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Reproduction > Contraception > Flashcards

Contraception Flashcards

1
Q

List some forms of combined hormonal contraception?

A

Pills
Patch
Vaginal Ring

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2
Q

List some progestogen only methods of contraception?

A

Pill
Injectable
Implant

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3
Q

What are the features of an ideal contraceptive?

A
  • Reversible
  • 100% effective
  • Unrelated to intercourse
  • Free of adverse side effects
  • 100% Protective against STIs
  • Non-contraceptive benefits
  • Low maintenance, no ongoing medical input
  • Male and female options
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4
Q

What is the term for the number of contraceptive failures per 100 women-years of exposure?

A

The pearl index

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5
Q

What is the advantage of Long-Acting Reversible Contraception?

A

Minimises user input - minimises user failure rates

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6
Q

In what days of the cycle does ovulation normally take place?

A

Day 12-18

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7
Q

What days are the highest chance of pregnancy?

A

Day 8-19

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8
Q

What two hormones are used in combined hormonal contraception?

A 
Ethinyl estradiol (EE)
Synthetic progesterone (prostestogen)
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9
Q

What do combined hormonal contraceptions do to the ovulation cycle?

A

Stop ovulation through negative feedback

Affects cervical mucus and endometrium

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10
Q

What are some non-contraceptive benefits of combined hormonal contraceptions?

A
  • Regulate/reduce bleeding
  • Stop ovulation
  • Reduction in functional ovarian cysts
  • 50% reduction in ovarian and endometrial cancer
  • Improve acne/hirsutism
  • Reduction in benign breast disease, RA, colon cancer and osteoporosis
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11
Q

List some side effects of combined hormonal contraceptions?

A

Breast tenderness
Nausea
Headache
Irregular bleeding first 3 months

Serious effects

  • DVT/PE Risk
  • Arterial thrombosis risk/MI/Stroke
  • Avoid in active gallbladder disease
  • Increased risk of cervical/breast cancer
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12
Q

List side effects to progesterone contraceptions?

A
  • Appetite increase
  • Hair loss/gain
  • Mood change
  • Bloating/fluid retention
  • Headache
  • Acne
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13
Q

What type of contraception has a causal effect on weight gain, delayed return of fertility and bone density?

A

Injectable progestogen

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14
Q

How does injectable progesterone affect chances of fertilisation?

A
  • Prevents ovulation
  • Alters cervical mucus making it hostile to sperm
  • Makes endometrium unsuitable for implantation
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15
Q

What is the mode of action of the copper IUD?

A

Toxic to sperm - stop sperm reaching egg, sometimes prevent implantation of fertilised egg

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16
Q

What are the three types of emergency contraception?

A
  • Copper IUD - most effective
  • Levonorgestrel pill - ‘Levonelle’
  • Ulipristal pill - ‘Ellaone’
17
Q

What is the usual method of female sterilisation?

A

Laparoscopic - filshie clips applied across tube to block tube lumen

(Can also do salpingectomy at planned cesarean if discussed in advance)

18
Q

What are potential downsides to female sterilisation?

A
  • Risks of GA and laparoscopy
  • Irreversible - risks regret
  • Failure rate - 1 in 200 lifetime risk - could be ectopic
19
Q

What is involved in a vasectomy?

A

Vas deferens divided and ends cauterised - small incision midline scrotum

20
Q

What are potential downsides to male sterilisation?

A
  • Failure rate after x 2 clear samples 1 in 2000 lifetime
  • Irreversibility – Anti-sperm antibodies even if vas reconnected

< 1:100 risk long term testicular pain

21
Q

What fraction of UK women will have an abortion in their lifetime?

A

1/3

22
Q

What is involved in a consultation for termination?

A
  • Scan for gestation and viability
  • Medical history
  • Circumstances - reasons for seeking abortion (check no coercion)
  • Discuss methods of abortion, what to expect
  • Contraception for afterwards
  • FBC/Rhesus Groups
  • Vaginal swabs/Bloods for STIs offered
23
Q

What is involved in surgical termination of pregnancy?

A
  • Cervical priming (misoprostol) 3 hrs preop
  • GA/LA cervical block
  • Transcervical suction catheter

Complications - perforation/risks from GA

24
Q

What is involved in medical termination of pregnancy?

A
  • Mifepristone (antiprogesterone tablet)
  • 36-48hr later Misoprostol initiates uterine contraction

Complications - may need surgery if incomplete abortion
Infection
<1/1000 need blood transfusion

25
Q

What is the standard regime for combined hormonal contraception?

A

21 days, with a hormone free week

26
Q

How often does the combined hormonal contraception patch need changed?

A

Weekly

27
Q

What are some side effects of injectable progesterone?

A
  • Delayed return to fertility
  • Reversible reduction in bone density
  • Problematic bleeding
  • Weight gain
28
Q

What are some side effects of progestogen implant?

A
  • Most are almost bleed free, but some have prolonged/frequent bleeding
  • May cause mood change more often
29
Q

How long can the progestogen implant last?

A

3 years

30
Q

How long can intrauterine contraception ‘Coils’ be used?

A

5-10 years

31
Q

What are some side effects to intrauterine contraception?

A
  • Very small infection risk
  • Small perforation risk
  • Expulsion risk (Threads should be checked after each period
  • May increase risk of ectopic pregnancy if conception does occur
  • May make periods heavier/crampier
32
Q

What is the right of the clinician in termination of pregnancy?

A

To refuse participation - conscientious objection.

However, they are obligated to ensure the woman is still able to access abortion care

33
Q

When is termination of pregnancy legal?

A
  • Continuing pregnancy has grave risk to life of pregnant woman
  • Termination is necessary to prevent permanent injury to physical/mental health of pregnant woman
  • <24 weeks and continuing pregnancy involves greater risk to physical/mental health of pregnant woman/existing children
  • Substantial risk of physical or mental abnormalities
34
Q

What two medications are used in the medical termination of pregnancy?

A

Mifepristone

Misoprostol

35
Q

What medication can be given for self administration if a home abortion?

A

Misoprostol

(Mifepristone still needs to be taken in clinic/hospital).

36
Q

List some barrier methods of contraception

A

Male condoms
Female condoms
Diaphragm/cap

Reproduction (15 decks)

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