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Obstetrics and Gynaecology > Contraception > Flashcards

Contraception Flashcards

1
Q

What is the mechanism of action of the combined contraceptive pill

A

Prevents ovulation:
-ve feedback of oestrogen and progesterone on HP axis- prevents the LH surge

thickens cervical mucus- reduces chances of sperm penetrating womb
thins lining of the womb - reduce chance of egg implantation

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2
Q

How often is the COCP taken

A

taken every day for 3 weeks out of each month

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3
Q

What are the advantages of the COCP

A

does not interrupt sex
reduces risk of ovarian. uterine and colorectal cancer
can protect against PID and ovarian cysts
usually makes bleeds lighter, more regular and less painful

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4
Q

What are the disadvantages of the COCP

A 
effectiveness depends on user
Side effects- headaches, breast tenderness, mood changes
has to be taken routinely
increased BP
no protection against STIs
breakthrough bleeding
increased risk of thrombosis
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5
Q

What are the contraindications of the COCP

A

pregnancy
BMI >35
breastfeeding
smoking or stopped less than a year ago and over 35
Hx of thrombosis, stroke, hypertension, migraine, currently Dx breast cancer
prolonged inactivity

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6
Q

What is the mechanism of action of the implant (Nexplanon)

A

steady release of progesterone - prevents ovulation, thickens cervical mucus and thins womb lining

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7
Q

How long does the implant last

A

3 years

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8
Q

What are the advantages of the implant

A 
can be taken out at any point
doesnt interrupt sex
option for those who cant use oestrogen based contraception
safe during breastfeeding
not affected by other medication
decreased risk of endometrial cancer
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9
Q

What are the disadvantages to the implant

A 
no protection against STIs
oligomenorrhoea or amenorrhoea
weight gain
SE - loss of libido and mood swings
needs a procedure to insert - bruising and pain
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10
Q

What are the contraindications to the implant

A

pregnancy
arterial disease - Hx stroke and heart disease
unexplained bleeding post intercourse or inbetween periods
liver disease
breast cancer

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11
Q

How does the injection (depo-provera) work

A

Progesterone release
prevents ovulation
thickens cervical mucus
thins womb lining

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12
Q

How long does the injection last for

A

About 8-13 weeks

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13
Q

What are the advantages of the injection

A 
Lasts 8 or 13 wks at a time 
Doesn’t interrupt sex
Option for those who can’t use oestrogen based contraception
Safe whilst breastfeeding 
Not affected by other meds
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14
Q

What are the disadvantages of the injection

A 
Change to periods 
No protection against STIs 
Can be a delay of up to a year before periods return to normal and you can conceive once stopping it 
Weight gain 
SE: loss of libido, mood swings etc
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15
Q

What are the contraindications to the injection

A 
Pregnant 
Want to conceive in next year
Unexplained bleeding 
Liver disease 
Breast cancer 
Osteoporosis risk 
History of CV disease and stroke.
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16
Q

How does the patch work

A

Releases oestrogen and progesterone through the skin.

prevents ovulation, thickens cervical mucus and thins womb lining

17
Q

What are the advantages of the patch

A

easy to use
doesn’t interrupt sex
still works with D&V
reduced risk of ovarian and bowel cancer, fibroids and cysts

18
Q

What are the disadvantages to the patch

A 
may be visible
can cause skin irritation and soreness
no protection against STIs
breakthrough bleeding
needs to be changed weekly
19
Q

What are the contraindications to the patch

A 
pregnancy
breastfeeding a baby <6 weeks old
smoking and are 35 and over and have just stopped
overweight
other medication
20
Q

How does the intrauterine system (mirena/jaydess) work

A

small T shaped plastic device inserted into uterus
releases levonorgestrel.
thins womb lining - implantation less likely
can prevent ovulation but women will often still ovulate

21
Q

What are the advantages of the IUS

A

works for 3/5 years
one of the most effective forms of contraception
safe to use if breastfeeding
doesnt interrupt sex
good option if unable to take oestrogen
possible to conceive as soon as it’s removed

22
Q

What are the disadvantages to the IUS

A 
risk of developing small ovarian cysts
increased risk of ectopic pregnancies and PID and perforation
no protection against STIs
spotting in the first few weeks
may stop periods altogether
23
Q

What are the contraindications to the IUS

A

Untreated STI

Womb or cervix problems

24
Q

How does the intrauterine copper device (copper coil) work

A

small t shaped copper device that creates an unfavourable environment in the womb for sperm and causes a localised inflammatory response preventing implantation of eggs

25
Q

what are the advantages of the IUCD

A 
works for 5-10 years
works immediately - used as emergency contraception
option for those with a high BMI
no hormonal side effects
safe in breast feeding
can conceive as soon as its removed
26
Q

What are the disadvantages to the IUCD

A

altered periods - may be heavier, longer and more painful

no STI protection

vaginal bleeding and pain
increased risk of PID and ectopic pregnancy

27
Q

What are the contraindications to the IUCD

A 
Pregnant 
Untreated STI/ PID
Womb or cervix problems
Unexplained bleeding 
wilsons disease
heavy periods
trophoblastic disease or gynae malignancy
28
Q

How does the progesterone only pill work (Mini pill)

A

thickens cervical mucus.
thins endometrium
inhibits ovulation

29
Q

How should the progesterone only pill be taken

A

reliably every day at the same time (3 hour window)

30
Q

What are the advantages of the progesterone only pill

A

no interruption to sex
can be used in breastfeeding
useful if you cant take oestrogen
can be used at any age including over 35 and a smoker

31
Q

What are the disadvantages to the progesterone only pill

A 
user dependent effects
interruption to periods
no protection against STIs
need to remember to take it the same time every day
side effects
32
Q

What are the contraindications to the progesterone only pill

A

pregnancy
liver cirrhosis or cancer
stroke or CHD

33
Q

What are the hormonal emergency contraceptives

A

ullipristal acetate

levonorgestrel

34
Q

When can ullipristal acetate (ella one) be taken

A

within 120 hours of unprotected sex

efficacy decreases the longer it is.

35
Q

When can levonorgestrel be taken

A

within 72 hours

36
Q

What other form of contraceptive can be used in an emergency

A

IUCD within 120 hours

Obstetrics and Gynaecology (4 decks)

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