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Obs & Gynae > Contraception > Flashcards

Contraception Flashcards

1
Q

What is meant by a ‘99%’ effectiveness with regards to contraception?

A

That an average person using this method of contraception properly with a regular partner for a single year would only have a 1% change of getting pregnant

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2
Q

What is UKMEC used for?

Outline the 4 levels of UKMEC

A

To assess the safety of different contraceptive methods based on individuals

UKMEC1 = no restriction in use
UKMEC2 = advantages > disadvantages
UKMEC3 = disadvantages > advantages 
UKMEC4 = unacceptable risk, contraindicated
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3
Q

What is the effectiveness of the COCP if taken properly?

A

> 99%

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4
Q

What is the main mechanism of action of the COCP as contraception?

State two other actions

A

Prevents ovulation

Thickens cervical mucus
Thins endometrium

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5
Q

What are the different ways to take the the COCP (different types)? (3)

Describe each one

A

Monophasic - identical pills taken every day for 21 days followed by 7 day gap

Phasic - one pill taken every day for 21 days followed by 7 day gap, but pills contain varying amounts of hormones (need to be taken in correct order)

Every day - pill taken everyday, 7 are inactive placebo pills

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6
Q

What are common side effects of the COCP?

A 
Breakthrough bleeding/spotting
Breast tenderness
Headaches/migraines
Changes in libido
Acne
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7
Q

What are some risks associated with COCP use?

A

Stroke
DVT
HTN
Increased risk of breast cancer

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8
Q

What effect does COCP use have on cancer risk?

A

Increased risk - breast cancer

Reduced risk - endometrial, ovarian and colon cancer

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9
Q

What are some UKMEC 4 contraindications for COCP use?

A 
Over 35 + smoker
Pregnancy
Previous thrombosis
Previous stroke/heart disease
Uncontrolled HTN
FH thrombosis
Migraine with aura
Breast cancer
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10
Q

When should the COCP be started to offer immediate protection?

A

First day of the cycle (first day of menstrual period)

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11
Q

What is the missed pill rule for ONE missed pill?

A

Take missed pill as soon as possible, no extra protection required

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12
Q

If you start the COCP not on the first day of the cycle, what precautions should be taken?

A

Barrier contraception for 7 days

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13
Q

How should switching of combined pill types be done?

A

Once 21 days of first pill is over, start 21 days of new pill immediately

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14
Q

Name two types of COCP

A

Microgynon

Yasmine

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15
Q

How is the POP taken differently to the COCP?

A

POP is taken continuously

COCP is taken cyclically

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16
Q

How does the POP work as contraception? (2)

A

Thickens cervical mucus

Prevents ovulation

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17
Q

What is the effectiveness of the POP if taken perfectly?

A

> 99%

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18
Q

What time of the day should traditional POP be taken?

A

Within the same 6 hour window every day (3 hours +/- the same time from day before)

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19
Q

Name two types of POP

A

Norethisterone (traditional)
Levonorgestrel (traditional)
Desogestrel (new gen, 24 hr window)

20
Q

What are some side effects of the POP?

A 
Irregular bleeding
Amenorrhoea
Breast tenderness
Headaches
Change in libido
Acne
21
Q

What are the two types of IUD?

What is their effectiveness if inserted properly?

A

Copper coil

Mirena coil

> 99%

22
Q

What is the mechanism of action of the copper coil?

When is it effective after insertion?

A

Reduces sperm motility and survival

Effective immediately

23
Q

What is an alternative use for the copper coil other than traditional contraception?

A

Emergency contraception - inserted up to 5 days after unprotected intercourse

24
Q

What are some of the side effects/complications associated with copper IUD?

A

Menorrhagia/IMB (improves over time)
Uterine perforation/PID on insertion
Increased risk of ectopic pregnancies

25
Q

What is the mechanism of action of the Mirena coil?

A

Releases levonorgestrel (progestogen) to thicken the cervical mucus and reduce endometrial thickening

26
Q

How can the Mirena coil affect bleeding?

A

Can make periods lighter or stop altogether

Can cause irregular bleeding

27
Q

What are the side effects associated with the Mirena coil?

A

Spotting/irregular bleeding
PID/uterine perforation (more rare)
Increased risk of ectopic pregnancies

28
Q

What is the alternative use of the Mirena coil other than for traditional contraception?

A

First line treatment for menorrhagia (where pregnancy not desired)

29
Q

What does the Depo-provera injection contain?

How often is it taken?

A

Medroxyprogesterone acetate (progestogen)

3 monthly IM injection

30
Q

How effective is a regular 3 monthly Depo provera injection as contraception?

A

> 99%

31
Q

What is the mechanism of action of the Depo provera injection? (2)

A

Prevents ovulation

Thickens cervical mucus

32
Q

How long can it take for fertility to return in women who take the Depo provera injection as contraception?

A

12 months

33
Q

When should the Depo provera injection be given to provide immediate contraception?

What precaution should be taken if started at any other time?

A

First day of cycle (menstrual period)

7 day barrier contraception

34
Q

What side effects are associated with the Depo provera injection?

A 
Amenorrhoea
Irregular bleeding
WEIGHT GAIN
Acne 
OSTEOPOROSIS
35
Q

Which contraceptive method is the only one to have a proven association with weight gain?

A

Depo provera injection

36
Q

What is the name of the implant used as contraception in the UK?

Which hormone does it release?

A

NEXPLANON

Progesterone

37
Q

How long is the progesterone implant effective for?

A

3 years

38
Q

What is the mechanism of the progesterone implant?

A

Same as POP

  • Inhibits ovulation
  • Thins endometrium
  • Thickens cervical mucus
39
Q

What side effects are associated with progesterone implant use?

A

Minor operation required to insert/remove
Acne
Bleeding changes
Reduced libido

40
Q

For how long after giving birth, do all women not require contraception?

A

21 days after giving birth, no contraception required

41
Q

What contraception is considered safe in breastfeeding? When can it be started?

A

POP

Any time

42
Q

Can the COCP be used whilst breastfeeding?

A

Should be avoided

UKMEC4 before 6 weeks
UKMEC2 after 6 weeks

43
Q

Is lactational amenorrhoea (full breastfeeding + no periods) effective as contraception? For how long?

A

98% effective as contraception for 6 months

44
Q

What contraceptives are contraindicated if mother is not breastfeeding?

A

Any contraceptive is fine

45
Q

What are three types of emergency contraception?

A

Levonorgestrel - POP

Ulipristal - progesterone receptor modulator

Copper IUD

46
Q

How is female sterilisation performed?

A

Laparoscopically under GA

Blockage, tying, cutting or removal of Fallopian tubes

47
Q

How is male sterilisation performed?

A

Vasectomy, quick procedure under LA

Cutting and tying of vas deferens to prevent sperm reaching semen

Obs & Gynae (6 decks)

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