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3 REPRO > contraception > Flashcards

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
Q

why must there be no risk of pregnancy before female sterilisation

A

high risk of ectopic pregnancy

26
Q

what is UKMEC 1

A

no restriction for the use of contraceptive method

27
Q

what is UKMEC 2

A

advantages outweigh the risks

28
Q

what is UKMEC 3

A

risks outweigh the advantages, requires expert clinical judgement

29
Q

what is UKMEC 4

A

unacceptable risk

30
Q

what baseline examination is done before prescribing contraception

A

BP and BMI

31
Q

what risk factors should be considered before prescribing contraception

A

osteoporosis
CV disease
breast cancer
VTE

32
Q

what are the criteria to be ‘reasonably certain’ you’re not pregnant

A

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
Q

what is quick-starting contraception

A

starting contraception when patient presents ie not waiting until next period

34
Q

which contraception can be used for quick start

A

some CHC
POP
implant
depo

35
Q

what is bridging contraception

A

when the preferred method of contraception can’t be started immediately because pregnancy cannot be excluded and an interim method is used

36
Q

when might emergency contraception be needed

A

when contraception hasn’t been used
when contraception hasn’t been used properly
before new contraceptive method has had chance to become effective

37
Q

when is the highest risk of pregnancy

A

30% risk during 5 days before plus day of ovulation

38
Q

indications of EC

A

up to 5 days after UPSI

within 5 days of predicted ovulation

39
Q

methods of EC

A

copper IUD
LNG-EC
UPA-EC

40
Q

how long is LNG-EC effective

A

up to 72 hours post UPSI

41
Q

how long is UPA-EC effective

A

up t 120 hours post UPSI

42
Q

what is the most effective form of EC

A

IUD

43
Q

how does oral EC work

A

UPA = anti-progestogen
LNG = high dose progestogen
DELAY OVULATION

44
Q

when is oral EC likely to be effective

A

LNG-EC works until just before LH surge
UPA-EC can work during LH surge but not after peak
neither work after ovulation

45
Q

when to avoid UPA

A

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
Q

non-contraceptive benefits of contraception

A 
heavy menstrual bleeding 
painful periods 
irregular periods 
premenstrual symptoms 
endometriosis 
menstrual migraine (no aura)
47
Q

what is scheduled bleeding

A

menstruation or regular withdrawal bleeding with CHC

48
Q

what is the failure rate of CHC with typical use

A

9%

49
Q

what are tailored regimens

A

off licence uses of COC, generally to prevent withdrawal bleeding

50
Q

types of tailored regimes

A 
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
Q

what are the main risks of CHC

A

venous thrombosis
arterial thrombosis
adverse effects on some cancers

52
Q

how high is the the risk of VTE in users of COC

A

low but will affect individuals with other risk factors for VTE

53
Q

UKMEC risk factors for VTE

A 
obesity 
smoking 
age 
known thrombophilia
VTE in first degree relative <45 years 
up to 6 weeks post natal
54
Q

non-UKMEC risk factors for VTE

A

trekking >4,500 m for >1 week
long haul flights
reduced mobility
APS

55
Q

what is the VTE risk in pregnancy per 10,000 women

A

12-20

56
Q

what is the VTE risk on the first weeks post-natally per 10,000 women

A

300-400

57
Q

what is cyprterone acetate used to treat

A

acne and hirsutism

58
Q

why is CHC contraindicated in patients with migraine with aura

A

increases the risk of ischaemic stroke

59
Q

breast cancer and UKMEC criteria

A

personal history - CHC contraindicated
family history - UKMEC 1
BRACA - UKMEC 3

60
Q

risk factors to consider when prescribing CHC

A 
smoking
obesity 
age 
HTN
diabetes with vascular complications 
postnatal
vascular disease 
immobility 
FHx of VTE
APS
trekking at altitudes 
breastfeeding
61
Q

risks of IUS and IUD

A 
procedure 
infection 
perforation 
expulsion 
failure 
risk to pregnancy when in situ
62
Q

complications of vasectomy

A 
anaesthetic 
pain
infection 
bleeding/haematoma
failure

3 REPRO (40 decks)

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