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MFSRH > Contraception > Flashcards

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
Q

Major surgery and CHC

A

Stop 4 weeks before

Start 2 weeks after full mobilisation

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26
Q

Enzyme inducers

A

Reduced contraceptive efficacy

Carbamazepine, phenytoin, topiramate

Rifampicin rifabutin

St. John’s wort

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27
Q

Zoely regime and when missed pill

A

Estradiol containing
24 active 4 placebo

12 hour missed pill rule

7/7 to be effective

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28
Q

Qlaira regime

A

Quadriphasic
Estradiol
26active
2 placebo

9 days to work
Missed pill over 12 hours
If > day 24 take missed pill and nil additional

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29
Q

Post vasectomy advice

A 
Rest
No sex for 1/52 post
Tight underwear for first 48hours
NSAIDs
Watch for bleeding and pain
Leaflet
PVSA
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30
Q

When to counsel pre sterilisation at time of section.

A

At least 2 weeks before hand

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31
Q

Failure rate of vasectomy post PVSA

A

0.05%

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32
Q

When to do PVSA

A

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

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33
Q

When to stop contraception post lap steri

A

CHC/ pop / IUC 7/7

34
Q

How long to wait to check essure occlusion and how to confirm occlusion

A

3/12
X-ray
Hsg better but only use when unable to confirm with X-ray or if difficult procedure

35
Q

Pregnant with coil in situ

A

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
Q

Key changes in
Temp
Cervical secretions
Use of Callander method

A

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
Q

2 day method describe

A

Simplified cervical secretions

Nil UPSI if secretions in prev 2 days

38
Q

Standard days method

A

Simplified calendar

No sex D8 to D19

Only for cycles between 26-32

39
Q

Symptothermal method

A

Combine cervical secretions with BBT and calendar

Failure rate 0.6 perfect and 7% typical

40
Q

LAM feedign criteria

A

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
Q

How long after baby can you use FAM and how long post stopping contraception can you use FAM

A

Wait until at least 3 cycles

42
Q

Contraceptive methods and cardiac Hx consideration

A

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
Q

Cardiac conditions with increased risk of VTE

A 
Patent FO
ASD
Right to left shunts 
Closure of cardiac defect in prev 6/12
Arrhythmia, impaired cardiac function or mechanical value
44
Q

POP failure rate

A

Perfect 0.3%

Typical 9%

45
Q

POP and

VTE
Breast ca
Ovarian cysts

A

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
Q

POP and bleeding side effect

A

Common
Half no bleeding after taking for a year
4 in 10 reg bleeding
1in 10 frequent bleeding

47
Q

Which contraceptive methods can’t measure FSH with?

A

CHC and HRT

48
Q

Implant and VTE risk?

A

None

49
Q

When to diagnose menopause

A

Over 50 with one year of amenorrhoea

Under 50 with 2 years of amenorrhoea

50
Q

If recurrent miscarriage which methods to avoid for contraception and why?

A

Avoid CHC until ix for antiphospholipid syndrome

51
Q

Fertility post molar pregnancy and when can conceive

A

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
Q

Contraceptive methods with GTD which contraindicated

A

IUC until hcg normal

CHC ok

53
Q

Doses of lng in different coils and size of fit

A

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
Q

IuD coils duration and size

A

T380A 10 years 4.75

Nova T 380 5 years 3.6mm

55
Q

Risks with IUC

A

1 in 1000 for ectopic
Expulsion 1 in 20
Infection
Perforation 2 per 1000

56
Q

Risk of peer with IUC if breastfeeding

A

6 fold higher

57
Q

Brady with IUC fit

A

Atropine 500mg Iv or IM

Max 3g so 6 doses

58
Q

ALOs and pelvic pain and IUC in situ

A

Remove coil

Abx 8 weeks

59
Q

Dmpa failure rate

A

Perfect 0.2%

Typical 6%

60
Q

Measurement of coil from fundus and when not ok?

A

2cm

61
Q

Osteoporosis risk factors

A 
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
Q

Dmpa and cv risk

A

Not significant evidence for VTE

Small data which can’t exclude link with MI or strokif SLE with positive antiphospholidpid antibodies- Mec 3

63
Q

Risks of cancer and dmpa

A

Slight increase with breast ca possible

Cervical ca - weak link over 5 years

64
Q

Dmpa and weight gain, what is predictive

A

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
Q

Obesity risk factors

A 
VTE
HTN
Dm
Raised cholesterol 
Cv disease
Stroke
EndometriL and breast ca
66
Q

VTE risk and obesity

A

Rises over 30 and again over BMI 35

2 fold higher risk

67
Q

Raised BMI with other CV risk factors ukmec

A

IUD Mec 1
Ius, pop, implant Mec 2
Dmpa and CHC Mec 3

68
Q

Obesity and CHC Mec

A

BMI > 35 Mec 3

69
Q

Implant and obesity

A

Nil evidence of increased CV risk

Nil evidence to change early
Nil evidence of procedural difficulty

70
Q

Dmpa and obesity Mec

A

Obesity alone Mec 1

With cv rfs mec 3

71
Q

Which contraceptive methods ok with obesity

A 
POP
Implant
ius
IUD 
Dmpa aslonf as no additional CV risk factors
72
Q

EC and BMI

A

Levonelle less effective over 70kg or BMI > 26

Upa over 85kg or BMI over 30

73
Q

Considerations for LARC fit and anorexia

A

Deep implant
Small strophic uterus with short cavity

Bradycardia and vasocagal as not eaten
Long qt syndrome Mec 3

74
Q

How to manage unscheduled bleeding with contraception

A

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
Q

Ukmec and postnatal

A

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
Q

VTE risk factors postnatal

A 
Immobility
Transfusion 
BMI > 30
Pph 
Post c/section
Pet
Smoking
77
Q

IBD and contraception

A 
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
Q

FAM failure rate

A

0.5

24

79
Q

IUD failure rate

A
  1. 6

0. 8

80
Q

Ius failure rate

A
  1. 2

0. 2

81
Q

Female sterilisation failure rate

A

0.5

Vasectomy 0.1

MFSRH (8 decks)

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