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REPRO > CONTRACEPTION > Flashcards

CONTRACEPTION Flashcards

1
Q

Solutions for Unwanted pregnancy (3)

A
  • keep it
  • terminate
  • adoption
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2
Q

What percent is unplanned in the UK?

A

40%

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3
Q

Mechanisms of Actions of Contraception

A
  1. Prevention of ovulation (most HORMONAL methods (emergency contrac.)
  2. Prevention of Fertilization (by toxicity/ mechanical/ surgical barrier)
  3. Prevention of Implantation (hostile endometrium or direct toxicity)
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4
Q

How to thicken cervical mucus

A

ius, DMPA, POP, SDI

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5
Q

Form of female sterlization

A
  • Tubal Occlusion
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6
Q

How to classify contraception

A
  1. Permanent/ Reversible
  2. Hormonal vs non hormonal
  3. Combined vs progesterone only
  4. iNTRAUTERINE METHOD
  5. emergency methods
  6. LARC
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7
Q

Spermicides can be only be used with _____

A

diaphragm

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8
Q

Family Planning vs Contraception

A
  • avg age to have a child 27-28 years

vs avg. age at which people have sex 16 y.o

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9
Q

When does life truly start according to some Gynaecological organisation?

A
  • at implantation!
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10
Q

Factors that may influence choice of contraceptive method.

A 
PERSONAL PREFERENCE 
1. : good for STI prevention,
2. cost: 
3. forgetful 
4. mental capacity 
5. freq of sex and type of sex
6. previous experience with contraceptive method 
7. future preg plans (short and long term)
8. relationship status 
9. child protection
age
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11
Q

Major Complication of Hormonal pills

A

MIGRAINES

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12
Q

Noncontraceptive benefits of Hormonal Contraception

A
  • acne/hirstuism (decr. TESTOSTERONE)
  • endometriosis (heavy, painful periods)
  • PMS
  • Ovarian cysts/ Ovarian cancer
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13
Q

Method vs User failure

A

Method- goes wrong (1 in 5 condom failing)

User failure- incorrect use or poor compliance to methos

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14
Q

Reasons for User failure

A 
poor compliance 
wrog lube
wrong storage 
diaphgram removed too early 
no replacement

CHC, POP, DMPA: late injection, wrong use, wrong storage

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15
Q

Iatrogenic user failure

A
  • wrong instructions

- poor support

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16
Q

2 types of IUD

A
  1. Mirena —HAS PROGESTOGEN ( makes endometrium thick; thickens mucus; abstain for 7 days)
  2. Copper IUD (can continue with sex right after; EMERGENCY contraception! )
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17
Q

How long do the IUDs last?,

A

mirena: 5 years

Copper IUD: 5-10 years

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18
Q

What are COMPLICATIONS of IUD?

A
  • risk of INFECTION ( after a couple of months
  • perforation of the womb
  • ectopic pregnancy
  • does not protect against STI
  • can fall out
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19
Q

What is UKMEC?

—READ UP and on FPA

A
  • used for CONTRACEPTION only
  • more prochoice than BNF and MIMS
  • less relevant for therapeutic use …use clinical judgement
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20
Q

What are the big themes of UKMEC?

A

VTE risks
CVD risks
Liver problems
Hormone Dependent Tumor

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21
Q

What is LARC stand for?

A

Long-Acting Reversible Contraception

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22
Q

What is lactational amenorrhea?

A
  • 3 criteria:
    1. Exclusively breast feeding
    2. Less than 6 months post natally
    3. Amenorrhoeic
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23
Q

Name 3 types of IUS; diff. based on doses.

A

Mirena (52mg) —lasts 5 years

These last 3 years
Kyleena (19.5mg)
Jaydess (13.5mg)

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24
Q

How does CHC act?

A
  • contains estrogen and progesterone
  • —INHIBITS ovulation
  • effect on cervical MUCUS and ENDOMETRIUM
25
Q

Mode of axn of POP?

A

Newer POP: Inhibits ovulation/ effect on cervical mucus, fallopian tube transport, endometrium

Older POP: effect on cervical mucus, fallopian tube transport, endometrium

26
Q

What is the pearl index?

A

the no. of contraceptive failure per 100 women

27
Q

The pearl index of POP and CHC?

A

CHC: 0.2
POP: 0.3%

28
Q

What should be considered when prescribing CHC and POP?

A
  • absorption

- Metabolism

29
Q

What is the mode of axn of an implant and failure rate ?

A
  • inhibition of ovulation (+ effect on endometrium and cervical mucus)
  • 0.05%
30
Q

What is the mode of action of depo injection?

A
  • inhibits ovulation

- axn on cervical mucus and endometrium

31
Q

Is depo injection considered to be a LARC?

A
  • yes

- it lasts 14 weeks; given every 13 weeks

32
Q

What is pearl index for depo injection?

A
  • 0.2%
33
Q

Name the most effective contraceptive.And state why.

A

Subdermal Implants

  • SAFE for most women (esp. because its progesterone only)
  • less hormonal effects
  • lasts 3 years
34
Q

What is the main s.e of SDI?

A

PV bleeding- controlled with CHC

35
Q

What is main mode of action of IUS?

A
  • effects IMPLANTATION (effect on cervical mucus and endometrium)
36
Q

What is suggested if Mirena is inserted after the age of 45?

A

-can be kept in place until after Menopause (when it is no longer needed)

37
Q

How do the IUS affects periods?

A
  • Mirena and Levosert: periods become lighter, shorter and less painful
  • —-MAY happen with Jaydess
38
Q

How painful is the insertion of an IUD or IUS?

A

QUICK but painful with insertion

  • 5/10 for Nulliparous
  • 3/10 for multiparous
39
Q

What is the mode of action of IUD?

A
  • prevention of fertilisation (by making it hard for the sperm to survive)
  • INFLAMMATORY response in endometrium
40
Q

What medical conditions is C/I with IUD use ?

A 
PID
unexplained vaginal bleeding
cervical cancer 
persistently high hCG levels 
endometrial cancer 
STI symptoms
41
Q

How does IUD affect periods?

A
  • makes it HEAVIER, longer and PAINFUL

esp. first 3 months

42
Q

Which contraceptive might be the only acceptable contraceptive after Breast Cancer?

A
  • Copper IUD
43
Q

Which LARC can be used as emergency contraceptive, post-coital?

A
  • Copper IUD (no need to abstain)

- IUS (need to abstain from sex for 7 days)

44
Q

How long does IUD last and what is its pearl index?

A
  • 5-10 years

- 0.6%

45
Q

Methods of female sterlization?

A
  • filshie clips
  • essure
  • blocks fallopian tubes
  • —-SHOULD ensure no risk of being pregnant when performed
46
Q

Least effective contraception

A
  • female diaphragm
47
Q

What does it mean to quick start contraception?

A
  • starting contraception when patient comes to the clinic for the first time
48
Q

Which contraceptives can be given on the first occasion?

A
  • some CHC
  • POP
  • IMPLANT
  • DEPO
49
Q

What is bridging contraception?

A
  • when the preferred method can’t be started
    (as pregnancy cannot be excluded)
  • interim method is used
50
Q

IN what situations may emergency contraception be needed?

A
  • when more than one COC is missed
  • ring has been out for more than 48 hrs
  • patch has been OFF for more than 48 hrs
  • up to 5 days AFTER UPSI or within 5 days of predicted date of ovulation
51
Q

What is the importance for the implant to be fitted within the first 5 days of your menstrual cycle?

A
  • if put on any other of your menstrual cycle —need to use additional contraception (condoms) for 7 DAYS
52
Q

Name the 3 methods for emergency contraception.

A
  • Copper IUD
  • ORAL ( LNG- EC: up to 72 hrs post UPSI…96hrs off licence)

(UPA-EC: up to 120 hrs post upsi =5days)

53
Q

What is 10x more effective oral EC?

A
  • copper IUD

- —-toxic to sperm, anti-implantation

54
Q

When can copper IUD be inserted?

A
  • 120 hrs post UPSI
    OR
  • up to 5 days AFTER earliest expected date of ovulation
55
Q

What should the pt be screened for prior to insertion of Cu IUD?

A
  • STI and she should be treated for ti
56
Q

Why is there a specific time in which a Cu-IUD can be inserted (within 5 days of UPSI) ?

A

a pregnancy does NOT implant in first 5 days

—84% IMPLANT at 8-10 days POST fertilization; earliest 6 days

57
Q

Wht is the diff. btw UPA- EC and LNG-EC? And their similarity?

A

UPA-EC: Anti-progesterone
LNG-EC: high dose progesterone

—-both delay ovluation (not abortive)

58
Q

When is the ORAL EC most effective?

A

LNG-EC just before LH surge
UPA-ECcan work durign LH not after peak

—–BOTH ineffective after ovulation

59
Q

When is UPA c.i?

A
  • if pt has severe acute asthma (uncontrolled by oral steroid)
  • if wishing to QUICK start hormonal contraception
  • must delay ongoign contraception for 5 days
  • —-if hormonal contraception has been sued in past 7 days

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