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Reproduction Physiology > Contraception > Flashcards

Contraception Flashcards

1
Q

Types of combined contraception

A

pills
patch
vaginal ring

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2
Q

Types of progesterone only contraception

A

pill
injection
implant

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3
Q

Which contraception has the most serious side effects

A

Ones containing oestrogen

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4
Q

Non contraceptive benefits are particularly evident in

A

COC

mirena

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5
Q

Contraception that is most effective

A

Vasectomy followed by implant

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6
Q

Pearl index definition

A

Number of contraceptive failures per 100 women-years of exposure

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7
Q

Life table analysis definition

A

Contraceptive failure rate over a specified time frame and can provide a cumulative failure rate for any specific length of exposure

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8
Q

Failure rates in clincial trials for contraception are reported by

A

Pearl index

Life table analysis

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9
Q

Combination of which hormones are in the combined oral contraceptive pill?

A

Ethynyl estradiol (EE) and Synthetic progesterone (progesterone)

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10
Q

Combined oral pill mode of action

A

Prevents ovulation
Alters FSH and LH => no surge
Prevents implantation by providing an inadequate endometrium
inhibits sperm penetration of cervical mucus by altering quality and character of mucus

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11
Q

Non-contraceptive benefits of combined contraceptive pill

A

Regular bleed with potential reduction in painful heavy menstruation and anaemia
Reduction in functional ovarian cysts
50% reduction in ovarian and endometrial cancer
improvement in acne
reduction in benign breast disease, rheumatoid arthritis, colon cancer and osteoporosis

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12
Q

Risks of the combined oral pill

A

VTE
No increase of MI in non smokers
Very small increase in ischaemic stroke which is increased further in those with focal migraine
Breast cancer risk likely small and disappears after 10 years COC
Cervical cancer risk doubles after 10 years use
Liver disease

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13
Q

Mode of action of progesterone only pill

A

Cervical mucus rendered impenetrable by sperm

Spectrum of effects on ovulation

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14
Q

When is the max effect seen of the POP?

A

48 hours after ingestion

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15
Q

What is the solution in the contraceptive injection?

A

Aqueous solution of crystals of the progesterone depomedroxyprogesterone acetate

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16
Q

How is the contraceptive injection taken?

A

150mg given IM into upper quadrant of buttock every 12 weeks (3 months)

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17
Q

Mode of action of the contraceptive injection

A

Prevents ovulation
Alters chemical mucus making it hostile to sperm
Prevents implantation by rendering endometrium unstable

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18
Q

Side effects of contraceptive injection

A

Delay in return to fertility (no reduction in fertility)
Reversible reduction in bone density
Problematic bleeding
Weight gain

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19
Q

What hormones are in the subdermal implant?

A

Core - etonogestrel (ENG)

Membrane - ethinyl vinyl acetate (EVA)

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20
Q

Mode of action of the subdermal implant

A 
PRIMARY = inhibition of ovulation (100% of women)
SECONDARY = effect on cervical mucus (inhibiting sperm entry into upper repro tract)
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21
Q

Intrauterine contraception lasts for

A

5-10 years

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22
Q

Most effective emergency contraception

A

CU-IUD

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23
Q

Pill that you have to use within 72 hours of unprotected sex

A

Levonorgestrel

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24
Q

Pill that you have to use within 120 hours of unprotected sex

A

Ellaone

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25
Q

Vasectomy definition

A

Permanent division of vas deferens under local anaesthetic

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26
Q

Side effects of vasectomy

A

Pain due to sperm granulomas

Irreversibility

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27
Q

Clinic consultation about TOP should involve

A 
Methods of termination 
Prolonged bleeding after TOP
Counselling available after TOP
Contraception agree and advise 
Certificate A signed 
FBC, group and screen, rubella
Self obtained swab for chlamydia and gonorrhoea 
STI bloods offered
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28
Q

TOP meaning

A

Termination of Pregnancy

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29
Q

How medical termination of pregnancy is carried out

A

Take MIFEPRISTONE then take MISOPROSTOL 48 hours later

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30
Q

Mifepristone method of action

A

Switches off pregnancy hormone which is keeping uterus from contracting and allowing pregnancy to grow

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31
Q

Misoprostol method of action

A

Initiates uterus contraception which opens the cervix and expels the pregnancy

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32
Q

Complications of TOP

A 
failure <5 in 100
haemorrhage <5 in 100
infection (screen)
prolonged bleeding <5 in 100
uterine perforation
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33
Q

When discussing emergency contraception, need to ask

A 
first day of LMP
Used before?
are they on contraception and is it reliable?
regular cycles?
Medications?
allergies?
untreated UTI?
problems with womb/cervix e.g. unexplained bleeding
age of partner 
timings
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34
Q

Fertility of the menstrual cycle

A

Days 1-0 = 2-3%
Days 10-17 = 20-30%
Days 18-28 = 2-3%

35
Q

High risk for BBV if

A

Blood donation from certain countries
Unlicensed tattoo parlours
MSM
IVDU

36
Q

Barrier methods of contraception

A

Condoms
Cervical Cap
Diaphragm

37
Q

Until how many weeks gestation can you have surgical TOP?

A

up to 12 weeks

38
Q

Which intrauterine device can be used as an emergency contraceptive?

A

the copper intrauterine device

the mirena intrauterine device IS NOT an emergency contraceptive

39
Q

Teratogenic drugs

A 
Chemotherapy
Radiotherapy
Lithium 
Retinoids
ACEIs
Tetracycline
Methotrexate
40
Q

Causes of false +ves for pregnancy tests

A

Fertility treatment

Germ cell tumours

41
Q

What types of USS are done before 12 weeks and after 12 weeks gestation?

A

< 12 Transvaginal USS

> 12 Abdominal USS

42
Q

If you can see the yolk sac on USS, what does this indicate?

A

An IU pregnancy

43
Q

What type of drug is mifepristone?

A

Anti-progesterone

44
Q

What type of drug is misoprostol?

A

Prostaglandin

45
Q

When is misoprostol used?

A

Abortion
Inducement of labour
PPH

46
Q

What is a common S/E after TOP and how long do you get it for?

A

Heavy periods

1 - 2 week

47
Q

How does SMM work?

A

Cervical priming 3 hours before procedure

Suction tube

48
Q

Risk of perforation in SMM

A

1 in 1000 risk

49
Q

Blood tests done before TOP

A

Syphillis
HIV
Rheus status
Chlamydia

50
Q

Does TOP affect fertility?

A

Not unless a complication arises

51
Q

How quickly can someone get pregnant after TOP?

52
Q

How quickly can someone start contraception after TOP?

A

Pill next day
Implant same day
Injection same day

53
Q

How many women have a TOP in their lifetime?

54
Q

Is the patch combined contraception?

55
Q

How often is the patch changed?

A

Every week

56
Q

Who is the patch good for?

A

Patients with

  • bulimia
  • GI upset
57
Q

How long does the vaginal ring stay in for?

58
Q

Can the vaginal ring be taken out?

A

Yes, 4 hours every 24 hours and it will still work

59
Q

Is the vaginal ring combined contraception?

60
Q

Side effects of the subdermal implant

A

VERY irregular bleeding that may settle or may not

61
Q

Side effects of the copper coil

A

Sore to fit

Heavier, longer, more crampier periods

62
Q

Risks of IUD

A

5/100 risk of expulsion

1/1000 risk of perforation

63
Q

Risk of ectopic pregnancy with coil

64
Q

Which female barrier methods have a high failure rate?

A

Diaphragm

Female condom

65
Q

If 100 couples are trying for a baby, how many will get pregnant?

66
Q

If 100 couples use condoms perfectly, how many will get pregnant?

67
Q

If 100 couples are on the pill/patch, how many will get pregnant?

A

<1

Real life 4 - 8

68
Q

If 100 couples are on LARC, how many will get pregnant?

A

<1

Depo in real life 2 - 3

69
Q

What does LARC stand for?

A

Long acting reversible contraception

70
Q

Examples of LARC

A

Injection
Coil
Implant

71
Q

What is the most effective emergency contraception?

A

Copper coil

72
Q

How long after sex can you get the copper coil as emergency contraception?

A

120 hours after accident or predicted ovulation

73
Q

What type of drug is ellaone?

A

Anti-progesterone

74
Q

Contraindications of ellaone

A

Acid enzyme reducing drugs

Pregnancy

75
Q

Contraindications of levonelle

76
Q

How long does a vasectomy take to work?

A

3 - 5 months

77
Q

Failure rate of female sterilisation

A

1 in 200 which could be ectopic

78
Q

How does the IUS / Mirena work?

A

Thickens cervical mucus

Some women may prevent ovulation

79
Q

What are the unacceptable health risks which means that the COCP is not an option for the patient?

A

> 35 y/o and smoking > 15 cigarettes / day
Migraine with aura
History of thromboembolic disease or thrombogenic mutation
History of stroke or ischaemic heart disease
Breast feeding < 6 weeks post partum
Uncontrolled HTN
Current breast cancer
Major surgery with prolonged immbolisation

80
Q

How does the IUD / copper coil work?

A

Slows down sperm and survival

81
Q

How long is there a window to forget to replace your contraception patch in which it still protects against pregnancy?

82
Q

When should oestrogen contraceptives be stopped before major elective surgery?

A

4 weeks before

83
Q

What is an absaloute contraindication to the copper IUD?

Reproduction Physiology (13 decks)

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