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Contraception Flashcards

1
Q

what hormone are in combined hormonal contraception

A

oestrogen and progesterone

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2
Q

what are the combined hormonal contraceptive methods

A

pill, patch, vaginal ring

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3
Q

what is the failure rate of CHC

A

perfect use 0.3%

typical use 9%

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4
Q

how do you take the COC

A

start in first 5 days of period or at any time if reasonably sure you arent pregnant
take for 21 days and have 7 day break
OR
tricycle (run three packets together and have 7 days withdrawal bleed at end of three months)

if you bleed for more than 4 days or more stop for another 4 and then restart (some people cannot take pills continuously will still bleed)

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5
Q

what can affect the effectiveness of CHC

A 
impaired absorption (GI condition and COC) 
increased metabolism (liver enzyme induction, drug interaction) 
compliance
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6
Q

what are the risks of CHC

A

venous thrombosis (especially with other RF- BMI, smoking)
arterial thrombosis
adverse effects on some cancers

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7
Q

which type of pill have bigger risk for VTE

A

oestrogen dominant ones- gestodene, desogestrel, etonogestrel

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8
Q

what are oestrogen dominant pills better for

A

skin

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9
Q

when are you most at risk of VTE

A

postnatally

also high risk in pregnancy

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10
Q

what are the unwanted circulatory effect of COC

A

systemic hypertension (need to check before starting prescription)

arterial disease - increased risk of MI (esp in smokers), and ischaemic stroke (both higher in HPTx)

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11
Q

what does migraine with aura mean for contraception

A

increases risk of ischaemic stroke

CHC use is contraindicated in patients with migraine with aura

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12
Q

what age is a relative CI to COC

A

> 35

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13
Q

what cancers can be affected by CHC

A 
breast 
cervical (long term use >5 years, returns to baseline after 10 years not taking, condom use + cervical screening important)
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14
Q

what is the UKMEC

A

quantifies risk of contraception

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15
Q

what cancers can CHC protect against

A

ovarian and endometrial

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16
Q

which CHC have a beneficial act on acne

A

all

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17
Q

why is dianette good and bad

A

EE/Cyproterone acetate (Dianette)

very good for acne= antiandrogen/ progestagen/ antiglucocorticoid

higher risk of blood clots

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18
Q

what are the non contraceptive benefits of CHC

A 
less bleeding 
fewer functional decreased ovarian cysts 
premenstrual syndrome (cycling stops so no ups and downs) 
polycystic ovarian syndrome- helps regulate cycle 
endometriosis
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19
Q

what are the common side effects of CHC

A 
nausea 
spots 
breast tenderness 
bleeding 
headaches
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20
Q

should you avoid CHC in people with thrombophilia/ FHx of clots

A

yes

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21
Q

how do you take the progesterone only pill

A

every day, dont have a break, even if getting period
day 1-5 of period/ any time if sure not pregnant
use condoms when starting pill for 7 days/ 2 days if POP

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22
Q

what are the forms of progesterone only contraception

A

progesterone only pill
subdermal implant
DMPA

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23
Q

what is the lower risks of in progesterone only methods rather than CHC

A

cardio events, clots, cancer

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24
Q

is a common SE of progesterone only treatments

A

irregular bleeding

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25
Q

what is depo provera / sayana press

A

large injection of progesterone
lasts 3 months
syanan press is self administered, depo is done by health care professional

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26
Q

what are the pros of progesterone injection

A

very effective
high chance of amenorrhoea
lasts 3 months
doesnt interact with enzyme inducing drugs (antiepileptics)

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27
Q

how does depo injection work

A

lowers estradiol

suppresses FSH

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28
Q

what is a risk of depo injection

A

oestopenia due to lack of oestrogen

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29
Q

what advice should you give on condoms

A

wear them with other contraceptive methods, good for STIs

not good on own

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30
Q

who are diaphragms good for

A

women in 40s with CI to hormonal contraceptives

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31
Q

how do diaphragms work

A

put spermacide along rim
squeeze into right shape then insert
leave in for 6 hours after sex, gives spermicide and vaginal acid time to kill sperm
if have sex 3 hours after insertion need to reapply spermicide

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32
Q

what is more invasive, male or female sterilisation

A

male - no scalpel technique

can be done under local or general anaesthetic

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33
Q

what are the possible complications of a vasectomy

A

anaesthetic
pain
infection
bleeding/ haematoma

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34
Q

can a vasectomy fail

A

yes

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35
Q

what method of female sterilisation is done in UK

A

clips

36
Q

is female sterilisation good

A

no
high failure rate
invasive
permanent if successful

37
Q

how effective is natural family planning

A

76% with typical use

38
Q

what are the possible SEs of estrogenic contraceptives

A 
bloating 
breast swelling and tenderness 
decreased sex drive 
growth of uterine fibroids 
headaches 
irregular bleeding 
mood swings 
nausea and vomiting 
raised BP 
weight gain (water retention, cyclical gain)
39
Q

what are the possible SEs of progestogenic contraceptives

A 
acne 
anxiety 
bloating 
breast tenderness 
associated with depression 
depression 
headaches 
hirsutism 
irregular bleeding 
mood swings 
weight gain (increased appetite, sustained gain, mostly DMPA)
40
Q

what are the possible side effects of combined

A 
acne/ hirsutism 
bloating 
breast tenderness 
headache 
heavy withdrawal bleeding 
loss of sex drive 
mood changes (depression, anxiety, irritability) 
nausea 
unscheduled bleeding 
water retention 
weight gain
41
Q

how many pregnancies a year are unplanned

A

40%

42
Q

what are the mechanisms of action of contraception

A

preventing ovulation- hormonal methods, suppresses FSH and LH

preventing fertilisation- condoms, diaphragms + spermicide, female and male sterilisation, IUD, hormonal methods (cervical mucous effect)

prevention of implantation- IUD (esp copper coil) hormonal method, create a hostile endometrium/ direct toxicity

43
Q

what contraceptives thicken the cervical mucous

A

IUS (hormonal coil, IU system), DMPA, POP, SDI (subdermal implant)

44
Q

what contraceptives have a direct toxic effect

A

IUD (Copper), spermicides

45
Q

what contraceptives act as a mechanical barrier

A

F+M condoms, diaphragms, cervical caps

46
Q

what contraceptives cause endometrial changes/ thinning

A

IUS, IUD, SDI, DMPA, POP, CHC

47
Q

what contraceptives suppress ovulation

A

CHC, DMPA, SDI, LAM (lactational amenorrhoea method), desogestrel-containing POP, IUS

48
Q

what are the emergency methods of contraception

A

copper IUD

pills- ulipristal acetate, levonorgestrel

49
Q

what is the most important thing when choosing a contraceptive method

A

her personal preference

50
Q

what are the 3 most effective contraceptive methods

A 
SDI
vasectomy 
IUS
female sterilisation 
IUD
51
Q

what type of lube shouldnt you use with condoms

A

oil based

52
Q

what is the average pain for IUD insertion

A

parous women 3/10

nulliparous 5/10

53
Q

what makes a women unsuitable for and IUD

A

submucosal fibroids

54
Q

how long does a copper IUD last

A

up to 10 years

55
Q

what are the common SEs of the copper IUD

A

often makes periods heavier, longer and more painful (especially in first 3 months)

56
Q

what can help with pain and bleeding caused by the copper IUD

A

NSAIDs

57
Q

is a copper IUD or IUS more effective

A

IUS

58
Q

how long can IUS’s last

A

3-5 years

59
Q

what is common in the weeks/ months following IUS insertion

A

spotting, unpredictable periods/ bleeding, acne or headaches for first few months usually settles to no/ light periods

60
Q

what can a mirena treat

A

heavy periods, HRT, endometriosis, hyperplasia

61
Q

how many women with IUS have amenorrhoea

A

50% at 6 months

62
Q

why are hormonal side effects low with an IUS

A

as systemic hormones low

63
Q

what is nexplanon

A

subdermal contraceptive device

64
Q

how long does an SDI last

A

3 years

65
Q

what hormone in SDI

A

progesterone only

66
Q

what is the main side effect of SDIs

A

prolinged PV (vaginal) bleeding

67
Q

what can help prolonged bleeding in a SDI

A

CHC

68
Q

how long after sex can a copper coil be used an emergency contraception

A

5 days

69
Q

how does the CHC help to regulate cycle and reduce acne

A

decreases testosterone in blood by increasing sex hormone binding globulin

70
Q

what do you have to do in patients under 13 having sex

A

involve social work

71
Q

when should patients check threads of an IUD after fitting

A

4-6 weeks after fitting

72
Q

when should you use condoms when getting IUD fitted/ rmoved

A

7 days before/ after insertion/ removal

73
Q

what are the big risks in contraception

A

VTE, cardiovascular, liver problems, breast cancer, IUDs- perforation, ectopic pregnancy

74
Q

how do you use the patch

A

how to use a patch
apply 1 on 8th day
apply another after 7 days (take old one off)
apply another for last 7 days
if falls off for less than 48 hours reapply, if more than than use condoms and start a whole new patch cycle

75
Q

what is the main side effect of the implant

A

bleeding problems

76
Q

what are the differentials for irregular bleeding

A

STI, cancer, miscarriage, pregnancy

77
Q

what are the negatives of the depot injection

A

Risk of weight gain
Can not be stopped once injected
Delayed return of fertility (up to a year)
(CVD risk, VVA, osteopenia/osteoporosis, mood/depression)

78
Q

what has higher risk of VTE the ring or the COC

A

ring

79
Q

how do you use the ring

A

keep ring in the fridge, lasts 3 week when inserted, ring free week, insert again on same day as taken out. if falls out in weeks 1-2 then rinse and reinsert if out for less than 3 hours, more than 3hrs use condoms. if more than 3 hours in 3rd week then insert new ring immediately (may have withdrawal bleed) or stay ring free week

80
Q

what are the pros and cons of 2nd gen and 3rd gen CHC

A

2nd gen CHC have lower risk of DVT than 3rd gen but 3rd may have better non contraceptiv effects

81
Q

what is the mini pill

A

progesterone only pill

82
Q

what are the option of emergency contraception

A

IUD (copper coil) up to 5 days after, most effective
pills that stop ovulation:- ulipristal acetate (progesterone receptor, non hormonal, makes uterine contract) (aka ellaone) and levonorgestrel (progesterone pill)

pills need to be taken before ovulation so only work at specific time in cycle

83
Q

what are the pros and cons of levonorgestrel

A

least effective EC method
only works up to 72hrs after UPSI
not effected after start of LH surge (48 hours before ovulation)
affectiveness best at BMI<30

can quick start it
Double dose can be given when on liver enzyme inducers.
No reduced effectiveness with lower gastric pH.
No problems with breastfeeding.

84
Q

what are the pros and cons of ulipristal acetate

A

most effective pill
effective after LH surge
not affected by BMI
effective up to 120 hours after UPSI (5 days)

less effective if already on pill
delay in quick starting necessary
Not effective just before LH peak (24 hours before ovulation).
Can’t be given with liver enzyme inducers.
Can’t be given with drugs reducing gastric pH.
Breast-feeding is contraindicated (or discard milk for a week).

wait 5 days before starting normal pill again if forgot (ella one stops ovulation for 5 days)

85
Q

when can you start contraception after mini pill

A

48 hours

86
Q

what are the non contraception benefits of progesterone

A

thins endometrium- light periods and prevents endometrium cancers, ovarian cysts.
Thickens cervical mucous so protective against PID

Reproduction (51 decks)

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