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Reproductive System > Contraception > Flashcards

Contraception Flashcards

1
Q

How popular are different methods of contraception in those aged 16-49?

A 
From most to least commonly used:
Sterilised male or female
Combined hormonal contraception (CHC)
Intrauterine methods (coil)
Progestogen-only pill (POP)
Progestogen-only implants or injectable
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2
Q

What percentage of women are sexually active and not planning pregnancy but are not on any contraception?

A

12%

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3
Q

How is contraceptive effectiveness measured?

A

Using the Pearl index

Defined as the number of contraceptive failures per 100 women-years of exposure

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4
Q

What does the term “method failure” mean?

A

The occurrence of pregnancy despite the correct use of the method by the user

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5
Q

What does the term “user failure” mean?

A

Refers to the occurrence of pregnancy because the method is not used correctly

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6
Q

What is LARC?

A

Long-acting reversible contraception (LARC) minimises user input and so minimises user failure rates.

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7
Q

When does ovulation occur?

A

Days 12-18 of a woman’s cycle if they are not on hormonal contraception

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8
Q

When is fertilisation most likely?

A

From sex on days 8-19 of a woman’s cycle

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9
Q

What are the component parts of combined hormonal contraception?

A
  • Pill- taken anytime daily, not good if frequent GI upset
  • Patch- EVRA, changed weekly, <5% have skin reaction
  • Ring- Nuvaring, changed every 3 weeks, can be taken out for 3/24hrs
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10
Q

What hormones are given in combined hormonal contraception?

A

Ethinyl estradiol

Synthetic progesterone

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11
Q

What are the combined effects of ethinyl estradiol and synthetic progesterone?

A

These two hormones work together to stop ovulation but also have an affect on cervical mucus and the endometrium

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12
Q

What do standard regimes of combined hormonal contraception involve?

A

21 days of treatment with a hormone-free week but tailored regimes can be used

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13
Q

Why might a tailored regime for combined hormonal contraception be required?

A

To avoid withdrawal bleeds, and forgetting to restart after break

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14
Q

What are the non-contraceptive benefits of combined hormonal contraception?

A
  • Regulate/reduce bleeding- help heavy or painful natural periods
  • Stop ovulation- may help premenstrual syndrome
  • Reduction in functional ovarian cysts
  • 50% reduction in ovarian and endometrial cancer
  • Improve acne / hirsutism
  • Reduction in benign breast disease, rheumatoid arthritis, colon cancer and osteoporosis
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15
Q

What are the possible side effects of combined hormonal contraception?

A
  • Breast tenderness
  • Nausea
  • Headache
  • Irregular bleeding for first three months
  • Mood (link not 100%)
  • No link to weight gain
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16
Q

What serious risks are associated withcombined hormonal contraception?

A
  • Increased risk of venous thromboembolism
  • Increased risk of arterial thrombosis/MI/stroke
  • Increased risk of cervical cancer
  • Increased risk of breast cancer
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17
Q

What are the characteristics of the progesterone only pill?

A

Needs to be taken at the same time every day
No pill free window
Not a good choice if the patient has frequent GI upset

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18
Q

What are the characteristics of the desogestrel pill?

A

12 hour window period
Almost all cycle anovulant
Affects mucus
Bleed free

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19
Q

What are the characteristics of the LNG NET pills?

A 
Three hour window period
1/3 anovulant
1/3 bleed free
1/3 irregular bleeding
1/3 regular period
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20
Q

What are the contraindications of progesterone only methods?

A

Personal history of breast cancer or liver tumour

21
Q

What are the most common progestogenic side effects?

A
  • Appetite increase
  • Hair loss/gain
  • Mood change
  • Bloating or fluid retention
  • Headache
  • Acne
22
Q

What are the characteristics of injectable progesterone?

A

Aqueous solution of depopprovera
Requires IM injection into buttock every 12 weeks
Prevents ovulation
Alters cervical mucus
Makes endometrium unsuitable for implantation
Causes 70% of women to be amenorrhoeic after three doses
Oestrogen-free so few side effects

23
Q

What are the downsides of injectable progesterone?

A 
Delay in return to fertility of ~9 months
Can cause a reversible decrease in bone density
Bleeding common (especially after first two doses)
Weight gain (average 2-3kg).
24
Q

What are the characteristics of “the rod”?

A

Subdermal progestogen implant
Inhibits ovulation
Affects mucus
Can last up to three years (can be removed at any point)
No user input required
No causal effect on weight gain
30% have prolonged or frequent bleeding
May cause more serious mood change effects than other progestogen only methods

25
What are the benefits of the coil?
- Little user input after fitting- neither woman or partner should be aware of device - Can be fitted for any age and any parity - Effects and side effects immediately reversible when removed
26
What are the downsides of the coil?
- Very small infection risk in first 3 weeks (Offer STI testing to all with new partner or age under 25) - Risk of perforation during fitting - 5:100 risk expulsion- check threads after each period - If conceives may be ectopic (1 in 10 of pregnancies with coil)- but method is so effective that ectopic risk lower than for condoms
27
What are the characteristics of a copper IUD?
Hormone free Can last 5-10 years Can make periods heavier and cramps more severe
28
What are the characterisrics of the levonorgestrel IUS?
Affects cervical mucus and endometrium Most still ovulate Irregular bleeding initially but resolved after 4 months Causes lower circulating levels of progesterone than other methods
29
What are the possible methods of emergency contraception?
- Copper IUD (most effective method), fit within 120 hours of unprotected sexual intercourse (UPSI) at any time of the cycle or by day 19 of a 28 day cycle - Levonelle- levonorgestrel pill taken within 72 hours, slightly less effective than IUD - Ellaone- ulipristal pill, take within 120 hours, less effective than IUD but more so than levonelle, however there are a few contraindications (breast feeding, enzyme reducing/acid reducing drugs)
30
When in the cycle is cover provided from when starting contraception?
If contraception is started within the first 5 days of a cycle then cover is provided immediately. If it is started at other times however, need to use condoms or abstain for the next 7 days and then do a pregnancy test after 4 weeks
31
When is it possible to get pregnant again following delivery, an abortion or miscarriage?
Delivery- 21 days | Abortion or miscarriage- 5 days
32
When is breast feeding contraceptive?
First 6 months if feeding occurs every 4 hours and the woman is amenorrhoeic
33
What contraceptive methods can breast-feeding women use?
Any
34
What are the pros and cons of barrier methods?
``` Pros: -Only contraceptive to protect against STIs Cons: -Can break -High user input ```
35
What are the effects of female sterilisation?
- Risks of GA and laparoscopy - Irreversible- risk regret - Failure rate 1 in 200 lifetime risk – could be ectopic - No effect on periods / hormones - Reduces ovarian cancer risk
36
How long does it take for a vasectomy to be effective?
4-5 months
37
How can the effectiveness of a vasectomy be checked?
Testing two sperm samples Failure to get two clear samples is ~2:100 Lifetime failure rate of vasectomy after two clear samples have been obtained is 1:2000
38
What are the cons of a vasectomy?
Irreversible Risk of chronic testicular pain (<1:100) NO effect on testosterone or sexual function NO increased risk of cancer
39
In what population are abortions most common?
20-24 Link to deprivation 90% of abortions in Scotland done under 12 weeks
40
What steps are taken in a termination of pregnancy clinic consultation?
- Scan for gestation and viability - Medical history- risk VTE/bleeding/ from GA/ contraceptive eligibility - Circumstances – reasons for considering abortion- see alone, language line, check no coercion or gender-based violence - Discuss methods of abortion - What to expect and when to seek medical advice - Contraception for afterwards - FBC/Rhesus Group - Vaginal swab for Chlamydia and gonorrhoea - STI bloods offered
41
When can a surgical termination of pregnancy be offered?
5-12 weeks
42
What are the risks of a surgical termination of pregnancy?
Slight risk of perforation and cervical injury, | Risks of infection and adverse effects of general anaesthetic
43
When can a medical termination of pregnancy be offered?
5-24 weeks
44
How is a medical termination of pregnancy administered?
A mifepristone oral antiprogestogen tablet needs to be taken, followed 36-48 hours later with misoprostol (initiates uterine contraction and expels pregnancy)
45
How long does it take to pass a pregnancy under 12 weeks in a medical termination of pregnancy?
4-6 hours
46
What are the possible complications of a medical termination of pregnancy?
Failure (1:100 <8 weeks, 8:100 >12 weeks) Infection Blood loss
47
When can a home abortion be offered?
When the pregnancy is less than ten weeks
48
What are the contraindications of combined hormonal contraception?
``` BMI >35 Previous VTE 1st degree relative had VTE <45 Smokers >35 Previous arterial thrombosis Focal migraine Age >50 BP >140/90 BRCA +ve Active gall bladder Previous liver tumour ```

Reproductive System (30 decks)

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