of the LARC implant

A

Non-biodegradable subdermal rod inserted above elbow that releases progestogen

36
Q

How does a LARC implant work?

A

Inhibits ovulation
Thickens cervical mucous
Thins endometrium

37
Q

When should a LARC implant be started? How long does contraception last?

A

Within first 5 days of menstrual cycle

3 years

38
Q

List some side effects of LARC implant

A

Irregular bleeding
Weight gain
Acne
NV injury

39
Q

List the LARC methods in order of lowest to highest Pearl index score
[highest = increased failure rate]

A

Implant, IUS, Depo Provera, IUD

40
Q

What are the 3 main methods of non-LARC/short-acting contraception?

A

Combined hormonal contraceptive (CHC)
Progesterone-only pill (POP)
Emergency hormonal contraception (EHC)

41
Q

List the non-contraceptive benefits of CHC

A 
Reduce all of:
Heavy menstrual bleeding
Painful periods
Acne
Irregular periods
Endometriosis
Menstrual migraine
42
Q

What are the 3 forms of CHC available?

A

Combined oral contraceptive pill (COC)
Combined transdermal patch (CTP)
Combined vaginal ring (CVR)

43
Q

How does CHC work?

A

Inhibits ovulation via the HPO axis to reduce LH and FSH
Thickens cervical mucous
Thins endometrium

44
Q

Describe a standard regime for taking COC

A

Take daily for 21 days then stop for 7 days, during which withdrawal bleed occurs
Use condom for 7 days after starting

45
Q

Describe a standard regime for taking CTP

A

One patch worn for 1 week and reapplied weekly for further 2 weeks
Fourth week is patch-free to allow withdrawal bleed
Use condom for 7 days after starting

46
Q

Describe a standard regime for taking CVR

A

Ring is placed and left in vagina for 21 days, then removed to allow withdrawal bleed
New ring inserted afterwards
Use condom for 7 days after starting

47
Q

What factors may affect the effectiveness of CHC?

A 
Impaired absorption (GI conditions
)Increased metabolism (drug interactions)
Forgetting
48
Q

If a woman missed one pill of CHC, what should she do?

A

Take the last pill missed immediately

Continue taking the rest of the pack normally

49
Q

If a woman missed 2 or more pills of CHC, what should she do?

A

Take the last pill missed immediately
Continue taking the rest of the pack normally
Use an additional contraceptive method for the next 7 days

50
Q

What are the risks/side-effects of CHC?

A

Venous thrombosis
Arterial thrombosis
Alteration of clotting factors
Adverse effects on some cancers

51
Q

CHC’s that contain which compounds have the lowest risk of venous thromboembolism?

A

Levonorgestrel
Norethisterone
Norgestimate[3rd generation COCs]

52
Q

COC use can increase blood pressure. True/False?

A

True

53
Q

Migraine with aura in COC users further increases the risk of what?

A

Stroke

Thus COC is contraindicated in these patients

54
Q

CHC can aggravate breast cancer. If there is a personal history of breast cancer, what score on UKMEC is given?

A

4 - CHC contraindicated in these patients

55
Q

CHC can aggravate breast cancer. If there is a family history of breast cancer, what score on UKMEC is given?

A

1 - CHC can be used

56
Q

CHC can aggravate breast cancer. If there is a BRACA mutation, what score on UKMEC is given?

A

3 - CHC generally avoided

57
Q

CHC offers protection against which cancers?

A

Ovarian and endometrial cancer

58
Q

When should COC and POP be started?

A

COC started up to or on day 5 of cycle

Anytime after day 5 providing “reasonably certain” not pregnant and has been using condoms

59
Q

What does the POP notably interact with?

A

Liver enzyme inducers

60
Q

Which has the higher Pearl index - CHC or POP?

A

Neither! Both the same at 0.3%

61
Q

How do barrier methods of contraception work?

A

Blocks sperm getting to female genital tract

62
Q

How does female sterilisation work?

A

Blocks fallopian tubes

63
Q

How does male sterilisation work?

A

Divides vas deferens (prevents passage of sperm)

64
Q

List investigations to consider before prescribing contraception

A

BP
BMI
Cervical smear (check up-to-date)
PV to check uterine size if IUD being used

65
Q

List the 3 main methods of emergency contraception

A 
Intra-uterine copper IUD
Oral LNGEC (Levonorgestrel) - progesterone only
Oral UPAEC (Ulipristal acetate) - progesterone antagonist
66
Q

When can oral LNGEC be used as emergency contraception?

A

Up to 72 hours post UPSI

Before ovulation

67
Q

When can oral UPAEC be used as emergency contraception?

A

Up to 120 hours post UPSI

Before ovulation

68
Q

What is it important to screen for before prescribing emergency contraception?

A

STI risk assessment

69
Q

What is the significance of inhibiting ovulation with contraception?

A

No egg to be fertilised

70
Q

State one advantage of taking POP over COC

A

Reduced side effect profile - no oestrogen

71
Q

How long after emergency contraception can long-term contraception be started?

A

Intra-uterine copper IUD - immediately
Oral LNGEC - immediately
Oral UPAEC - wait 5 days

Y3 OBS AND GYNAE (44 decks)

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