Contraception Flashcards
1
Q
Which survives longer in the female genital tract - sperm or ovum?
A
Sperm
2
Q
How long can sperm live in female genital tract?
A
up to 5 days
3
Q
How long can ovum survive in the female genital tract?
A
Up to 24 hours
4
Q
Name 3 types of combined hormonal contraception (CHC)?
A
Pill
Patches
Vaginal ring
5
Q
Name 3 types of progesterone only contraception (POC)?
A
Pill
Implant
Depo injection
6
Q
Name 7 broad categories of contraception?
A
Combined hormonal contraception (CHC) Progesterone only contraception (POC) Intra uterine system (IUS) Intra uterine device (IUD) Barrier methods Sterilisation Emergency contraception
7
Q
If a patient wants quick starting contraception (i.e. they don’t want to wait until next period before starting contraception) then they could get…
A
Some CHCs
POP
Implant
8
Q
If a patient wants quick starting contraception (i.e. they don’t want to wait until next period before starting contraception) then they CANNOT get ….
A
IUD - copper coil
Pills containing cyproterone acetone
9
Q
Uses of contraceptives
A
Contraception Heavy menstrual bleeding Painful periods Irregular periods Premenstrual symptoms Endometriosis
10
Q
Name 4 short acting methods of contraception
A
Combined hormonal contraception
Progesterone only pill
Condoms
Diaphragms
11
Q
Whats more effective: long acting or short acting methods of contraception? why is this?
A
Long acting
= they don’t rely on routine and continuous compliance
12
Q
Name 4 long acting methods of contraception
A
Implant
Copper IUD
IUS
Sterilisation
13
Q
What is the most effective method of contraception?
A
Progesterone only implant
14
Q
How often should you check the patients history when they are on contraception?
A
Annually
15
Q
Before prescribing contraception: what is needed?
A
History Examination - Must report BP - Must record BMI - Vaginal exam (if Intra uterine method is used)
16
Q
CHC - which hormones does it contain?
A
Oestrogen and progestogen
17
Q
CHC - mode of action
A
Primarily inhibits ovulation
18
Q
CHC - causes THIN/THICK cervical mucous and THIN/THICK endometrium?
A
Thick cervical mucous
Thin endometrium
(this reduces the likelihood of getting pregnant)
19
Q
CHC - failure rate
A
Pearl index 0.2%
higher failure rate if people forget to take it
20
Q
CHC - Protects against which cancers?
A
Ovarian and endometrial cancer
21
Q
CHC worsens acne. True or false?
A
False
22
Q
CHC - Pill - example
A
Rigavedon 30mcg
23
Q
What is one of the most commonly used contraceptive methods in the UK ?
A
Combined oral contraceptive pill
24
Q
CHC - pill - how/when to take it?
A
Start in first 5 days of regular menstruation
25
CHC - Can you take the pill at any time of the menstrual cycle?
Yes
- when reasonably sure you are not pregnant
- use condoms for first 7 days after starting pill
26
CHC - pill - regimen
Take daily for 21 days followed by 7 day break
27
CHC - can you use the pill continuously?
Tri-cycling - you can take 3 packs of pill back to back then have 4-7 days off (NEVER have more than 7 days off)
Extended use - use continuously until breakthrough bleeding occurs then stop for 4-7 days
28
CHC - pill - unwanted effects
```
Venous thrombosis
Arterial thrombosis
Systemic hypertension
- small increase in BP in some people
- withdraw if BP >140/90
Adverse effects on some cancers
- breast cancer
- cervical cancer (long term use)
```
29
CHC - pill - when should BP be checked?
Before initiating
3 months after starting
Annually thereafter
30
CHC - pill - contraindications
Migraine with aura (increases risk of ischaemic stroke)
| Rifampicin drug
31
CHC - how long does vaginal ring last?
3 weeks
32
CHC - patch - contraindications
If you weigh over 90kg
33
POC - pill - mode of action
Causes thick cervical mucous, thin endometrium and reduces fallopian tube transport
34
POC - pill - how to start
Start on day 1-5 of period
35
POC - pill - can you start at any time of menstrual cycle?
Yes
- if reasonably certain you are not pregnant
- use condoms for first 7 days
36
POC - implant - how long does it provide contraception for?
Up to 3 years
37
POC - implant - mode of action
Inhibits ovulation
| Causes thick cervical mucous and thin endometrium
38
POC - implant - example
Nexaplanon
39
POC - implant - insertion
Sub dermal
| Upper arm
40
POC - implant - failure rate
Pearl index - 0.05%
41
POC - implant - complications
Irregular periods
| Some people get spotting
42
POC - depo injection - how often is it administered?
Every 13 weeks
43
POC - depo injection - mode of action
Inhibits ovulation
Causes FSH suppression
- which suppresses estradiol levels
- causes thick cervical mucous and thin endometrium
44
POC - depo injection - examples (2)
Depo-provera
| Sayana press
45
POC - depo injection - failure rate
Pearl index 0.2%
46
IUS - definition
Coil
| Works as soon as its inserted
47
IUS - how long does it last?
5-10 years
48
IUS - mode of action
Insert into vagina (T shaped)
Releases progestogen into the womb to prevent you from getting pregnant
Causes thick cervical mucous and thin endometrium
49
IUS - can it be inserted at any time in the menstrual cycle?
Yes....if
- no unprotected sex in past 3 weeks
- no unprotected sex since last menstrual period
- pregnancy is excluded
50
IUS - name 3 examples
Mirena
Kyleena
Jaydess
51
IUS - which one do you use if someone has a particularly small uterus?
Jaydess
52
IUD - definition
T shaped copper coil that is inserted into the vagina
53
IUD - mode of action
Does not release hormones
Copper released as it is toxic to an egg and sperm joining
Therefore, it prevents fertilisation
54
IUD - can it be started at any time of the menstrual cycle?
Yes...if
- no unprotected sex in past 3 weeks
- no unprotected sex since last menstrual period
- not pregnant
55
IUD - disadvantages
Positioning
| - if not fitted in correct location, a pregnancy could form above it
56
A copper coil can be used as emergency contraception. True or false?
True
57
Name 2 barrier methods
Condoms
| Diaphram
58
Barrier methods - diaphragm
Sits over the cervix and prevents spree from entering
59
Barrier methods - how long should diaphragm stay in after sex?
6 hours
60
Sterlisation is a reversible form of contraception. True or false?
False
| - non-reversible
61
Female sterilisation - method
Block fallopian tubes
| Must make sure patient is not pregnant
62
Male sterilisation - method
Vasectomy
| Division of vas deferens so it stops sperm from getting up the vas deferens
63
Natural family planning
Woman monitors and records a number of fertility signals during menstrual cycle to either plan/avoid pregnancy
64
Natural family planning - which fertility signals are monitored?
```
Basal body temperature
Cervical mucous
Cervical position
Standard days
Breast feeding
```
65
Natural family planning - basal body temperature
Taken before rising in morning
There is an increase in basal body temperature after ovulation
This increased temp is sustained for 3 days
66
Natural family planning - cervical mucous
Watery, thin, slippery - just before ovulation
Thick,moist, creamy - post ovulation
67
Natural family planning - cervical position when fertile
Cervix is high in vagina, soft and open
68
Natural family planning - cervical position when less fertile?
Cervix is low in vagina, firm and closed
69
In a 28 day regular cycle, which days are most fertile?
days 8 -> 18
70
It is possible to be fertile ___ days before and ___ days after ovulation ?
5
71
You are unlikely to get periods if you breast feed exclusively and baby is under 6 months. True or false?
True
72
Natural family planning - 3 criteria for lactational amenorrhoea
Exclusive breast feeding
Less than 6 months post delivery
Amenorrhoeic
73
Cyproterone acetate
Not a contraceptive but acts as a contraceptive.
| Used for acne and hirsutism treatment
74
Emergency contraception - When can it be used
Up to 5 days after unprotected sex
Can be used within 5 days of predicted ovulation date
75
What do you do if you miss more than 1 COC pill ?
emergency contraception
76
What do you do if patch/ring has been out for more than 48 hours?
Emergency contraception
77
Emergency contraception - intrauterine option
Copper IUD
78
What is the most effective form of emergency contraception?
Copper IUD
79
Emergency contraception - Copper IUD - when can it be inserted?
Up to 5 days after unprotected sex OR
| Up to 5 days after earliest expected date of ovulation
80
Emergency contraception - name 2 oral options
```
Levonorgestrel (LNG)
Ulipristal acetate (UPA)
```
81
Emergency contraception - LNG - when can you use it
Up to 72 hours after unprotected sex
82
Emergency contraception - LNG - mode of action
High dose progestogen
Delays ovulation
Works before LH surge
83
Emergency contraception - LNG - what happens to the dose if BMI is over 26
double dose required
84
Emergency contraception - UPA - when can you use it
Up to 120 hours after unprotected sex
85
Emergency contraception - UPA - mode of action
Anti-progestogen
Delays ovulation
Works until after start of LH surge
86
Emergency contraception - UPA - what happens to the dose if BMI is over 26
Same dose
87
Emergency contraception - which oral form is more effective?
UPA
88
Emergency contraception - which oral form is most cost effective?
LNG
89
When should you not use UPA as emergency contraception?
If you are also wishing to quick start hormonal contraception
- As UPA is anti-progestogen you may stop the ongoing contraception from working
If patient has acute severe asthma
90
Bleeding patterns with contraceptives - Scheduled bleeding
menstruation or regular withdrawal bleeding
91
Bleeding patterns with contraceptives - breakthrough bleeding
Unscheduled bleeding
92
Bleeding patterns with contraceptives - amenorrhoea
No bleeding or spotting in a 90 day period of time
93
Bleeding patterns with contraceptives - spotting
Vaginal discharge containing blood
94
Pearl index
Represents the number of contraceptive failures per 100 woman users per year
95
When to take a pregnancy test?
3 weeks after last unprotected sex
96
What is the most commonly used contraception method worldwide?
Withdrawal
| - have sex without condom and pull out before ejaculation
97
When can you be reasonably certain that patient is not pregnant?
No sex since last period
Crorrectly using reliable contraception
Within first 7 days of the onset of a normal menstrual period
Within 4 weeks postpartum in non breastfeeding women
Within 6 months postpartum in exclusively breastfeeding women
98
Exclusively breast feeding + baby under 6 months. Is breastfeeding alone good enough contraception?
Yes
99
What is the new self injectable contraception ?
Syanapress
100
Can't use COCP within X weeks of pregnancy?
6
101
POP can be given immediately postnataly. True or false?
True
102
Which type of pill gives you most 'regular periods'
- COCP
- POP
COCP
103
Depo-provera takes X months before fertility returns?
12 months
