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Contraception Flashcards

1
Q

What would the ideal contraceptive be?

A

Reversible, effective, convenient and unrelated to intercourse, free of SEs, protective against STIs, have non-contraceptive benefits, be low maintenance

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2
Q

What are the two ways of measuring the effectiveness of a contraceptive method?

A

Pearl index: no of pregnancies per 100 woman years

Life table analysis: contraceptive failure for each month of use (this is the one we tend to use)

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3
Q

What is the difference between typical and perfect use?

A

Perfect use is using it as you are supposed to perfectly, typical use is how most people use it and is associated with a higher failure rate in most contraceptives

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4
Q

What is the % of woman experiencing an unintended pregnancy using male condoms perfect use vs typical use?

A

Perfect - 2

Typical - 15

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5
Q

What is the % of woman experiencing an unintended pregnancy using hormonal IUD perfect use vs typical use?

A

0.1 for both

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6
Q

How effective is the COCP?

A

> 99%

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7
Q

What is the COCP made up from?

A

Ethinyl estradiol (EE) and synthetic progesterone (progestogen)

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8
Q

What is the usual dose of COCP?

A

20-35microgram

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9
Q

What are the second and third generated COCPs made from?

A

Second - levonogestrel (LNG) and norethisterone (NET)

Third - gestodene (GSD) and desogestrel (DSG)

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10
Q

How is the COCP taken?

A

21 days on, 7 days off

Takes 7 days to work unless taken in first 5 days of period starting

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11
Q

Is it okay to run packets of COCP together?

A

Can tricycle

Even evidence that continuous use may be okay

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12
Q

How does the COCP work?

A

Synthetic hormones supress GnRH through negative feedback so reduced FSH –> reduced follicular development
Inhibition of LH surge –> no ovulation
Inadequate endometrium is not suitable for implantation
Cervical mucus thickening acts as physical barrier to sperm

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13
Q

What are the non-contraceptive benefits of the COCP?

A

Regular bleeds
Reduction in heavy/painful menstruation and anaemia
Reduction in ovarian and endometrial cancer, acne and benign breast disease, RA, colon cancer and osteoporosis

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14
Q

What is the main risk of the COCP?

A

VTE

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15
Q

What other factors increase risk of VTE?

A 
Major surgery, immobility
Thrombophilia
FH of VTA in under 45s
BMI >30
Underlying vascular dx 
Post-natally within 21 days
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16
Q

In which group of people would we not prescribe COCP and why?

A

Focal migraine

Increases risk of stroke

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17
Q

What cancer does COCP increase the risk of?

A

Cervical cancer

Breast (risk disappears after 10y)

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18
Q

What are the two main brands of POP?

A

Cerelle/cerazette

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19
Q

How do you take the POP?

A

Every day within 3h (some now have 12h period) of the same time

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20
Q

How does the POP work?

A

Thickens cervical mucus so sperm cannot penetrate

21
Q

How many days does it take the POP to work?

A

2 days

22
Q

What substance is in the DeproProvera?

A

Depot medroxyprogesterone acetate

23
Q

How is DeproProvera administered?

A

150mg deep IM into upper quadrant of buttocks

24
Q

How does DeproProvera work?

A

Prevents ovulation
Thickens cervical mucus
Makes endometrium inhabitable for implantation

25
Q

What are the pros of DeproProvera?

A

Don’t have to remember to take pills
Most amenorrhoeic
Oestrogen free

26
Q

What are the cons of DeproProvera?

A

Delay in return to fertility
Reversible reduction in bone density
Problematic bleeding
Wt gain

27
Q

What substance is in the subdermal implant?

A

68mg of progesterone etonogesrel in matrix of EVA

28
Q

How long does the subdermal implant last for?

A

3y

29
Q

How does the subdermal implant work?

A

Inhibits ovulation

Thickens cervical mucus

30
Q

What is the non-hormonal IUD and how does it work?

A

Copper coil

Copper toxic to sperm so prevents penetration and implantation

31
Q

What is the issue with the copper coil?

A

Can lead to heavy more painful periods

32
Q

What are the three hormonal coils and how long do they last for?

A

5y - mirena
5y - kyleena
3y - Jaydess

33
Q

How do the hormonal IUDs work?

A

Progesterone thins endometrium so it is not habitable for implantation

34
Q

What is first line treatment for heavy menstrual bleeding?

A

Hormonal IUDs

35
Q

What is the most effective emergency contraception?

A

CU-IUD

36
Q

What are the other options of emergency contraception?

A

Levonorgestrel in 72h
Ella one in 120h

NB longer you wait –> less effective it is

37
Q

What are the barrier methods?

A

Male and female condoms
Cervical cap
Diaphragm and spermicide

38
Q

How is female sterilisation done?

A

Laparoscopically

Traditionally done with tube ligation by Filshie clips

39
Q

What is vasectomy?

A

Permanent division of the vas deferens under LA

40
Q

What are the SEs of vasectomy?

A

Pain due to sperm granuloma (mass of degenerating spermatoxoa surrounded by macrophages)

41
Q

When should termination be aimed to be carried out by?

A

9wks

42
Q

If it is passed how many weeks of pregnancy, you must be referred to England?

A

20wks

43
Q

What is involved in clinical consultation of termination?

A

Methods of termination
Contraception
FBC/group and screen/rubella/scan/self obtained swab for chlamydia and gonorrhoea, STI blood testing offered

44
Q

What is the medical method of termination?

A

Mifepristone (anti-progesterone) switches of progesterone which keeps uterus from contracting allow pregnancy to grow
48h later get misoprostol which initiates uterine contraction and opens cervix

45
Q

What are the risks with medical termination?

A

Failure
Haemorrhage
Infection
Prolonged bleeding

46
Q

What are the risks with surgical termination?

A

Haemorrhage
Infection
Failure
Cervical trauma

47
Q

What is conscientious objection?

A

Right of medical staff to refuse participation in a termination as they have a conscientious objection
Obligation to ensure woman has access to appropriate care, and that their refusal doesn’t affect the physical/mental health of the mother

48
Q

What are the rules for having a termination?

A

<24wks and would be less harmful to mother/baby’s health (mental or physical) to have termination

Reproduction (28 decks)

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