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Contraception Flashcards

1
Q

Failure rate of diaphragm

A

Typical 12%

Perfect 6%

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2
Q

Failure rate condom

A

18% typical

2% perfect

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3
Q

Ukmec and diaphragms/ caps

A

High risk hiv (due to N9 not ok with condoms)
HIV positive
Hx of TSS
Sensitive to latex
Parous mec2
Uti Mec 2
Congenital or valvular heart disease mec 3

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4
Q

Progestogens first and second line and third

A

First northisterone
Second levonorgestrel
Third desogestrel gestodene, norgestimate

Newer other: drospirenone

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5
Q

Which cocp is used for mx of acne and hirsuitism

A

Co-cyprindiol

35ee with cyproterone acetate which is antiandrogen

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6
Q

How to use patch and CHC ring

A

Patch- new patch every week

Ring - new ring every 3 weeks (store an room temp)

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7
Q

CHC failure rates

A

Perfect 0.3%

Typical 9%

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8
Q

Enzyme inducers and CHC

A

Effectiveness reduced and for 28days post

If declines alternative then minimum of 50ug ee or increase to 70ee if breakthrough bleeding
(Not for rifampicin and rifabutin)

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9
Q

Lamotrigine and CHC

A

Serum lanotrigine reduced
Can reduced seizure control when on CHC
Can cause toxicity in HFI

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10
Q

D and v and CHC rules

A

Diarrhoea severe for over 24hours

If vomits within 3 hours - missed pill

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11
Q

Which pill 1st line for PMS

A

Yasmin

Drospirenone and ee

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12
Q

CHC which cancers does it reduce risk of?

A

Endometrial
Ovarian
Colorectal

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13
Q

How long can cap and diaphragm stay in for?

A

Diaphragm 48hours

Cap 30 hours

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14
Q

Vte and CHC discuss risk

A

X3-5 risk
Absolute risk v small - 10/10,000 compared to 2/10,000
Of small rate only 1% fatal

Highest risk in months after initiating or when restarting after 1/12 break

Progestogen lower risk with lng or net compared with dsg or drospirenone

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15
Q

Inherited thrombophilias and CHC

A

Mec 4

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16
Q

When to give EC for ring and patch

A

If patch or ring off for >48hours or extension of HFI of >48 hours

If I’m 1st week and UPSI in HFI or week 1

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17
Q

CHC increases risk of which cancers

A

Breast

Cervical

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18
Q

CHC and arterial thrombosis risk

A 
Increased risk of MI stroke
Increased with higher ee 
RR MI 1.6
RR stroke 1.7
consider with additional RFs
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19
Q

Migraine with aura and CHC what to quote

A

Double the risk of ichaemic stroke with CHC and migraine with aura

New migraine when starting CHC - Mec 3

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20
Q

Breast ca and CHC

A

X 1.2
Brca Mec 3
Prev breast ca Mec 3
Fhx nil restriction

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21
Q

Cervical ca risk with CHC

A

X2 risk over 5 years

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22
Q

Progestogen ses

A

Mood
Acne
Hirsuitism
Libido

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23
Q

Oestrogen ses

A

Bloating
Breast tenderness
Nausea
Headaches

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24
Q

Pill choice talk through pathway

A

1st line ee less than 30 and net or lng but more androgenic

If oestrogen ses - loestrin 20

If progestogen ses - marvelon (dsg/ ee30

Or less androgenic are :
Cilest - 35ee and norgestimate or
Yasmin 30ee and drospirenone

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25
Major surgery and CHC
Stop 4 weeks before | Start 2 weeks after full mobilisation
26
Enzyme inducers
Reduced contraceptive efficacy Carbamazepine, phenytoin, topiramate Rifampicin rifabutin St. John’s wort
27
Zoely regime and when missed pill
Estradiol containing 24 active 4 placebo 12 hour missed pill rule 7/7 to be effective
28
Qlaira regime
Quadriphasic Estradiol 26active 2 placebo 9 days to work Missed pill over 12 hours If > day 24 take missed pill and nil additional
29
Post vasectomy advice
``` Rest No sex for 1/52 post Tight underwear for first 48hours NSAIDs Watch for bleeding and pain Leaflet PVSA ```
30
When to counsel pre sterilisation at time of section.
At least 2 weeks before hand
31
Failure rate of vasectomy post PVSA
0.05%
32
When to do PVSA
12 weeks post procedure If azoospermia ok to use If non motile sperm less than 100,000/ ml then can use If at 7/12 still motile sperm - failed
33
When to stop contraception post lap steri
CHC/ pop / IUC 7/7
34
How long to wait to check essure occlusion and how to confirm occlusion
3/12 X-ray Hsg better but only use when unable to confirm with X-ray or if difficult procedure
35
Pregnant with coil in situ
If less than 12 weeks remove - counsel woman that adverse or outcome greater risk than without M/c risk Left in risk of 2nd trimester m/c , preterm del and infection
36
Key changes in Temp Cervical secretions Use of Callander method
Temp once raised on 3 days of at least over 0.2 degrees can have sex until next period Cervical secretions - 3 dry days and can then have sex. When fertile near ovulation secretions become wetter, slippery, clear and stretchy and alkaline and v fertile Calendar - record over. 1 year and work our shortest and longest cycle shortest cycle length minus 20 first fertile day Longest cycle length minus 10 is last fertile day
37
2 day method describe
Simplified cervical secretions Nil UPSI if secretions in prev 2 days
38
Standard days method
Simplified calendar No sex D8 to D19 Only for cycles between 26-32
39
Symptothermal method
Combine cervical secretions with BBT and calendar Failure rate 0.6 perfect and 7% typical
40
LAM feedign criteria
Fully day and night No other liquids or water in addition to feed Not longer than 4 hours during day or 6hiurs over night No use of dummies
41
How long after baby can you use FAM and how long post stopping contraception can you use FAM
Wait until at least 3 cycles
42
Contraceptive methods and cardiac Hx consideration
CHC- increases MI risk, stroke, thrombosis and increased fluid retention and raised BP DMPA - higher dose of progestogen an effect on lipid profiles IUC - vasovagal and Brady POP safe bridging method whilst seeking advice of cardio
43
Cardiac conditions with increased risk of VTE
``` Patent FO ASD Right to left shunts Closure of cardiac defect in prev 6/12 Arrhythmia, impaired cardiac function or mechanical value ```
44
POP failure rate
Perfect 0.3% | Typical 9%
45
POP and VTE Breast ca Ovarian cysts
VTE- no evidence Breast ca - no clear evidence of link but small data did show increase but likely to be very small Ovarian cysts - caused by POP
46
POP and bleeding side effect
Common Half no bleeding after taking for a year 4 in 10 reg bleeding 1in 10 frequent bleeding
47
Which contraceptive methods can’t measure FSH with?
CHC and HRT
48
Implant and VTE risk?
None
49
When to diagnose menopause
Over 50 with one year of amenorrhoea | Under 50 with 2 years of amenorrhoea
50
If recurrent miscarriage which methods to avoid for contraception and why?
Avoid CHC until ix for antiphospholipid syndrome
51
Fertility post molar pregnancy and when can conceive
If complete mole then 6/12 from first normal hcg or from evac if hcg normal within 8 weeks of op If partial mole aboid PT until 2 consecutive months of normal hcg
52
Contraceptive methods with GTD which contraindicated
IUC until hcg normal CHC ok
53
Doses of lng in different coils and size of fit
Mirena 52mg 5 years 4.4 insertion tube Jaydess 13.5 mg 3 years 3.8 tube Kyleena 19.5mg 5 years 3.8 tube
54
IuD coils duration and size
T380A 10 years 4.75 | Nova T 380 5 years 3.6mm
55
Risks with IUC
1 in 1000 for ectopic Expulsion 1 in 20 Infection Perforation 2 per 1000
56
Risk of peer with IUC if breastfeeding
6 fold higher
57
Brady with IUC fit
Atropine 500mg Iv or IM | Max 3g so 6 doses
58
ALOs and pelvic pain and IUC in situ
Remove coil | Abx 8 weeks
59
Dmpa failure rate
Perfect 0.2% | Typical 6%
60
Measurement of coil from fundus and when not ok?
2cm
61
Osteoporosis risk factors
``` Female Over 50 Menopausal Fhx Low bmi Low ca vit D Malnutrition Inactivity Smoking Alcohol over 3 units per day Steroids for over 3/12 Medical conditions- ckd, Crohns RA Cushing t1dm, copd, chronic liver disease ```
62
Dmpa and cv risk
Not significant evidence for VTE | Small data which can’t exclude link with MI or strokif SLE with positive antiphospholidpid antibodies- Mec 3
63
Risks of cancer and dmpa
Slight increase with breast ca possible | Cervical ca - weak link over 5 years
64
Dmpa and weight gain, what is predictive
If higher initial BMI and < 18 years with BMI over 30 Or If gain more than 5% of body weight in first 6/12
65
Obesity risk factors
``` VTE HTN Dm Raised cholesterol Cv disease Stroke EndometriL and breast ca ```
66
VTE risk and obesity
Rises over 30 and again over BMI 35 2 fold higher risk
67
Raised BMI with other CV risk factors ukmec
IUD Mec 1 Ius, pop, implant Mec 2 Dmpa and CHC Mec 3
68
Obesity and CHC Mec
BMI > 35 Mec 3
69
Implant and obesity
Nil evidence of increased CV risk Nil evidence to change early Nil evidence of procedural difficulty
70
Dmpa and obesity Mec
Obesity alone Mec 1 With cv rfs mec 3
71
Which contraceptive methods ok with obesity
``` POP Implant ius IUD Dmpa aslonf as no additional CV risk factors ```
72
EC and BMI
Levonelle less effective over 70kg or BMI > 26 Upa over 85kg or BMI over 30
73
Considerations for LARC fit and anorexia
Deep implant Small strophic uterus with short cavity Bradycardia and vasocagal as not eaten Long qt syndrome Mec 3
74
How to manage unscheduled bleeding with contraception
First 3/12 no need to examine If over 3/12 then examine and trial 3/12 coc or pop Unless risk factors for endometrial ca - obese, smoker, pcos, diabetes Consider txa mefanamic Pipellle if > 45 or < 45 with rfs or perisitent Sx
75
Ukmec and postnatal
Breastfeeding and less than 6 weeks - CHC Mec 4 dmpa Mec 2 rest Mec 1 ``` Non breastfeeding 0-3 nil VTE rfs CHC 3 dmpa 2 rest 1 0-3 weeks with VTE rfs CHC 4 dmpa 2 rest 1 Same as above for 3-6 weeks with rfs 3-6 weeks nil other rfs CHC 2 rest 1 ```
76
VTE risk factors postnatal
``` Immobility Transfusion BMI > 30 Pph Post c/section Pet Smoking ```
77
IBD and contraception
``` VTE- increases risk Osteoporosis more common Heaptobilarh disease can cause cirrhosis Can impact on sperm quality Check if on methotrexate Mycophenolate 6/52 Infliximab 6/12 All methods suitable CHC and pop Mec for oral absorption ```
78
FAM failure rate
0.5 | 24
79
IUD failure rate
0. 6 | 0. 8
80
Ius failure rate
0. 2 | 0. 2
81
Female sterilisation failure rate
0.5 Vasectomy 0.1

MFSRH (8 decks)

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