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contraception Flashcards

1
Q

which hormones have a negative feedback effect on the hypothalamus

A

oestrogen and progesterone

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2
Q

which hormones have a negative feedback effect on the pituitary gland

A

oestrogen and progesterone

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3
Q

which hormones are involved in the hypothalamic-pituitary-ovarian axis

A

GnRH
LH and FSH
oestrogen and progesterone

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4
Q

how long can sperm survive in the female genital tract

A

5 days

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5
Q

how long do ovum survive in the female genital tract

A

up to 24 hours

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6
Q

what is the pearl index and how is it calculated

A

it represents the number of contraceptive failures per 100 women users/year
(no. of accidental pregnancies x 1200)/total number of months of exposure

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7
Q

what are some methods of using natural family planning as contraception

A 
basal body temperature 
cervical position
cervical mucous 
'standard' days 
breast feeding
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8
Q

how is basal body temperature measured and how is it affected by fertility

A

taken before rising every morning
increase in body temp >0.2 degrees post ovulation
increase in temp sustained for 3 days
increase in temp follows at least 6 days of lowered temperature

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9
Q

how can changes to cervical mucous predict ovulation

A

thick and sticky post ovulation (3 days)

then become thinner, watery, ‘stretchy’

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10
Q

how does cervical position indicate fertility

A

when fertile the cervix is high in the vagina, soft and open

when less fertile it is low, firm and closed

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11
Q

what are ‘standard’ days

A

in a regular 28 day cycle, days 8 to 18 are most fertile

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12
Q

what are the criteria for lactational amenorrhoea

A

exclusively breast feeding
less than 6/12 post natal
amenorrhoeic

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13
Q

which hormones are present in combined hormonal contraception

A

oestrogen and progesterone

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14
Q

mode of action of combined hormonal contraception

A

primarily inhibits ovulation
effect on cervical mucous
effect on endometrium

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15
Q

mode of action of newer POP

A

inhibits ovulation
effects on cervical mucous
effects on Fallopian tube transport
effects on endometrium

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16
Q

mode of action of older POP

A

effects on cervical mucous
effects on Fallopian tube transport
effects on endometrium

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17
Q

which factors can affect the efficacy of CHC and POP

A

absorption

metabolism

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18
Q

what is LARC

A

long acting reversible contraception

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19
Q

mode of action of the implant

A

inhibition of ovulation
effect on endometrium
effect on cervical mucous

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20
Q

mode of action of depo injection

A

inhibits ovulation
effect on cervical mucous
effect on endometrium

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21
Q

mode of action of IUS

A

effect on implantation (endometrium rendered unfavourable for implantation)
also effect on cervical mucous and pre-fertilisation effects

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22
Q

what are the 3 doses of IUS currently available

A

mirena 52 mg
kyleena 19.5 mg
jayvees 13.5 mg

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23
Q

mode of action of IUD

A

prevention of fertilisation

inflammatory response in endometrium

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24
Q

mode of action of female sterilisation

A

blocs the Fallopian tubes (filshie clips)

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25
why must there be no risk of pregnancy before female sterilisation
high risk of ectopic pregnancy
26
what is UKMEC 1
no restriction for the use of contraceptive method
27
what is UKMEC 2
advantages outweigh the risks
28
what is UKMEC 3
risks outweigh the advantages, requires expert clinical judgement
29
what is UKMEC 4
unacceptable risk
30
what baseline examination is done before prescribing contraception
BP and BMI
31
what risk factors should be considered before prescribing contraception
osteoporosis CV disease breast cancer VTE
32
what are the criteria to be 'reasonably certain' you're not pregnant
no sex since last period consistently using reliable contraception <7 days since last normal period <4 weeks post party (not breast feeding) lactational amenorrhoea negative pregnancy tests AND >3 weeks since UPSI
33
what is quick-starting contraception
starting contraception when patient presents ie not waiting until next period
34
which contraception can be used for quick start
some CHC POP implant depo
35
what is bridging contraception
when the preferred method of contraception can't be started immediately because pregnancy cannot be excluded and an interim method is used
36
when might emergency contraception be needed
when contraception hasn't been used when contraception hasn't been used properly before new contraceptive method has had chance to become effective
37
when is the highest risk of pregnancy
30% risk during 5 days before plus day of ovulation
38
indications of EC
up to 5 days after UPSI | within 5 days of predicted ovulation
39
methods of EC
copper IUD LNG-EC UPA-EC
40
how long is LNG-EC effective
up to 72 hours post UPSI
41
how long is UPA-EC effective
up t 120 hours post UPSI
42
what is the most effective form of EC
IUD
43
how does oral EC work
UPA = anti-progestogen LNG = high dose progestogen DELAY OVULATION
44
when is oral EC likely to be effective
LNG-EC works until just before LH surge UPA-EC can work during LH surge but not after peak neither work after ovulation
45
when to avoid UPA
if wishing to 'quick-start' hormonal contraception must delay ongoing contraception for 5 days if hormonal contraception has been used in past 7 days if patient has acute severe asthma uncontrolled by oral steroids
46
non-contraceptive benefits of contraception
``` heavy menstrual bleeding painful periods irregular periods premenstrual symptoms endometriosis menstrual migraine (no aura) ```
47
what is scheduled bleeding
menstruation or regular withdrawal bleeding with CHC
48
what is the failure rate of CHC with typical use
9%
49
what are tailored regimens
off licence uses of COC, generally to prevent withdrawal bleeding
50
types of tailored regimes
``` tai-cycling (taking 3 packs back to back then 4-7 days off) shortened hormone free interval (3/52 on, then 4/7 off) extended use (use continuously until breakthrough bleeding, then stop of 4-7 days) ```
51
what are the main risks of CHC
venous thrombosis arterial thrombosis adverse effects on some cancers
52
how high is the the risk of VTE in users of COC
low but will affect individuals with other risk factors for VTE
53
UKMEC risk factors for VTE
``` obesity smoking age known thrombophilia VTE in first degree relative <45 years up to 6 weeks post natal ```
54
non-UKMEC risk factors for VTE
trekking >4,500 m for >1 week long haul flights reduced mobility APS
55
what is the VTE risk in pregnancy per 10,000 women
12-20
56
what is the VTE risk on the first weeks post-natally per 10,000 women
300-400
57
what is cyprterone acetate used to treat
acne and hirsutism
58
why is CHC contraindicated in patients with migraine with aura
increases the risk of ischaemic stroke
59
breast cancer and UKMEC criteria
personal history - CHC contraindicated family history - UKMEC 1 BRACA - UKMEC 3
60
risk factors to consider when prescribing CHC
``` smoking obesity age HTN diabetes with vascular complications postnatal vascular disease immobility FHx of VTE APS trekking at altitudes breastfeeding ```
61
risks of IUS and IUD
``` procedure infection perforation expulsion failure risk to pregnancy when in situ ```
62
complications of vasectomy
``` anaesthetic pain infection bleeding/haematoma failure ```

3 REPRO (40 decks)

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