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Gynaecology > Contraception > Flashcards

Contraception Flashcards

1
Q

What is the Fraser Criteria used for?

A

When a girl aged under 16 asks for contraception

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2
Q

What are the Fraser Criteria?

A
  • The girl understands the doctors advise
  • The doctor has tried to persuade her to tell her parents or allow the doctor to
  • She will begin or continue to have intercourse without contraception
  • Her physical or mental health is likely to suffer if she doesn’t receive contraceptive advice
  • Best interests require the prescriber to give contraceptive advice +/- treatment without parental consent
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3
Q

Which contraceptives are user-failure methods?

A
  • Combined oral contraceptive pill (COCP)
  • Contraceptive patch
  • Progesterone only pill (POP)
  • Barrier methods  condoms, diaphragm, cap, spermicides
  • Natural family planning
  • Lactational amenorrhoea method (LAM)
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4
Q

Which contraceptives are non-user failure methods?

A
  • Contraceptive injection (depo-provera)
  • Implant
  • IUD
  • Intrauterine system (IUS)
  • Male or female sterilisation
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5
Q

COCP: what does it do to provide contraception?

A

It prevents ovulation from occurring, alters cervical mucus and thins the lining of the womb to keep the endometrium non-adhesive to blastocyst.

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6
Q

COCP: failure rates?

A

The failure rate ranges from 0.1% to 2%, but with typical use the failure rate is 8%.

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7
Q

Advantages of COCP?

A
  • Reversible, reliable, has 12-hour window
  • Regular predictable period
  • Decreased menorrhagia, dysmenorrhoea
  • Decreased risk of PID due to increased cervical mucous
  • May help reduce PMS
  • Protective against ovarian, endometrial and colorectal cancer
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8
Q

Disadvantages of COCP?

A
  • Drug interactions with AEDs, Abx etc.
  • Doesn’t protect against STIs
  • Decreased efficacy when taken late or if they have D&V
  • Possible small risk of breast cancer
  • Possible small risk of cervical cancer
  • 2 times risk of thromboembolic disease
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9
Q

What hormone(s) are used in contraceptive patches (Evra)?

A

both oestrogen and progesterone

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10
Q

How is the contraceptive patch used?

A

Each patch is worn for 7 days for 3 weeks, and then have one patch free week a month. A withdrawal bleed usually occurs in this period.
920% women have skin irritation or reaction to these patches. Has been found to have a better hormone delivery than pills, but is more expensive.)

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11
Q

How does the POP provide its contraceptive effect?

A

• Thickens the cervical mucus, thins endometrium, decreases tubal mobility (so reduces sperm’s motility within FRT)
• Can stop ovulation in 15-45% of patients
(Cerazette – has different type of progesterone (Desogestrel) which stops ovulation in 98-99% women

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12
Q

What is the failure rate for typical use?

A

0.5% to 13%

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13
Q

Advantages of POP?

A
  • Can be used to stop oestrogen side effects (breast tenderness, headache, nausea)
  • Suitable for smokers >35yrs
  • Can be used in gross obesity
  • Used with medical problems e.g. migraine, hypertension
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14
Q

Disadvantages of POP?

A
  • Less effective than COCP except Cerazette
  • 3hr window except Cerazette which is 12hr
  • Increased risk of ectopic pregnancies due to slow ovum transport
  • Disrupts menstrual pattern
  • Functional ovarian cysts may develop
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15
Q

How dome condoms provide contraception?

A

• Barrier contraceptive – prevents pregnancies as well as STIs
(Ensure awareness of how to use correctly)

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16
Q

What is the failure rate for condoms? and what are she reasons for failure?

A

• 2% failure rate, some reasons for failure:
o Condom put on after genital contact
o Condom not completely unrolled onto penis
o Condom slipped off when withdrawing penis or during sexual intercourse
o Leakage of sperm hen penis withdrawn
o Condom rupture
o Mechanical damage – fingernails, sex toys, lubricants

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17
Q

Advantages of femidoms?

A
  • Protects from STIs
  • Can be inserted at any time before intercourse
  • Not affected by any lubrication
  • Non-latex material
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18
Q

Disadvantages of femidoms?

A
  • Failure rate higher than in male condoms
  • Needs careful insertion
  • Easy for the penis to miss it
  • Can be noisy and intrusive
  • Do not use with male condom as they can stick together and cause slippage/displacement
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19
Q

Failure rate of diaphragms?

A

• Failure rate 2-5% dependent on user

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20
Q

Advantages of diaphragms?

A
  • Allows woman to be in control
  • Insert any time prior to intercourse - Fitted in advance to sexual intercourse to allow for spontaneity
  • Can protect against some STIs
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21
Q

Disadvantages diaphragms?

A
  • Requires correct initial fitting by trained staff
  • Requires spermicide which is messy
  • May become dislodged
  • Must remain in same position for 6hrs after intercourse
  • If weight changes by >3kg need to use a different size diaphragm
  • Requires good pelvic muscle tone
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22
Q

What are the barrier contraceptives?

A

Condom, femidom, diaphragm

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23
Q

What is the fertility awareness method (FAM)/ Family Planning?

A

Is used to assess a woman’s fertility by charting daily temperature and vagina secretions

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24
Q

What are the disadvantages of family planning?

A

• Need 3-12 months of cycles to predict the fertile time
• Commitment is required from both partners
• Ideally need a FAM teacher
• Requires daily charting of temperature and vaginal secretions to predict onset and end of fertile time
• Periods of abstinence or barrier methods
 Predictor kits e.g. Persona
Not 100%

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25
Q

What are the types of Long Acting Reversible Contraceptives (LARCs)?

A

Injection (depo-provera)
Implant (Nexplanon)
IUD (copper coil)
IUS (Mirena)

26
Q

What are the types of Long Acting Irreversible Contraceptives?

A

Male and female sterilisation

27
Q

How does the injection produce its contraceptive effect?

A

It inhibits ovulation by suppressing LH and FSH.

28
Q

How is the depo-provera injection administered?

A

Administered at 12-week intervals.

IM injection of progesterone. Can be given immediately following an abortion or miscarriage, has immediate effect.

29
Q

What can depo-provera injections interfere with?

A

It can interfere with diabetes as insulin requirements may alter on initiation of depo and so should closely monitor their blood sugar.

30
Q

Advantages of Depo-Provera?

A
  • Effective and reversible with little user dependence
  • May help with Sx of PMS, ovulation pain and painful heavy periods
  • 55% women are amenorrhoeic after a year
31
Q

Disadvantages of Depo-Provera?

A
  • Irregular, prolonged bleeding
  • Amenorrhoea
  • Increased appetite can lead to weight gain
  • May have a delay in returning to fertility
  • Linked to reduced bone mineral density especially under the age of 19
32
Q

How does the implant provide its contraceptive effect?

A

Is a single rod (Nexplanon) that contains slow release progesterone (Etonogestrel 68mg). It is easily inserted and removed and may be fit in within 5 days following an abortion or a miscarriage. Contains barium sulphate so can be located on an X-Ray, USS or MRI.

33
Q

Advantages of the implant?

A
  • Last 3 years, low dose long acting
  • Are reversible
  • No oestrogenic side effects
  • Minimal medical intervention – only insertion and removal
  • Decreases dysmenorrhoea and menstrual blood loss
34
Q

Disadvantages of the implant?

A
  • Irregular bleeding
  • Requires minor operation for insertion and removal
  • Occasional discomfort
  • Rarely infection occurs at the site
35
Q

What examinations/investigations should be conducted prior to administering contraception?

A
  • BP (>140-159mmHg systolic and/or >90-94 mmHg diastolic)
  • BMI (≥30-34, 35-39 and ≥40)
  • Cervical smear if over 25 yrs
  • STI screen
36
Q

What is the Lactational Amenorrhoea Method (LAM)?

A

 Based on postpartum infertility when woman amenorrhoeic if fully breast feeding, on demand day and night
 At <6 months post-partum = 98-99% effective
 If hand/pump breast milk then failure rate increases
 Once menses return then no longer amenorrhoeic and LAM less effective
 Always have a back-up contraceptive!!

37
Q

What is the IUD?

A

Copper contained within plastic frame
Prevent implantation
Fitted immediately following abortion or miscarriage
Can still become pregnant but this is usually because the coil has slipped down and is no longer in the fundus

38
Q

Advantages of copper IUD?

A

Long term, reliable and reversible
Effective immediately
Effective as emergency contraception

39
Q

Disadvantages of copper IUD?

A

Causes foreign body reaction within the uterus, toxic to sperm and egg significantly reducing chance of fertilisation
May cause menstrual irregularities, spotting and IMB
Can cause menorrhagia and dysmenorrhoea
 risk of PID first 20 days of insertion
Risk of ectopic
Perforation at insertion
Risk of expulsion

40
Q

What is the IUS?

A

LNG-IUS (Mirena) - is like IUD but contained progesterone (Levonorgestrel - more potent gestagen) Also, used for menorrhagia and progesterone HRT
Causes endometrial atrophy and may suppress ovulation
Can be fitted immediately post abortion or miscarriage and 6 weeks’ post delivery

41
Q

How does IUS exert its contraceptive effect?

A
  • reduce sperm motility
  • increase cervical mucus
  • result in endometrial atrophy
  • surpresses ovulation
42
Q

Advantages of LNG-IUS?

A 
	Very effective 
	 menstrual blood loss
	 dysmenorrhoea
	 risk of ectopic
	Lowest hormone levels of any methods
	Lasts 5 yrs
43
Q

Disadvantages of LNG-IUS?

A

 Can cause irregular bleeding especially in first 3 -6 months
 Fitting may be painful
 Increased risk of PID after fitting
 Should not be used as emergency contraception

44
Q

Advantages of female sterilisation?

A

Highly effective
Immediate effect
Permanent
No hormonal effects

45
Q

Disadvantages of female sterilisation?

A

Surgical procedure
General anaesthetic
Not easily reversible
Associated complications

46
Q

What is involved in hysteroscopic sterilisation (Essure)

A 
	Soft flexible insert placed into each of the fallopian tubes - forms natural barrier
	Outpatient procedure in GOPD
	30 mins to insert 
	99.74% efficacy
	Totally irreversible
	Not effective immediately
	Inability to insert in 5% of women 
	Pelvic x-ray required 3 months following procedure to check tubes fully blocked
47
Q

Advantages of male sterilisation?

A

Safe and effective
Permanent
Minor op under local
Done by GP or in clinic

48
Q

Disadvantages of male sterilisation?

A

Not easily reversible
Not immediately effective
Associated complications

49
Q

Short term complications of male sterilisation?

A

 LA reaction
 Wound infection
 Failure to achieve azoospermia

50
Q

Long term complications of male sterilisation?

A 
	Sperm granulomas
	Chronic scrotal pain 
	Sperm abs
	Late recanaliation
	Regret
51
Q

What are the different types of emergency contraception (EC)?

A

Hormonal EC -> Levonelle and ellaOne

Non-hormonal EC -> e.g. copper IUD

52
Q

How do the hormonal ECs work?

A

Decreases viability of ova, decreases sperm numbers and may prevent implantation
 Doesn’t dislodge implanted embryo

53
Q

If someone requested the emergency contraception but regularly take contraceptive pills - when should they restart this?

A

For oestrogen contraceptives resume regular contraception within 12 hours plus barrier contraception for 7 days
For progesterone contraceptives resume regular contraception after 2 days with barrier method for 7 days

54
Q

Advantages of hormonal ECs?

A 
Effective, low failure rate
Easily available
Levonelle - 72hrs after sex
ellaOne - 120 hrs
Can be repeated in same cycle if necessary
55
Q

Disadvantages of hormonal ECs?

A

Associated N & V
Can disrupt menstruation cause IMB
Doesn’t protect against STIs

56
Q

How does the non-hormonal EC work?

A

Inserted copper IUD in order to prevent implantation

57
Q

When can non-hormonal EC be fitted?

A

up to 5 days after calculated earliest day of ovulation or for a single episode of unprotected sex at any stage in the cycle

58
Q

How is the non-hormonal EC fitted?

A

Requires professional fitting

59
Q

Advantages of non-hormonal ECs?

A

Can be used w multiple episodes of sex if within 5 days of ovulation
Can be used if vomiting from hormonal method
Ideal if IUD choice of long term contraception
Most effective method especially after 72 hrs

60
Q

Disadvantages of non-hormonal ECs?

A

Can be painful to insert especially in primipara (1st pregnancy)
Increased risk of PID

61
Q

Reasons to avoid combined hormonal contraception?

A 
1.	Venous disease
Avoid if current/past VTE or sclerosing treatment to varicose veins
Avoid if >1 of:
	>35y
	Smoker
	BMI >30
	FHx of VTE in 1DR
	Immobility
	Superficial thrombophlebitis
  1. Arterial disease
    Avoid if:
    Valvular or CHD w complications
    Hx of CVD - stroke, TIA, IHD, PVD, hypertensive retinopathy
    Use w caution if 1, avoid if >1 RF of CVD:
     >35y
     smoker
     FHx of arterial disease in 1DR
     DM
     HTN
     Migraine w/o aura (avoid if migraine w aura)
  2. Liver disease
  3. Cancer:
    Current or past hx of breast cancer
  4. Previous pregnancy complications:
    Pruritis in pregnancy
    Obstetric cholestasis
    Chorea
    Avoid if postpartum and breastfeeding
  5. Hepatic enzyme-inducing drugs:
    Avoid if taking rifampicin or rifabutin

Gynaecology (4 decks)

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