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Obs & Gynae > Contraception > Flashcards

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
Q

When would you not give the injection

A

Older women due to osteoporosis risk / RF or FH of osteoporosis

26
Q

What do you do if bleeding on progesterone

A

Speculum - look for STI / cancer
Have regular smear
Can test for C+G
Prescribe OCP on top

27
Q

What is most reliable

A

Implant = LARC

28
Q

What is IUS / mirena coil good for

A 
Lighter period as thins endometrium
Menorrhagia = 1st line treatment 
Endometriosis = 2nd line 
PCOS
HRT as protection
29
Q

How does IUS work as contraception

A

Alters cervical mucous - thickens

30
Q

What are SE of hormonal contraception

A 
Headache
Mood swing
Bloating
Breast change
Erratic bleeding pattern
Worsening of acne 
Change to libido
31
Q

How long should you give as a trial for contraception

A

3 months

32
Q

What is used for emergency contraception

A

IUD
Ellaone
Levonelle

33
Q

What does Copper IUD do and how do you use

A

Prevents implantation

Within 5 days of sex or within 5 days of suspected ovulation (14 days prior to next period)

34
Q

How do you work out when you should ovulate

A

Length of cycle / next period - 14 days

35
Q

What do does Ellaone do

A

Delay ovulation so can’t take if ovulated
Use within 120 hours of sex
Not if Levonelle within 7 days of same cycle

36
Q

What does Levonelle do

A

Delay ovulation so can’t take if ovulated
Use within 72 hours of sex
Not if Ellaone within 5 days of same cycle

37
Q

What should you discuss with emergency contraception

A 
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
Q

What should you do if underage

A 
Discuss danger
Encourage to tell parents
Discuss contraception
Consent
Age of partner
Gillick / Fraser if <16
<13 = child protection
39
Q

When are abortions allowed

A

Not >24 weeks

Continuation would cause greater harm

40
Q

When can you have a medical abortion

A

Up to 20 weeks

Early = up to 9 weeks

41
Q

What happens at medical abortion

A

2 tablets 24 hours apart
Mifepristone = steroid (anti-progesterone) to induce
Misoprostol = prostaglandin for contractions
Ax to reduce infection

42
Q

What should be done before abortion

A

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
Q

When can surgical abortion be carried out and what happens

A

Up to 12 weeks

Cervical dilatation and suction

44
Q

How long for pregnancy to become -ve

A

4 weeks

45
Q

What type of USS

A

Abdominal

Transvaginl if very early

46
Q

Complications of abortion

A 
Often abdominal cramps after / bleeding 
Failure
Haemorrhage
Infection = most common and can lead to PID 
Uterine perforation
RPOC
Future fertility
Psychaitric
47
Q

How long does IUS last

A

5 years

48
Q

How long does IUD last

A

5-10 years

49
Q

Complications of intra uterine

A

Spotting/. irregular bleeding
Uterine perforation
Ectopic - but actually reduced as less pregnancy
PID

50
Q

How long is contraception needed for if think going through menopause

A

> 50 12 months since LMP

<50 24 months since LMP

51
Q

What criteria for risk of contraception

A 
UKMEC 
Graded 1-4
1 = no risk
2 = benefit outweighs risk 
3 = risks outweigh benefit 
4 = unacceptable risk
52
Q

Contraception post partum

A

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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