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Gynaecology > Contraception > Flashcards

Contraception Flashcards

1
Q

The efficacy of the contraception is measured by

A

the pearl index

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2
Q

Whats the problem with giving contraception to women with IBD and what should be given?

A

Wont be absorbed, wont be effective.

Combined patches, prog only injectibles and implants, IU and vaginal methods.

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3
Q

Why should you avoid depo provera in <18 years?

A

Risk of osteoporosis

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4
Q

COCP is contraindicated in how much time postpartum

A

Defs not in the first 6 weeks- affects breast milk, relatively in 6 months

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5
Q

What recommended contraception for pregnant women?

A

Progesteron only after 6 weeks

IUS after 4 weeks

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6
Q

Advice on contraception for women over 40 under 50?

A

Continue contraception 2 years post last period

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7
Q

Advice on contraception for women over 50?

A

Continue contraception 1 year post last period

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8
Q

Which contraceptives are ideal for over 40?

A

IUDs- may not need to be replaced
IUS- greatly reduces menstrural loss
Others are all viable
Sterilization is preferred.

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9
Q

What are the forms of hormone contraception?

A 
Progesterone
- POP
-Progesterone as depot- Nexplanon/Depo-provera/IUS (levonogestrel)
Combined:
-COCP-mono/bi/triphasic
-Transdermal patch
-Vaginal ring
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10
Q

How is COCP taken?

A

3 weeks and 1 week withdrawal bleed

Can be back to back to avoid bleeds but irregular spotting increases

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11
Q

What are the 2 types of COCP

A

-With Ethinyloestradiol- low dose/high dose, based on progesterone type.
Oestradiol valerate- Qlaira. 26 days with 2 days withdrawal

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12
Q

What do you do about missed pills?

A

2 days can be missed on high dose but low dose only 1. If more missed use condoms for 7 days.

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13
Q

What to do about the pill when ill or going for surgery?

A

Reduced absorption with D&V so should follow the missed pill regime for days of illness but use condoms.
Antibiotic use-use condoms and 7 days after.
Stop taking 4 weeks before surgery due to thrombotic effects

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14
Q

What are the major complications of COCP (2+8)

A

VTE and myocardial infarction

CVA, hypertension, headaches, focal migraine, jaundice, liver, cervical and breast cancer

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15
Q

What COCP would you prescribe some at high risk of thromboembolic disease?

A

2nd gen! 3rd gen progesterones are worse than 2nd gen

gestodene/desogestrel vs norethisterone and levonogestrel

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16
Q

Absolute contraindications for COCP

A 
History of CVA/Heart disease/VTE
History of migraines with aura
Active breast/endometrial cancers
Pregnancy
Inherited thrombophilia
BMI>40 
Smoking Age>35 years or >15 cigarettes
Diabetes with vascular complications 
Active/ chronic liver disease
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17
Q

What are the minor side effects for COCP

A

Nausea, headaches, breast tenderness, breakthrough bleeds settles in 3 months

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18
Q

Useful effects of COCP

A

Lighter periods, hirsutism and acne improve, prevents ovarian cysts, fibroids, endometriosis, bowel breast and endometrial cancer

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19
Q

Relative contraindications for COCP

A

Smoker, Chronic inflam disease, renal disease, diabetes, >40, BMI 35-40, Breastfeeding up to 6 months post partum.

20
Q

Whats Evra

A

Combined transdermal patch changed every 3 weeks with patch free week

21
Q

Whats Nuvaring

A

Combined vaginal ring

22
Q

How is POP taken?

A

Everyday, no breaks Same time +/- 3 hours

23
Q

How does POP work?

A

Makes cervical mucus hostile to sperm and inhibits ovulation in 50% women

24
Q

Side effects of POP?

A

Breakthrough bleeds, Weight gain, mastalgia, PMS,functional ovarian cysts

25
Q

indications of use of POP

A

Older women or postpartum, everyone who COCP is contraindicated in, no thrombotic effects or with antibiotics.

26
Q

What if a POP is missed?

A

By more than 3 hours then take ASAP and use condoms for 2 days.

27
Q

Whats cerazette?

A

POP preparation, 12h window, stops ovulation in 95%

28
Q

What are LARCs

A

Long acting reversible contraceptives- pretty perfect progesteron release bypassing portal circulation.

29
Q

Depo provera

A

IM 3 monthly injection progesterone

30
Q

Explaining depo provera

A

Prog side effects, prolonged amenorrhoea post cessation warn if want to conceive, osteoporosis risk- not to children/older women

31
Q

Noristerat

A

8 week depot as an interim for say vasectomy

32
Q

Nexplanon

A

Subdermal progesterone rod in upper arm for 3 years

33
Q

Good things about nexplanon vs depo provera

A

No osteoporosis and resumes fertility quickly

34
Q

What are the 3 morning after options?

A

Levonelle-progesterone- within 24h <72h- vomiting/disrupted menstural cycle
Ulpristal (ellaOne)- selective progesterone receptor modulator. Prevents delays ovulation and implantation. Upto 120h. Reduces the effectiveness of contraceptives so intercourse should be avoided until next period.
IUD-prevents implantation, most efficacious can be used upto 5 days, antibiotic prophylaxis.

35
Q

What are the methods of barrier contraception?

A

Male condom, female condom, diaphragms and caps, spermicides

36
Q

Types of IUDs

A

Copper containing devices - copper ions toxic prevent fertilization and block implantation
Mirena coil- progestogen containing released over 5 years

37
Q

Absolute contraindications for IUD

A 
Endometrial/cervical cancer
Undiagnosed vaginal bleeding
Active/recent pelvic infecton
Current Breast cancer
Pregnancy
38
Q

Relative contraindications for IUD

A 
Previous ectopic pregnancy
Excessive menstrural loss 
Multiple sexual partners
Young/nulliparous
Immunocompromised/HIV
39
Q

Two methods of female sterilization

A

Filshie clip and Essure

40
Q

Whats a filshie clip?

A

Occlusion of fallopian tube lap under GA

41
Q

Whats Essure?

A

microinserts placed hysteroscopically into fallopian tubes- cause fibrosis and occlusion - confirm 3 months later with HSG

42
Q

Complications of IUD

A 
Pain/cervical shock
Perforation/migration through the wall
Heavier or more painful menses
Infection-already have STI/young/multiple partners
Ectopic pregnancy
43
Q

Complications of female sterilization

A

Primary visceral damage/inadequate aceess to tubes, ectopic pregnancy if it happens

44
Q

Vasectomy

A

Ligation and removal of small segment of vas deferens under LA.

45
Q

How long do vasectomies take to lead to azoospermia

A

6 months, confirmed with 2 semen analyses

46
Q

Complications of vasectomy

A

Failure, post op, haematoma, infection and chronic pain

47
Q

Sterilization reversal is often prevented by

A

antisperm antibody formation which restricts motility

Gynaecology (11 decks)

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