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Sexual and Reproductive Health > Contraception > Flashcards

Contraception Flashcards

1
Q

Name the LARC

A

Depot injection

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2
Q

What is the mechanism of action by which the depot injection works?

A

Inhibition of ovulation

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3
Q

How often do you have to get the IM depot injection?

A

Every 12-14 weeks

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4
Q

What are the contraindications for LARC/depot injection?

A

Pregnancy
Breast cancer
Severe cardiac disease
Undiagnosed vaginal bleeding

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5
Q

Before starting the depot injection what do we have to consider?

A

osteoporosis

pregnancy

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6
Q

Side effects of the depot injection (5)

A

Weight gain
Increased risk of osteoporosis
Risk of ectopic pregnancy
Delay in return of fertility - roughlt 10 months
Irregular bleeding - which usuallly settles with time

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7
Q

When can we start the depot injection?

A 
Any time! 
No need for other contraceptives if:
Up to day 5 of cycle 
Up to 5 days after TOP 
Up to 21 days PP

Need for contraception 7/7 if the above not met

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8
Q

Name the types of VLARC

A

Copper coil IUD
Mirena coil IUS
Implant

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9
Q

What is the mechanism of action of the copper coil IUD?

A

Prevents fertilisation

Non-hormonal IUD

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10
Q

What are the contraindications for the copper coil IUD? (5)

A

Pregnancy - increased risk of ectopic pregnancy and second trimester miscarriage
Intra-uterine infection
Abnormal uterine anatomy - will need a PV to check
Peptic ulcer disease
Hx of/current endometrial/cervical cancer

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11
Q

When would you be able to insert the copper coil IUD?

A

Anytime if reasonably certain they are not pregnant
Within 7 days of period
Up to 5 days after UPSI for emergency contraception
Immediately after TOP
< 2 days or > 4 weeks post partum

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12
Q

Name the problems/side effects associated with the copper coil IUD

A

Heavy, prolonged periods

Problems with insertion: pain, increased risk of infection, uterine perforation, expulsion of device

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13
Q

What is the mechanism of action by which the Mirena coil IUS works?

A

Prevention of implantation

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14
Q

How long is the Mirena coil IUS effective for?

A

Either 3 or 5 years

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15
Q

What are the contraindicaitons for the Mirena coil IUS?

A

Pregnancy - increased risk of ectopic pregnancy and second trimester miscarriage
Intra-uterine infection
Abnormal uterine anatomy - will need a PV to check
Peptic ulcer disease
Hx of/current endometrial/cervical cancer

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16
Q

Name the problems/side effects associated with the Mirena coil IUS?

A

Irregular menstrual bleeding that usually becomes lighter with most women becoming amenorrhoeic
Problems with insertion: pain, increased risk of infection, uterine perforation, expulsion of device

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17
Q

When is the Mirena coil suitable for insertion

A

Anytime if reasonably certain they are not pregnant
Within 7 days of period, if more than 7 use another form of contraception as cover
Up to 5 days after UPSI for emergency contraception
Immediately after TOP
< 2 days or > 4 weeks post partum

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18
Q

What can be used for emergency contraception, the Mirena coil or the copper coil?

A

Copper only

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19
Q

What is the most effective form of contraception?

A

The implant

20
Q

What is the implant?

A

A non-degradable rod impregnated with progesterone that is inserted into the arm

21
Q

What is the mechanism of action of the implant?

A

Inhibition of ovulation

22
Q

How long does the implant last?

A

3 years, may need to be changed more frequently if obese

23
Q

What problems are associated with the implant?

A

Nerve damage/pain on insertion

24
Q

What are the side effects of the implant?

A

Irregular bleeding, weight gain, acne

25
Q

When can you be given the implant?

A 
No additional cover needed if:
Within first 5 days of cycle
On/before 21 days PP
Up to 5 days post 1st/2nd trimester abortion 
Starting after last active pill taken

Additional cover needed if:
starting at any other time in the cycle
switching contraception from POP, Mirena, IUD
used as a quick start after emergency contraception

26
Q

What is the mechanism of action of Short Acting Combined Hormonal Contraception?

A

Inhibition of ovulation

27
Q

Give examples of Short Acting Combined Hormonal Contraception

A

Combined Oral Contraceptive Pill

And others - fill in later

28
Q

If you vomit 4 hours after taking the COCP should you take another one for cover?

A

No

Only need to take additional cover if vomiting 2 hours within taking the pill

29
Q

Other than vomiting, what other illness requires you to change how you take the pill?

A

Diarrhoea

for more than 24 hrs

30
Q

What are the benefits of taking the COCP?

A

Reduces acne
Improves premenstrual symptoms
Protects against ovarian, endometrial and colorectal cancer

31
Q

What are the minor side effects of taking the COCP?

A 
Elevated BP
Mood swings
Nausea/Vomiting 
Irregular bleeding - should settle with time 
? weight gain
32
Q

What are the major side effects of taking the COCP?

A

Increased risk of VTE
Increased risk of CVD and stroke
Increased risk of breast/cervical cancer

33
Q

What are the risk factors of a VTE?

A 
>35
Smoker
Immobility
Long haul flights 
6 weeks post-partum
High altitudes for >1 week
34
Q

What is the latest date for a TOP?

A

24 weeks gestation

unless for medical reasons

35
Q

What are the 2 most common ‘grounds’ for requesting a TOP?

A

ground C - social abortion

ground E - abnormality

36
Q

Describe ground C abortions

A

Pregnancy has not exceeded 24th week and continuance of the pregnancy would involve risk greater than if the pregnancy were terminated, of injury to the physical and mental health of the woman

37
Q

Describe ground E abortions

A

there is a substantial risk that if the child were born it would suffer from physical or mental abnormalities as to be seriously handicapped

38
Q

How is a medical abortion carried out?

A

Stage 1: oral mifepristone

Stage 2: oral or vaginal prostaglandins (misoprostol)

39
Q

What is mifepristone?

A

An anti-progesterone - it acts to increase contractions and increase expression of prostaglandin receptors

40
Q

How does stage 2 of termination (prostaglandins) affect the pregnancy?

A

act to promote passage of POC by increasing contractions and opening the cervix

In late/mid trimester abortions may need repeated doses of prostaglandin 3 hourly (max 5/24 hours)

41
Q

In a medical abortion at 12 weeks is it completed in home or hospital?

A

Hospital

only <10 weeks can be completed at home

42
Q

What is the success rate of medical abortion?

A

95%

43
Q

Describe options within surgical TOP

A

vacuum aspiration 9-14 weeks

14+ dilation and evacuation (D&E not carried out in scotland)

44
Q

In Scotland what is the latest date a woman can have a medical abortion?

A

19 + 6

45
Q

Before starting the COCP, what test have to be done?

A

Blood Pressure

Sexual and Reproductive Health (9 decks)

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