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Contraception Flashcards

1
Q

What assess effectiveness of contraception

A

Pearl index

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2
Q

When are each contraception method effective

A 
Copper = immediate
POP = within 2 days unless 1st day of period
Others = within 7 days
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3
Q

What are barrier options for contraception

A

Male condom
Female condom
Pelvic diaphragm
Cervical cap

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4
Q

How does copper IUD work

A

Prevents implantation of sperm and egg

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5
Q

SE of copper IUD

A

Heavier period as thicken endometrium + more painful

Not useful for gynae conditions

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6
Q

What are possible benefits of copper IUD

A

No hormonal SE
Insert any time in cycle
Can be used as emergency contraception

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7
Q

How long do you have to wait to insert postpartum

A

4 weeks

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8
Q

What are complications of vasectomy

A

Chronic pain due to sperm granuloma
Irreversible
No reduction in testosterone

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9
Q

What are options of Combined oral contraceptive

A

Pill (Rigevidon)

Patch / vaginal ring - bypass gut

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10
Q

What does COCP contain

A

Oestrogen (ethinyl oestrodiol)

Form of progesterone (norethisterone)

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11
Q

How does COCP work

A

Inhibits ovulation by preventing LH surge

Prevents implantation as inadequate endometrium due to progesterone

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12
Q

How do you take the pill and when do you start

A

Take for 21 days then pill free work to allow degeneration of endometrium + withdrawal bleed
Can take continuous
Start on first day of period = immediate protection
If later need 7 day barrier

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13
Q

What do you do if forget the pill

A

If forget one = fine

If forget 2 = take asap and precautions until completed 7 days

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14
Q

What are risks of COCP

A 
DVT / VTE
Ischaemic stroke if migraine with aura
Breast cancer
Cervical cancer
Hypertension 
Drug interactions 
Metabolised by liver so affected by p450 inducer  
Also affected by D+V
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15
Q

What does COCP decrease risk of

A

Ovarian
Endometrial
Bowel

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16
Q

When is COCP CI

A

6 weeks post partum

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17
Q

Who is at increased risk of complications of COCP / UKMEC4

A 
Hypertension uncontrolled 
BMI >
Smoking >15
Previous stroke or heart disease or VTE 
Migraine with aura 
Breast cancer or BRCA +Ve 
FH of VTE <45
Immobility
Age >35 + smoker 
DM
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18
Q

What do you do if planned surgery and on OCP

A

Stop 4 weeks before and 2 weeks after

Use POP as alternative

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19
Q

What are options for progesterone only contraception

A

Pill
Implant every 3 years
Injection every 3 months (effective if 1st day period, if not barrier for 7 days)
IUS

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20
Q

How does progesterone only contraception work

A

Prevention of ovulation - all but IUS

IUS altered cervical mucous making it hostile to sperm

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21
Q

What affects progesterone

A

p450 inducer

D+V

22
Q

How do you take the pill

A

Take it every day within 3 hours

New generation can now be taken within 12 hours

23
Q

What do you do if miss a pill

A

Take ASAP

Precautions for 48 hours

24
Q

What are complications of injection

A 
Delay in return to fertility - 1 year
Reversible reduction in bone density
Bleeding
No period - 70%
Weight gain - only contraceptive with evidence 
Acne 
Larger hormonal SE as large dose
25
When would you not give the injection
Older women due to osteoporosis risk / RF or FH of osteoporosis
26
What do you do if bleeding on progesterone
Speculum - look for STI / cancer Have regular smear Can test for C+G Prescribe OCP on top
27
What is most reliable
Implant = LARC
28
What is IUS / mirena coil good for
``` Lighter period as thins endometrium Menorrhagia = 1st line treatment Endometriosis = 2nd line PCOS HRT as protection ```
29
How does IUS work as contraception
Alters cervical mucous - thickens
30
What are SE of hormonal contraception
``` Headache Mood swing Bloating Breast change Erratic bleeding pattern Worsening of acne Change to libido ```
31
How long should you give as a trial for contraception
3 months
32
What is used for emergency contraception
IUD Ellaone Levonelle
33
What does Copper IUD do and how do you use
Prevents implantation | Within 5 days of sex or within 5 days of suspected ovulation (14 days prior to next period)
34
How do you work out when you should ovulate
Length of cycle / next period - 14 days
35
What do does Ellaone do
Delay ovulation so can't take if ovulated Use within 120 hours of sex Not if Levonelle within 7 days of same cycle
36
What does Levonelle do
Delay ovulation so can't take if ovulated Use within 72 hours of sex Not if Ellaone within 5 days of same cycle
37
What should you discuss with emergency contraception
``` First day of LMP Normal cycle Contraception Last smear Any previous emergency contraception Any other medications Allergies / asthma / untreated UTI Unexplained bleeding STI risk Assault ```
38
What should you do if underage
``` Discuss danger Encourage to tell parents Discuss contraception Consent Age of partner Gillick / Fraser if <16 <13 = child protection ```
39
When are abortions allowed
Not >24 weeks | Continuation would cause greater harm
40
When can you have a medical abortion
Up to 20 weeks | Early = up to 9 weeks
41
What happens at medical abortion
2 tablets 24 hours apart Mifepristone = steroid (anti-progesterone) to induce Misoprostol = prostaglandin for contractions Ax to reduce infection
42
What should be done before abortion
Discuss method Offer counselling Offer contraception - need to use straight away STI check Sign certificate A - 2 medical practitioners agree USS to confirm intrauterine and date Ax to reduce infection
43
When can surgical abortion be carried out and what happens
Up to 12 weeks | Cervical dilatation and suction
44
How long for pregnancy to become -ve
4 weeks
45
What type of USS
Abdominal | Transvaginl if very early
46
Complications of abortion
``` Often abdominal cramps after / bleeding Failure Haemorrhage Infection = most common and can lead to PID Uterine perforation RPOC Future fertility Psychaitric ```
47
How long does IUS last
5 years
48
How long does IUD last
5-10 years
49
Complications of intra uterine
Spotting/. irregular bleeding Uterine perforation Ectopic - but actually reduced as less pregnancy PID
50
How long is contraception needed for if think going through menopause
>50 12 months since LMP | <50 24 months since LMP
51
What criteria for risk of contraception
``` UKMEC Graded 1-4 1 = no risk 2 = benefit outweighs risk 3 = risks outweigh benefit 4 = unacceptable risk ```
52
Contraception post partum
Do not require until 21 days POP = safe if breast feeding Avoid COCP if breast and till 6 weeks postpartum due to VTE risk Any is fine if not breast feeding

Obs & Gynae (23 decks)

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