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Becks Gynaecology Qs > Contraception > Flashcards

Contraception Flashcards

1
Q

Why should other forms of contraception to the Depo-Provera be considered first for adolescents?

A

Due to associated loss of bone density.

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2
Q

What types of contraception should be used in IBD?

A

Non-oral due to malabsorption.
Patches, progesterone-only injectables, implants, intrauterine and vaginal methods.
Depo-Provera should not be first-line in under 18 due to women with IBD being at increased risk of bone density loss.

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3
Q

What contraception is recommended and contraindicated in breast feeding women?

A

Progesterone-only pill have no effect on milk production and can be used in the first 6 weeks postpartum and thereafter.
IUD can be inserted from 4 weeks post-partum.
COCP affects milk volume and is avoided in the first 6 weeks postpartum and is relatively contraindicated 6 weeks to 6 months postpartum.

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4
Q

How does breast-feeding affect ovulation?

A

It delays the return of ovulation.

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5
Q

What is the contraceptive advice in perimenopausal women?

A

If under 50, continue contraception for at least 2 years after the last period.
If over 50, continue contraction for 1 year after last period.

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6
Q

What are the 3 types of hormonal contraception?

A

Progesterone-only pill
Progesterone depot (Nexplanon, IUD, Depo-Provera)
Combined hormonal contraception (pill, vaginal ring, patch)

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7
Q

What are the common side effects of oestrogen and progesterone?

A 
Progesterone:
Depression
PMT
Amenorrhoea
Acne
Breast discomfort
Weight gain
Reduced libido
Oestrogen: 
Nausea
Headaches
Increased mucus
Fluid retention and weight gain
Occasionally hypertension
Breast fullness/tenderness
Bleeding
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8
Q

What reduces absorption of the pill?

A

Vomiting, diarrhoea and antibiotics (need to use condoms whilst on antibiotics and for 7 days after)

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9
Q

What are the major complications of taking the COCP?

A

Venous thrombosis and myocardial infarction.

Also cerebrovascular accidents, focal migraine, hypertension, jaundice and liver, breast and cervical carcinoma.

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10
Q

What are the non-contraceptive advantages of the COCP?

A

Regular, lighter periods.
Reduced risk of ovarian, endometrial and bowel cancer.
Helps reduce fibroids, endometriosis and simple ovarian cysts.
Reduces risk of PID (probably due to thicker mucus).

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11
Q

What are the contraindications to taking COCP?

A 
Absolute contraindication:
History of DVT/heart disease/stroke
Migraine with aura
Active breast/endometrial cancer
Inherited thrombophilia
Smokers >35 years smoking >15 day. 
BMI > 40
Diabetes with vascular complications
Liver disease
Relatively contraindicated
Chronic inflammatory disease
Renal impairment (diabetes)
Age >40 
BMI >35 
Breastfeeding up to 6 months post-partum
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12
Q

What are the non-oral combined hormonal contraception?

A

Combined transdermal patch (Evra)

Combined vaginal ring (Nuvaring)

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13
Q

What are the differences between the progesterone only pill and COCP in administration?

A

Progesterone-only must be taken every day with no break at the same time (no more than +/- 3 hours)

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14
Q

Which has the higher failure rates out of COCP and progesterone only?

A

Progesterone-only (1/100)

the COPC has 0.2/100

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15
Q

How do the COCP and progesterone work as contraceptives?

A

COCP = exerts negative feedback of gonadotrophins (FSH and LH) to prevent ovulation, thin the endometrium and thickens cervical mucus.
Progesterone only = makes cervical mucus hostile to sperm, in 50% of women it inhibits ovulation.

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16
Q

What should you do if you miss the progesterone-only pill by more than 3 hours?

A

Take the pill as soon as possible and use condoms for the next 2 days.

17
Q

When is the progesterone-only pill okay and the COPC isn’t?

A

You can use to progesterone-only pill in nearly all the contraindications of COCP - there is no increased risk of thromboembolism.

18
Q

What 2 things should you counsel women on before taking the mini pill?

A 
Breakthrough bleeding (spotting) 
Need for meticulous timing of taking the pill.
19
Q

What are the non-oral progesterone only contraceptives?

A

Long-acting reversible contraceptives:
Injections (Depo-Provera - 3 month, Noristeral and Sayana Press) - these can all be given during breast-feeding, 6 weeks post-partum.
Depot (Nexplanon - 3 years)

IUD

20
Q

What are the types of emergency contraception and when can they be used?

A

Levonelle - up to 24 hours after unprotected sexual intercourse is most effective, but can be up to 72 hours.

Ulipristal (EllaOne) - up to 120 hours (5 days) after unprotected sexual intercourse.

Copper IUD - up to 5 days after unprotected intercourse or up to 5 days after earliest expected ovulation. E.g. if unprotected sexual intercourse happened 2 days before ovulation, the copper IUD could be inserted up to 7 days after the unprotected sex.

21
Q

When can you start contraception after the emergency contraception?

A

Levonelle - straight away
Ulipristal (EllaOne) - start/continue 5 days after
IUD - contraceptive instantly

22
Q

What are the forms of barrier contraception?

A

Male condoms
Female condoms
Cervical cap
Diaphragms

23
Q

What is given at the same time as the IUD in emergency contraception?

A

Prophylactic antibiotics

24
Q

What are the different types of IUD?

A

Copper IUD - prevents fertilisation as copper is toxic to sperm.
Progesterone IUD - Mirena (5 years) and Jaydess/Levosert (3 years).

25
Q

What is the contraceptive efficacy and advantages of IUD?

A

Not user dependent

<0.5/100 women-years failure rate

26
Q

What scale is used for contraceptive efficacy?

A

Pearl Index (PI)

27
Q

How long after pregnancy can an IUD be inserted?

A

6 weeks

28
Q

What are the complications and risk factors of IUD?

A

Painful insertion
Uterine perforation at time of insertion (<0.5%) or after
Expulsion/migration into walls
Increased risk of PID if there is an asymptomatic STI in the cervix
If pregnancy does occur, it is more likely to be ectopic

29
Q

What are the absolute contraindications to the IUD?

A 
Pregnancy 
Endometrial or cervical cancer
Undiagnosed vaginal bleeding
Active/recurrent pelvic infection
Current breast cancer (progesterone IUD)
30
Q

What are the types of female sterilisation?

A

Filshie clips - applied to the fallopian tubes laparoscopically to completely occlude the lumen.

At caesarian section, a portion of each tube can be excised.

Hysteroscopic placement of microinserts into the proximal part of each tubal lumen. These inserts expand and cause fibrosis, occluding the lumen.

31
Q

Can you reverse some female sterilisation?

A

Pretty irreversible, especially with microinserts, but IVF is possible after. Reversible surgery is not available on the NHS.

32
Q

What is male sterilisation? What does it involve? What is its efficacy?

A

Vasectomy.
Ligation of the vas deferens, preventing sperm release (checked by 2 negative semen analyses).
1 in 2000 (better than female sterilisation).

33
Q

What are the natural methods of contraception?

A

Rhythm method
Lactation
Withdrawal

Becks Gynaecology Qs (14 decks)

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