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Obstetrics and Gynaecology > Contraception > Flashcards

Contraception Flashcards

1
Q

What general advice would you give about taking contraceptive pills?

A

Doesn’t interfere with intercourse
Easily reversible

No protection against STI’s
May forget to take

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2
Q

How does the COCP work?

A

Negative feedback suppress FSH and LH surge - stop ovulation

Also thicken cervical mucus and reduce endometrial receptivity to blastocyst

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3
Q

What is the failure rate of the COCP?

A

9% with typical use - lot lower if used properly

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4
Q

What are the main risks and ADR’s of the COCP?

A 
VTE
Stroke
MI
Breast and cervical cancer
Breakthrough bleeding
Breast tenderness
Mood swings
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5
Q

What are the main benefits of the COCP?

A

Easy to reverse
Relief from menstrual problems
Reduce risk of ovarian, endometrial and colorectal cancer
Reduce risk of benign breast disease and ovarian cysts
Reversible upon stopping

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6
Q

What is the effect of vomiting, diarrhoea or CYP inducing drugs on the efficacy of COCP?

A

Reduced efficacy

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7
Q

What are the main contraindications for the COCP?

A 
>35yo + smoking >15/day
Migraine with aura
Uncontrolled hypertension
History of VTE, stroke or IHD
Current breast cancer
Breast feeding <6 weeks post partum
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8
Q

When should you be cautious with prescribing COCP?

A 
>35yo + smoking <15/day
Hypertension
BMI >35
FH of VTE
Immobility
BRCA 1/2
Diabetes diagnosed >20 years ago
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9
Q

What must you advise a woman if she starts COCP on day 10 of her cycle?

A

Require alternative contraceptive for 7 days

Needed unless starting in first 5 days of cycle

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10
Q

What advice is given regarding taking the COCP?

A

Take at same time every day

Regimes personalised

  • Continuous use 21 day, 7 day off
  • Tricycling - 3 packs then 7 day break

Intercourse when on pill free period is safe if next pack started on time

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11
Q

What advice is given if someone misses a pill while taking the COCP?

A

1 missed - take missed pill next day (2 pills taken) and continue as normal

Multiple missed - take last pill the next day (2 taken) and then continue as normal. Use condoms for 7 days.

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12
Q

If the COCP pill is missed during week 1, what additional action is needed?

A

Emergency contraception

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13
Q

If the COCP pill is missed during week 2 what additional action is needed?

A

Nothing

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14
Q

If the COCP pill is missed during week 3, what additional action is needed?

A

Start next pack as soon as current finish - omit pill free period

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15
Q

What are the forms of combined contraception?

A

COCP
Transdermal patch - Evra
Vaginal ring - Nuvaring

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16
Q

How is the transdermal contraceptive patch taken?

A

Change every week for 3 weeks then remove for 7 day patch free period - withdrawal bleed

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17
Q

How is the vaginal contraceptive ring taken?

A

Ring inserted for 21 day
Remove for 7 days
Insert new ring

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18
Q

What is the mechanism of action of the progesterone only pill?

A 
Thicken cervical mucus - prevent entry of sperm
Thin endometrium - inhibit implantation
Suppress ovulation (vary depending on exact pill)
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19
Q

How does the progesterone implant/injection work?

A

Suppress ovulation
+ thicken cervical mucus
+ thin endometrium

Implant = nexplanon
Injectable = depo-provera
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20
Q

When should the progesterone only pill be taken? What should be done if you miss a pill?

A

Exact time every day! No pill free period

<3hr late - continue as normal
>3hr late - take missed pill ASAP, continue, cover with condoms for 48hrs

Unless started within first 5 days, alternate contraception req. for first 2 days

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21
Q

What are the side effects and risks of progesterone only contraception?

A 
Irregular/heavy bleeding
Headache
Nausea
Breast tenderness
Skin changes
Increased risk of breast cancer
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22
Q

What is the failure rate of the progesterone only pill?

A

9%

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23
Q

What are the benefits of the progesterone only pill?

A

Can be used when COCP contraindicated

Reduce risk of endometrial cancer

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24
Q

What are the negatives of the progesterone only pill?

A

Increased risk of ovarian cysts

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25
Q

What are the contraindications for the progesterone only pill?

A

History of breast cancer, stroke, IHD, TIA
Liver cirrhosis
Weight >70kg

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26
Q

What are the benefits of the implant?

A 
0.05% failure rate
Pill benefits +
Don't think about contraception
Can be used at any BMI
Fertility return as soon as removed
Safe when breastfeeding
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27
Q

What are the negatives of the implant?

A

Fitting and removing can be painful and bruise

Implant may break in situ

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28
Q

How is the implant used?

A

Last for 3 years

Unless started within first 5 days, other contraception needed for 7 days

Affected by enzyme inducing drugs

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29
Q

What are the contraindications for the implant?

A

History of breast cancer, stroke, IHD, TIA
Liver cirrhosis
Unexplained vaginal bleeding

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30
Q

What is the failure rate of depo-provera?

A

6%

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31
Q

What are the benefits of depo-provera?

A

Pill benefits +
Dont think about contraception
No known drug interactions

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32
Q

What are the negatives of depo-provera?

A

Take upto 1 year for fertility to return
Gain 2-3kg weight/year
Lose bone mineral density with >1year usage

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33
Q

How long does depo-provera last?

A

12 weeks

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34
Q

What are the contraindications for depo-provera?

A

BMI > 35
Current breast cancer
History of severe arterial disease or diabetes with complications

35
Q

What is the mechanism of action of the copper IUD?

A

Copper decrease sperm motility and survival
+ reduced penetration - copper effect on cervical mucus
+ endometrial inflammatory response reduce chance of implantation

36
Q

When does the copper IUD become effective? How long does it last?

A

Immediately following insertion

Last 5 years

37
Q

What is the failure rate of the copper IUD?

A

0.8%

38
Q

What are the main benefits of the copper IUD?

A 
Effective on insertion
Some last upto 10 years
No hormones
Reduced risk of endometrial cancer
No delay in return to fertility
39
Q

What are the main problems with the copper IUD?

A

Higher risk of PID in first 20 days
Intermenstrual spotting and bleeding
Increased menstrual loss
Pelvic pain and dysmenorrhoea

40
Q

What are the contraindications for copper IUD?

A

Wilson’s disease

Copper allergy

41
Q

What is the mechanism of action of the mirena child (IUS)?

A

Reduce endometrial growth - prevent implantation

+ thicken cervical mucus - progesterone

42
Q

When is the mirena coil effective and how long does it last?

A

Need alternate contraception for 7 days post insertion

Licensed for 5 years

43
Q

What is the failure rate of the mirena coil?

A

0.2%

44
Q

What are the main benefits of the Mirena coil?

A

Reduce blood loss and dysmenorrhoea
Reduced risk of PID compared to IUD - thickened cervical mucus
Act locally - minimal drug interactions
No delay in return to fertility

45
Q

What are the main problems with the mirena coil?

A

6 month irregular menstruation common

46
Q

When is the mirena coil contraindicated?

A

Breast cancer

47
Q

What are the common problems associated with intrauterine contraception?

A

Insertion unpleasant
Risk of displacement or expulsion
Risk of uterine perforation
If pregnancy occur - higher risk of ectopic

48
Q

What are the common contraindications for intrauterine contraception?

A 
History of PID
Recent STI
Structural uterine abnormality
Ovarian, cervical or endometrial cancer
Unexplained vaginal bleeding
49
Q

What are the main forms of barrier contraception?

A

Diaphragm and caps
Female condoms
Male condoms

50
Q

What are the common benefits of barrier contraception?

A

No hormones - work by blocking sperm entry

51
Q

What are the common risks of barrier contraception?

A

Can get local reaction

Not as effective

52
Q

What are the ads and disads of diaphragms and caps as contraception?

A

Insertion before - spontaneity

Women need to be careful in using them
Little protection from STI’s

53
Q

What are the ads and disads of female condoms as contraception?

A

Prevent against STI’s

Can be uncomfortable and noisy

54
Q

What are the ads and disads of male condoms as contraception?

A

Prevent against STI’s
Readily available

Latex allergy
Lack spontaneity
Can break or slip off

55
Q

What counselling is required for sterilisation?

A

Can fail - unlikely
Considered irreversibly - can be reversed privately
No protection against STI’s
Explain all other options

56
Q

Which sterilisation technique is more likely to succeed/have fewer complications?

A

Vasectomy

57
Q

What happens in a vasectomy?

A

Simple operation - seal vas deferens
Done under local

Doesn’t work immediately - semen analysis 12 weeks later to confirm azoospermia before unprotected sex

58
Q

What are the main complications of a vasectomy?

A 
Bruising
Haematoma
Infection
Sperm granuloma
Chronic testicular pain
59
Q

How successful are vasectomy reversals?

A

Upto 55% if within 10 years

60
Q

How is tubal occlusion carried out?

A

Laparoscopically or hysteroscopically

61
Q

When do you become infertile following tubal occlusion?

A

Immediately

62
Q

What are the main complications associated with tubal occlusion?

A

Operation complications
Risk of ectopic if fails
Some say worsening menstrual problems - pain/heavy

63
Q

What are the options for emergency contraception? When can each be used?

A

Levonorgestrel - Within 3 days
Ulipristal - EllaOne - Within 5 Days
IUD - Within 5 days

64
Q

What is the MOA of levonorgestrel?

A

Stop ovulation and inhibit implantation

65
Q

How effective is levonorgestrel?

A

84% if within 72 hrs

66
Q

What are the main side effects and drug interactions for levonorgestrel?

A

Vomiting - if within 2 hr then repeat dose
Disturb current menstrual cycle
Abdominal pain

Double dose if on enzyme inducing drugs

67
Q

How does ulipristal work?

A

Progesterone receptor modulator - inhibit ovulation

68
Q

What are the main side effects of ulipristal?

A

Vomiting - if within 3hrs - repeat dose
Disturb current menstrual cycle
Abdominal pain

69
Q

What is important to know about using ulipristal?

A

Reduces effectiveness of hormonal contraception
Barrier methods should be used for 5 days after
Stop breastfeeding for 1 week

70
Q

What are the contraindications of ulipristal?

A

Enzyme inducing drugs

Caution in severe asthma or if on Ranitidine/omeprazole

71
Q

What other things should be considered when giving emergency contraception?

A

Offer STI screen
If <16 - prescribe emergency contraception if meet Fraser guidelines
If <12 - safeguarding
Talk about long term contraception

72
Q

What contraception is given in 40-50year olds?

A 
COCP
Injectable - depo-provers
POP
Implant
IUS

Non-hormonal - condoms, IUD - stop after 2 years amenorrhoea

73
Q

What is the contraception advice in >50year olds for those on non-hormonal contraception?

A

Stop after 1 year amenorrhoea

74
Q

What is the contraception advice in >50year olds for those on COCP?

A

Switch to non-hormonal or progesterone only

75
Q

What is the contraception advice in >50year olds for those on depo-provera?

A

Switch to either non-hormonal and stop after 2 years amenorrhoea

OR

Switch to progesterone only with advice for stopping

76
Q

What is the advice for progesterone only contraception (POP, IUS, Implant) in >50yo?

A

Can be continued

Amenorrhoeic - check FSH and stop after 1 year if FSH >=30 u/l or stop at 55yo

Not amenorrhoeic - consider investigating abnormal bleeding pattern?

77
Q

What is the advantage to COCP in >40 yo?

A

Maintain bone mineral density

Reduce menopausal symptoms

78
Q

What is the advantage of depo-provera in >40yo?

A

Small loss in bone mineral density

Delay in return to fertility

79
Q

What contraception should be used alongside HRT?

A

Oestrogen and Progesterone - POP

Oestrogen alone - IUS

80
Q

When is contraception needed post-partum?

A

After day 21

81
Q

When can POP be used post partum?

A

Any time post partum
Need additional contraception for first 2 days
Small amount enter breast milk but harmless

82
Q

When can the COCP be used post partum?

A

Absolutely CI if breast feeding and <6 weeks post partum

Caution 6 week - 6 month if breastfeeding

May reduce breast milk production

Can be started day 21 if not breastfeeding - need addition contraception for first 7 days

83
Q

When can the IUD and IUS be used post partum?

A

Within 48hrs after childbirth OR

After 4 weeks

84
Q

What is the lactational amenorrhoea method?

A

98% effective “contraception” if woman fully breast feeding, amenorrhoeic and <6months post partum

Obstetrics and Gynaecology (21 decks)

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