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Year 4 GOSH > Contraception > Flashcards

Contraception Flashcards

1
Q

If a child is under the age of 16 how will it be assessed whether they are suitable for contraception?

A

Using Fraser Competence guidelines: UPSSI

  • Understand - can the child understand the risks and benefits of that contraception
  • Parents - children should not be forced to tell their parents but it should be encouraged
  • Sexual intercourse - you should believe the child will continue to have sexual intercourse regardless of contraception
  • Suffer - you should have reason to believe the physical or mental health of the child will suffer without contraception
  • Interest - you should have reason to believe that having contraception is within the child’s best interests
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2
Q

What age is not suitable for contraception?

A

UNDER THE AGE OF 13 - they are unable to consent to sexual intercourse. Any sex in people of this age group is considered criminal

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3
Q

How can we categorise someone’s suitability for specific contraceptive methods?

A 
UKMEC CRITERIA 
UKMEC 1 = Always usable 
UKMEC 2 = Benefit outweigh risks 
UKMEC 3 = Risks outweigh benefits 
UKMEC 4 = Do NOT use
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4
Q

What are the broad categories of contraception?

A

Short acting reversible methods:
- The pills, patches and barrier contraception
Long acting reversible contraceptions (LARC):
- Coils, IUDs, IUSs, Implants and injectable contraceptives
Irreversible methods
- Male and female sterilisation

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5
Q

How effective is the combined pill at preventing pregnancy?

A

PERFECT USE = 0.3% of women become pregnant

TYPICAL USE = 9% of women become pregnant

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6
Q

How effective is the LNG IUS at preventing pregnancy?

A

PERFECT USE = 0.2% women become pregnant

TYPICAL USE = 0.2% women become pregnant

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7
Q

How effective are condoms at preventing pregnancy?

A

TYPICAL USE = 18% pregnancy rate

PERFECT USE = 2% pregnancy rate

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8
Q

What is the most effective method of contraception at preventing pregnancy?

A

Implant (0.05% perfect and typical use)

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9
Q

What is the main benefit of barrier contraceptives and when should they be encouraged?

A

They are the only contraceptive method that prevents against STIs (also no hormonal effect)
- Bad at preventing against pregnancy so advise use with other contraceptive method
(they also are poorly used, interrupt sex and are very user dependent)

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10
Q

When is it deemed to be an ‘established pregnancy’ under UK law?

A

When it has IMPLANTED in the uterine wall (this can happen any time between day 6-12 and usually day 9 s used)
- Therefore preventing pregnancy before this point is not legally deemed an abortion

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11
Q

What are the three options for emergency contraception the UK?

A
  • LEVONORGESTREL 1500mcg
  • ULIPRISTAL ACETATE 30mg
  • COPPER IUD
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12
Q

What do you need to know from the woman before you can decide which method of EC is most suitable?

A

Date of LMP and when the episode of UPSI was

- need to know where she is in her cycle

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13
Q

How do the two oral methods of EC work (LNG and UA)?

A

They work by preventing ovulation and so technically won’t work after day 14.

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14
Q

When is EC indicated?

A

ANY DAY of natural menstrual cycle
From day 21 after childbirth
From day 5 after abortion, miscarriage or ectopic
When regular contraception has been compromised or used incorrectly

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15
Q

When should EC be offered if a woman has missed pills?

A

If she has missed 2 or more pills during week 1 of her packet

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16
Q

How does LNG EC work and how long is it effective for?

A

Works by inhibiting/delaying ovulation
Effective for 96 hours (4 days) but only licensed for 72hours (3 days)
NOT EFFECTIVE IF WOMAN HAS ALREADY OVULATED

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17
Q

When do doses of LNG need repeating?

A

If woman vomits in 2 hours post ingestion then consider another dose

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18
Q

Can LNG EC be given more than once in the same cycle?

A

Yes but off licence - senior decision

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19
Q

Who need doubles doses of LNG EC?

A

Women with HIV, TB and epilepsy

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20
Q

How does ulipristal acetate work and how effective is it compared to LNG EC?

A

It is a selective progesterone receptor modulator (SPRM) and it works again by inhibiting/delaying ovulation (in reality it is still given at all stages of the menstrual cycle)

It is MORE EFFECTIVE than LNG

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21
Q

For how long after UPSI is UPA EC effective?

A

120 hours (5 days) - there is little reduction in its efficacy over this time

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22
Q

When should a repeat dose of UPA EC be given?

A

If the woman vomits within 3 hours of taking

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23
Q

Which women will need a double dose of UPA EC?

A

All women with BMI >26 or who weigh >70kg

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24
Q

What extra advice do you need to give to women taking UPA EC about its effects?

A

Cannot breastfeed within 1 week of taking

Its effectiveness will be reduced if progesterone has been taken in the 7 days prior or 5 days after (COCP or Prog pill)

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25
Q

What is the gold standard of emergency contraception?

A

The copper IUD. It should be offered to any woman seeking EC (although uptake is poor)

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26
Q

Why is copper IUD so good at EC?

A

Prevents egg from implanting even if fertilised, it is also toxic to sperm and slows down passage of egg
Often convince the woman to try and keep coil in as LARC

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27
Q

For how long is copper IUD effective as EC?

A

Within 5 days of UPSI OR with 5 days of the earliest expected date of ovulation

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28
Q

When can copper IUD not be given?

A

When there has been a previous period of UPSI in the same cycle. LNG and UPA should be given here as they will not disturb an ongoing pregnancy

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29
Q

When giving a woman EC what should you always consider?

A

Ongoing contraception (hence encourage IUD)
If taking LNG she can start suitable contraception immediately
If taking UPA then wait 5 days and then can start hormonal contraception
Always give advice about barrier contraception and STIs

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30
Q

How does the COCP work?

A

Primarily by SUPPRESSING OVULATION
If levels of oestrogen and progesterone are high LH and FSH will be low so no follicle will develop and be released

They also reduce stability of endometrium (make implantation less likely) and also thicken cervical mucus

31
Q

What advice should you given women on starting the COCP?

A

If they are starting the pill within the first 5 days of their cycle then it is effective immediately.
if they are starting it at any other time then they need to abstain/use condoms for 7 days before it becomes effective

They take the pill for 21 days and then stop for 7 days (during this period will experience similar bleed to menstruation) - can have UPSI during pill free week as long as next pack started on time
Try and take at same time every day

32
Q

What advice should be given to women in the post-natal period who want the COCP?

A

They should not take it for 21 days after the birth
They cannot take it for up to 6 weeks after birth if they are breastfeeding
They do not need to take it in the first 5 days post abortion

33
Q

What are some reasons women take the COCP?

A 
Pregnancy prevention
Cycle control
Acne treatment 
PMS management 
Reduces risk of endometrial, ovarian and colon cancer
34
Q

What advice should women be given about when the efficacy of the COCP might be reduced?

A

If they vomit within 2hrs of taking

If they’re taking other liver enzyme inducing drugs

35
Q

What are some common side effects of the COCP?

A

Nausea
Mastalgia
Skin changes (improved or worsening acne)
Irregular bleeding for a few months while changing pills
Headaches
Mood changes
Weight gain
Also increased risk of IHD, stroke, VTE, breast and cervical cancer

36
Q

What are some contraindications to the COCP?

A

ABSOLUTE: migraine w/ aura, >35y and smoking >15 a day, personal hx of VTE, hx of stroke/IHD, breast feeding <6w post partum

RELATIVE: >35 smoking<15, BMI >35, FH+ve of VTE, controlled HTN, immobility, BRCA1/2 carrier

37
Q

What missed pill advice should be given to a woman who has missed just one COC pill?

A

Take that pill as soon as you can even if it means taking two in one day
No further action required

38
Q

What missed pill advice should be given to the woman who has missed 2 or more COC pills?

A

Take pill as soon as possible and take 2 in one day (but no more)
Abstain from sex or use condoms for 7 days
IF PILL MISSED IN WEEK 1 and UPSI occurred in pill free week or week 1 then consider EC
IF PILL MISSED IN WEEK 2 UPSI will not need EC - just use condoms for 7 days
IF PILL MISSED IN WEEK 3 - use condoms for 7 days and run 2 packs together (omit pill free week)

39
Q

What are some examples of the COCP?

A

Norithisteorne, Desogestrel, jorgestrel (+ethinylestradiol)

40
Q

What are some non-contraceptive used of the COCP?

A

Control HMB and an irregular cycle
Help for endometriosis and dysmenorrhoea
Help in PCOS and PMS

41
Q

How does the Progesterone only pill (POP)/Mini pill work?

A

Thickens the cervical mucus and causes endometrial changes

Prevent ovulation by decreasing levels of FSH and LH

42
Q

How is the POP taken?

A 
OLD PILLS (e.g. microgynon): Every day at the same time (within 3 hour window)
NEWER VERSION (desogestrel/cerazette): 12 hour window

Usually taken continuously (no pill free interval)

43
Q

What advice can be given to women on starting the POP?

A

If taken in first 5 days of cycle effective immediately

If taken at any other time effective within 2 days

44
Q

What are some common side effects of the POP?

A

Bleeding abnormalities - this is more common than with the COCP
Headaches, weight gain, mood changes and acne

45
Q

What are some contraindications for the POP?

A

Breast cancer within the past 5 years
Current enzyme inducers
CVA
Severe cirrhosis

46
Q

What advice should be given for missed PO pills?

A

If <3h take it and continue as normal

If >3h/12h(cerazette) then take ASAP and use condoms for 48 hours and continue with the rest of the pack

47
Q

What four forms of contraception are classes as LARC?

A

Mirena IUS
Copper IUD
Nexplanon implant
Depo injections

48
Q

How does the copper coil work and how long does it last?

A

Makes uterus ‘hostile’
Directly toxic to sperm and ovum (reduced motility, restricts fertilisation and implantation)
Lasts 5-10 years

49
Q

What are some benefits of the copper coil?

A

It is non hormonal (some women prefer this) it is very effective
Effective immediately after implantation

50
Q

What are some risks/side effects of the copper coil?

A

It commonly makes periods heavier and more painful
Increased risk of ectopic (still lower than background risk)
Small risk of expulsion, haemorrhage, infection or perforation
When counselling think Eand6Ps
(Expulsion, Pregnancy, perforation, PID, periods, procedure and progesterone - if mirena)

51
Q

To what ages of women might the copper IUD be useful?

A

ALL

In women over 40 the copper coil can be implanted and left

52
Q

How does the mirena IUS work and for how long is it effective?

A

Releases small amounts of progesterone locally to prevent endometrial thickening and cause cervical mucus thickening
Effective for up to 5 years (might last less long in women of high BMI)

53
Q

How soon after implantation can the mirena coil be relied on? What side effects might occur initially, will this settle?

A

7 days
Initially women might get some irregular bleeding and spotting but this should settle after a few months and in many women their periods lighten and may even stop.

54
Q

What are some side effects/risks of the mirena IUS?

A

Perforation, haemorrhage, infection (IUD)

55
Q

What uses, beside contraceptive, are there for the mirena IUD?

A

Good at treatment of HMB and irregular bleeding

56
Q

What are some contraindications to an intrauterine method of contraception?

A 
Active pregnancy (take PT first)
PID 
Undiagnosed bleeding 
Cervical or uterine cancer pre-treatment 
Asymptomatic chlamydia 
Uterine abnormality
57
Q

In what proportion of women are intrauterine contraceptive expelled and when is this most likely?

A

1 in 20 women

Most likely in first three months

58
Q

What is the risk of perforation with and intra-uterine contraceptive?

A

1-2:1000

59
Q

What proportion of conceptions that occur with IUD are ectopic?

A

1 in 20

but still less likely to have a pregnancy of ANY form

60
Q

Where is the nexplanon implant placed and how long does it last for?

A

Sub-dermally (usually in medial upper arm) and it lasts for 3 years

61
Q

How does the nexplanon implant work?

A

Prevents ovulation and thickens cervical mucus

62
Q

What are some advantages of the nexplanon implant?

How quickly does it work?

A

VERY EFFECTIVE
Des not contain oestrogen so can be used in personals of VTE, migraine, breast cancer etc.
Can be safely implanted following TOP
Effective immediately if first 5 days of cycle. 7 day cover with condoms if not

63
Q

What are some disadvantages of nexplanon?

A

Needs to be implanted by trained professional

Does interact with CYp450 system

64
Q

What are some side effects of nexplanon?

A

Headache, nausea, myalgia and irregular heavy bleeding

65
Q

What agent is used in the injectable contraceptive (DEPO)?

A

Medroxyprogesterone Acetate (150mcg)

66
Q

How often is the DEPO injection required?

A

Every 12 weeks (max 14 weeks gap can occur without extra precautions)

67
Q

How does the depo injection work?

A

Prevents ovulation

Thickens cervical mucus and thins the endometrium

68
Q

What are some disadvantages/adverse effects of Depo?

A

IRREVERSIBLE
Can cause irregular bleeding, weight gain and increased risk of osteoporosis
There is also a delayed return to fertility

69
Q

How effective is male sterilisation and what is required after?

A

1 in 2000 failure rate

2 post vasectomy samples required to check it has worked

70
Q

What is the failure rate of female sterilisation?

A

1 in 200

71
Q

How soon after having a baby will a woman have to begin considering contraception?

A

21 days after
If the woman is fully breastfeeding, the baby is <6/12, she is completely amenorrhoeic then there is a 98% chance she is covered

72
Q

If a woman is breastfeeding how long should she wait before starting hormonal contraceptive methods?

A

6 weeks

73
Q

What are the risks of another delivery again within 12 months of the first?

A

Low birth weight
SGA baby
Pre-term birth

Year 4 GOSH (29 decks)

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