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Obs and Gynae > Contraception > Flashcards

Contraception Flashcards

1
Q

What are the methods of contraception?

A
  1. Combined oral contraception (COC)
  2. Transdermal patch
  3. Progesterone only pill (POP)
  4. Injections
  5. Implant
  6. Intrauterine copper device (IUCD)
  7. Intrauterine system (IUS)
  8. Diaphragm/cap
  9. Condoms
  10. Sterilisation
  11. Natural methods
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2
Q

What are the considerations for which type of contraception should be used?

A
  1. Age
  2. Medical contraindications
  3. Headaches
  4. Acne
  5. Sexual Hx (STI screen, cervical smears)
  6. Interactions
  7. Bleeding patterns
  8. Smoking
  9. BP
  10. BMI
  11. FHx
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3
Q

Contraindications of combines hormonal contraception (CHCs)?

A
  1. Migraine with aura
  2. VTE
  3. Htn
  4. BMI > 35
  5. Breast cancer
  6. Ischaemic heart disease
  7. Stroke
  8. Smoker > 35 years
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4
Q

What do CHCs protect against?

A

Ovarian, endometrial and colon cancer

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5
Q

What do CHCs increase the risk of?

A

Breast cancer (slightly)

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6
Q

What are the types of CHCs available?

A

Pills
Patch
Vaginal ring

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7
Q

Why can you not give pure oestrogen?

A

Because it will cause endometrial proliferation, increasing the risk of cancer

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8
Q

What do all CHCs contain?

A

Oestrogen, mostly ethinylestradiol (EE) and progestogen

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9
Q

What are oestrogenic side effects?

A 
(Similar to pregnancy)
o	Breast tenderness
o	Nausea
o	Headaches – Exclude migraine
o	Vaginal discharge
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10
Q

What are progestogenic side effects?

A

o Acne, hirsutism
o Mood swings, low mood
o Breakthrough bleeding – Exclude other causes

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11
Q

Missed COC pill guidance?

A
  • Can take pill up to 72 hours after the last one
  • If more than that, need to use condoms for 7 days
  • Assess need for Emergency Contraception (EC)
  • Missed pills more risky in 1st and 3rd week
  • Patch and vaginal ring = similar guidelines
  • Can take pill up to 72 hours after the last one
  • If more than that, need to use condoms for 7 days
  • Assess need for Emergency Contraception (EC)
  • Missed pills more risky in 1st and 3rd week
  • Patch and vaginal ring = similar guidelines
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12
Q

Do antibiotics affect COCs?

A

No, unless liver enzyme enducers

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13
Q

What is a monophasic 21 day COC pill?

A

o Most common type
o Each pill has same amount of hormone in
o Taken for 21 days with 7 day break

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14
Q

What is a phasic 21 day COC pill?

A

o Pills contain different amounts of hormone so must be taken in correct order
o Taken for 21 days with 7 day break

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15
Q

What is an everyday COC pill?

A

o 21 pills with hormones and 7 placebo pills

o Take for 28 days without a break between packs

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16
Q

How do COC pills work?

A

inhibiting ovulation, thickening cervical mucus and thinning the endometrium to prevent blastocyst implantation

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17
Q

How effective is the COC pill?

A

99%

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18
Q

Pros of the COC pill?

A

o Non invasive
o Effective
o Regular, lighter and less painful periods
o Control timings of periods
o Improve acne
o Reduce premenstrual Sx
o Reduces risk of ovarian, uterine and colon cancer

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19
Q

Cons of COC pill?

A

o Side effects; headache, nausea, mood changes, breast tenderness
o Breakthrough bleeding and spotting
o No STI protection
o User dependent

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20
Q

Risks of COC pill?

A

o VTE
o Breast cancer
o Cervical cancer

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21
Q

Contraindications of COC pill?

A 
o	Pregnancy
o	Smoker > 35
o	>35 and stopped smoking less than a year ago
o	BMI >35
o	Migraine with aura
o	Breastfeeding up to 6 weeks
o	CVD and VTE RFx
o	FHx of breast cancer
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22
Q

Effects of sickness and diarrhoea on COC?

A

o Sick within 2 hours, take another when feeling better

o Severe diarrhoea >24 hours, act as if missed a pill

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23
Q

Interactions with COC?

A

o Epilepsy meds
o HIV meds
o St Johns Wort

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24
Q

How long after starting POP until it is effective?

A

48 hours

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25
Q

Do you need to double the dose of POP in obese women?

A

No

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26
Q

Are POPs affected by liver enzyme inducing drugs?

A

Yes

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27
Q

3 main types of POP in the UK?

A

o Norethisterone
o Levonorgestrel (can also be used as emergency contraception)
o Desogestrel

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28
Q

How do POPs work?

A

inhibiting ovulation, thickening cervical mucus and thinning endometrium to prevent blastocyst implantation

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29
Q

How effective are POPs?

A

99%

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30
Q

Pros of POPs?

A

o Non-invasive
o Periods can become lighter, more regular and less painful
o Useful if oestrogens contraindicated
o Safe during breastfeeding

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31
Q

Cons of POPs?

A

o Side effects; headache, nausea, mood changes or breast tenderness
o Change in periods
o No STI protection
o User dependent

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32
Q

Risks of POPs?

A

o Ovarian cysts

o Breast cancer

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33
Q

Contraindications of POPs?

A

o Pregnancy
o Breast cancer
o Severe cirrhosis
o Liver tumours

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34
Q

Interactions of POPs?

A

Epilepsy meds
HIV meds
St John’s wort

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35
Q

What does LARC stand for?

A

Long Acting Reversible Contraception

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36
Q

Failure rate of LARCs?

A

<1%

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37
Q

Types of LARCs

A

Implants
Injectables
IUDs

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38
Q

How long does and implant last?

A

3 years

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39
Q

How long until an implant is effective?

A

Up to 7 days

40
Q

What is the active ingredient in an implant?

A

Etonorgestrel 68mg

41
Q

How to stop bleeding with an implant?

A

Use COC/POP

42
Q

Are implants affected by liver enzyme inducers?

A 
Yes;
Barbituates
Carbamazepine
Phenytoin
Rifampicin
43
Q

Pros of implants?

A 
o	Long term
o	Easily reversed
o	May make periods less heavy and painful
o	Safe to use when breastfeeding
o	Not affected by vomiting or diarrhoea
44
Q

Cons of implants?

A 
o	Unpredictable periods
o	Possible temporary side effects; (Headaches, Breast tenderness, Mood changes)
o	Acne
o	Small procedure required
o	No STI protection
45
Q

Risks of implants?

A

o Infection
o Bruising and bleeding
o Damage to local structures
o Slight increased risk of breast cancer

46
Q

What are the names of the injectable used in UK?

A

Depo-Provera or Noristerat

47
Q

How are injectables administered?

A

IM

48
Q

Do injectables cause weight gain?

A

Yes; only method proven to do this

49
Q

Do injectables delay fertility once stop taking them?

A

Yes; only method to do this

50
Q

How do injectables work?

A

inhibiting ovulation, thickening cervical mucus and thinning lining of endometrium (so difficult for fertilised eggs to implant)

51
Q

Effectiveness of injectables?

A

99%

52
Q

Pros of injectables?

A 
o	LARC
o	Effective
o	Not associated with ovarian cysts
o	Less painful periods
o	Useful if oestrogens can’t be taken
o	Safe during breastfeeding
o	Can be given straight after birth
53
Q

Cons of injectables?

A

o Side effects; headache, nausea, acne, mood changes and breast tenderness
o Change in periods; either lighter, irregular, more frequent, last longer or heavier
o No STI protection
o Weight gain; especially if under 18 or high BMI to begin
o Delay before return to normal fertility

54
Q

Risks with injectables?

A

o Osteoporosis
o Breast cancer
o Infection

55
Q

Contraindications of injectables?

A 
o	Pregnant
o	Thinking of getting pregnant in next year
o	Have breast cancer
o	Severe cirrhosis
o	Liver tumours
o	Hx of severe arterial disease
o	RFx for osteoporosis
o	Unexplained vaginal bleeding
56
Q

How often are injectables given?

A

Every 13 weeks

57
Q

How long for return to fertility after injectables

A

Up to 12-18 months

58
Q

Risks of IUS?

A

o Perforation risk <1:1000
o “Increased” risk of ectopic pregnancy (IF you get pregnant in the first place)
o Increased risk of infection in first 21 days

59
Q

Types of IUS?

A

Mirena

Copper

60
Q

Uses of Mirena?

A

Contraception
Menorrhagia
Endometiral protection with oestrogen HRT

61
Q

When can Mirena be kept in until menopause?

A

If fitted after age 45

62
Q

Is Mirena affected by liver enzyme inducers?

A

No

63
Q

How long can IUCD last?

A

Up to 10 years

64
Q

Effectiveness of condoms?

A 
Male = 98%
Female = 95%
65
Q

Types of barrier contraception?

A

Male and female condoms

Diaphragm

66
Q

Notes on diaphragms

A

Need to be assessed by doctor for size
Reassess size after weight change >3kg or post-partum
Use with spermicide
96% effective

67
Q

Is sterilisation considered permanent?

A

Yes

68
Q

Failure rate of vasectomy?

A

1:2000

69
Q

What needs to be done in vasectomy?

A

Semen analysis at 4 months

70
Q

Types of female sterilisation surgery?

A

Laparoscopic

Hysteroscopic

71
Q

Which types of female sterilisation surgery is less risky?

A

Hysteroscopic

72
Q

Risks of laparoscopic sterilisation?

A

Bowel/vessel damage

Increased ectopic pregnancy

73
Q

How long after UPSI can IUCD be inserted?

A

Within 5 days

74
Q

What does UPSI stand for

A

Unprotected Sexual Incidence

75
Q

Types of emergency contraception pills?

A

Levonelle

EllaOne

76
Q

How long after UPSI can Levonelle be used?

A

72 hours

77
Q

How does Levonelle work as EC?

A

Inhibits ovulation

78
Q

What needs to be done with Levonelle as EC if using liver enzyme inducers?

A

Double dose

79
Q

Problems with Levonelle as EC?

A

Less effective if high BMI

80
Q

How does EllaOne work?

A

Inhibits/delays ovulation

81
Q

How long after an UPSI can EllaOne be used?

A

120 hours

82
Q

Interactions of EllaOne?

A

Liver enzyme inducers

Antacids/PPIs

83
Q

Can you breastfeed after EllaOne?

A

Not for next week

84
Q

Where can EC be accessed?

A
  • Any GP that provides contraceptive services
  • Any sexual health or must GUM clinics
  • Any young person’s services
  • NHS walk-in centres
  • Many pharmacies
  • Some A&E departments
  • Purchased from pharmacies if >16
85
Q

Pros of IUCD?

A

o Effective contraception (most effective form of emergency)
o Regular contraception (for up to 10 years)
o No effects on other medication
o No hormonal content

86
Q

Cons of IUCD?

A

o Bleeding
o Heavier, more painful periods
o Procedure required

87
Q

Risks of IUCD?

A

o Can be expelled for no reason, so need to check it’s in place and use other contraception if it not
o Damage to the womb (2 in 1000 insertions) and would need surgery to repair
o Infection
o High risk of ectopic pregnancy if do fall pregnant

88
Q

Contraindications of IUCD?

A

o Less than 28 days following giving birth
o Less than 5 days following miscarriage or abortion
o Active STI

89
Q

Pros of EllaOne?

A

o Can be taken within 5 days of unprotected sex
o No procedure needed
o Very few side effects

90
Q

Cons of EllaOne?

A

o Nausea and vomiting

o Changes to next period

91
Q

Risks of EllaOne?

A

o Use with caution in severe asthma

92
Q

Contraindications of EllaOne?

A

o Less than 21 days following giving birth

o Less than 5 days following miscarriage or abortion

93
Q

Pros of Levonorgestrel?

A

o No procedure needed

Very few side effects

94
Q

Cons of Levonorgestrel?

A

o Nausea and vomiting; if vomit within 3 hours of taking it, need another dose
o Changes to next period
o Shorter window for emergency contraception than other
o High BMI issues; may need increased dose

95
Q

Contraindications of Levonorgestrel?

A

o Less than 21 days following giving birth

o Less than 5 days following miscarriage or abortion

Obs and Gynae (19 decks)

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