Contraception Flashcards
What assess effectiveness of contraception
Pearl index
When are each contraception method effective
Copper = immediate POP = within 2 days unless 1st day of period Others = within 7 days
What are barrier options for contraception
Male condom
Female condom
Pelvic diaphragm
Cervical cap
How does copper IUD work
Prevents implantation of sperm and egg
SE of copper IUD
Heavier period as thicken endometrium + more painful
Not useful for gynae conditions
What are possible benefits of copper IUD
No hormonal SE
Insert any time in cycle
Can be used as emergency contraception
How long do you have to wait to insert postpartum
4 weeks
What are complications of vasectomy
Chronic pain due to sperm granuloma
Irreversible
No reduction in testosterone
What are options of Combined oral contraceptive
Pill (Rigevidon)
Patch / vaginal ring - bypass gut
What does COCP contain
Oestrogen (ethinyl oestrodiol)
Form of progesterone (norethisterone)
How does COCP work
Inhibits ovulation by preventing LH surge
Prevents implantation as inadequate endometrium due to progesterone
How do you take the pill and when do you start
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
What do you do if forget the pill
If forget one = fine
If forget 2 = take asap and precautions until completed 7 days
What are risks of COCP
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
What does COCP decrease risk of
Ovarian
Endometrial
Bowel
When is COCP CI
6 weeks post partum
Who is at increased risk of complications of COCP / UKMEC4
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
What do you do if planned surgery and on OCP
Stop 4 weeks before and 2 weeks after
Use POP as alternative
What are options for progesterone only contraception
Pill
Implant every 3 years
Injection every 3 months (effective if 1st day period, if not barrier for 7 days)
IUS
How does progesterone only contraception work
Prevention of ovulation - all but IUS
IUS altered cervical mucous making it hostile to sperm
What affects progesterone
p450 inducer
D+V
How do you take the pill
Take it every day within 3 hours
New generation can now be taken within 12 hours
What do you do if miss a pill
Take ASAP
Precautions for 48 hours
What are complications of injection
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
When would you not give the injection
Older women due to osteoporosis risk / RF or FH of osteoporosis
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
What is most reliable
Implant = LARC
What is IUS / mirena coil good for
Lighter period as thins endometrium Menorrhagia = 1st line treatment Endometriosis = 2nd line PCOS HRT as protection
How does IUS work as contraception
Alters cervical mucous - thickens
What are SE of hormonal contraception
Headache Mood swing Bloating Breast change Erratic bleeding pattern Worsening of acne Change to libido
How long should you give as a trial for contraception
3 months
What is used for emergency contraception
IUD
Ellaone
Levonelle
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)
How do you work out when you should ovulate
Length of cycle / next period - 14 days
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
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
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
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
When are abortions allowed
Not >24 weeks
Continuation would cause greater harm
When can you have a medical abortion
Up to 20 weeks
Early = up to 9 weeks
What happens at medical abortion
2 tablets 24 hours apart
Mifepristone = steroid (anti-progesterone) to induce
Misoprostol = prostaglandin for contractions
Ax to reduce infection
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
When can surgical abortion be carried out and what happens
Up to 12 weeks
Cervical dilatation and suction
How long for pregnancy to become -ve
4 weeks
What type of USS
Abdominal
Transvaginl if very early
Complications of abortion
Often abdominal cramps after / bleeding Failure Haemorrhage Infection = most common and can lead to PID Uterine perforation RPOC Future fertility Psychaitric
How long does IUS last
5 years
How long does IUD last
5-10 years
Complications of intra uterine
Spotting/. irregular bleeding
Uterine perforation
Ectopic - but actually reduced as less pregnancy
PID
How long is contraception needed for if think going through menopause
> 50 12 months since LMP
<50 24 months since LMP
What criteria for risk of contraception
UKMEC Graded 1-4 1 = no risk 2 = benefit outweighs risk 3 = risks outweigh benefit 4 = unacceptable risk
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
