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Contraception Flashcards

1
Q

What is the most common type of contraception used by women in the UK?

A

Combined hormonal contraception (CHC)

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2
Q

Which contraceptives are reversible?

A

ALL

except sterilisation

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3
Q

Which contraceptive has a delayed reversal?

A

Injectables

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4
Q

Which contraceptives are 100% effective?

A

None

Vasectomy

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5
Q

Which contraceptives are free of adverse side-effects?

A

None

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6
Q

Which contraceptives protect against STIs?

A

None

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7
Q

Which contraceptives have non-contraceptive benefits?

A

CHC

IUS

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8
Q

Which contraceptives are best for low maintenance and no ongoing medical input?

A

Implant

IUT

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9
Q

What is The Pearl Index?

A

No of contraceptive failures per 100 women-years of exposure

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10
Q

What is Life Table Analysis?

A

Provides contraceptive failure rate over specified time-frame and can provide cumulative failure rate for any specific length of exposure

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11
Q

What is method failure?

A

Pregnancy desperate correct use of method by user

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12
Q

What is user failure?

A

Pregnancy because method not used correctly by user

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13
Q

What is LARC?

A

Long-acting reversible contraception

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14
Q

What are the benefits of LARC?

A

Minimises user input + failure rates

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15
Q

When during the cycle is there the highest chance of pregnancy?

A

Day 8-19

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16
Q

What days are likely ovulation days in the cycle?

A

Day 12-18

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17
Q

How long does an egg usually survive?

A

24hrs

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18
Q

How long does sperm usually survive?

A

<4 days

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19
Q

What are examples of combined hormonal contraception?

A

Pill, patch, vaginal ring

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20
Q

What are the two hormones used in combined hormonal contraception?

A

Ethinyl estradiol (EE) and synthetic progesterone

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21
Q

How does combined hormonal contraception work?

A

Stops ovulation, affects cervical mucus and endometrium

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22
Q

What is the standard regime for combined hormonal contraception?

A

21 days with hormone free week

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23
Q

What are tailored regimes for combined hormonal contraception?

A

Tricycling

Continuous use

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24
Q

How is the pill taken when combined hormonal contraception?

A

Taken daily

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25
Q

How is the patch used when combined hormonal contraception?

A

EVRA, changed weekly

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26
Q

How is the vaginal ring used when combined hormonal contraception?

A

Nuvaring, changed every 3 weeks

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27
Q

When can the vaginal ring (combined hormonal contraception) be taken out?

A

3hrs in 24

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28
Q

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

A

Regulate/reduce bleeding - painful/heavy periods
Stop ovulation - help premenstrual syndrome
Reduction functional ovarian cysts
50% reduction ovarian/endometrial cancer
Improve acne/hirsutism
Reduction benign breast disease, RA, colon cancer, osteoporosis

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29
Q

What are side effects of combined hormonal contraception?

A 
Breast tenderness
Nausea
Headaches
Irregular bleeding first 3mo
Mood
Weight gain
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30
Q

What are serious risks associated with CHC use?

A

Venous thrombosis: DVT, PE
Arterial thrombosis: MI, ischaemic stroke
Cervical cancer
Breast cancer

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31
Q

Who is not allowed CHC?

A 
Active gall bladder disease
Previous liver tumour
BMI >34
Previous VTE
1st degree relative VTE <45
Thrombophilis
Smokers >35
Hx arterial thrombosis
Focal migraines
Age >50
Hypertension >140/90
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32
Q

How is the progestogen-only pill (POP) taken?

A

Same time every day without pill-free interval

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33
Q

When is POP not a good contraceptive choice?

A

GI upset

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34
Q

What is the window period for the desogestrel pill?

A

12hr window period

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35
Q

What is the window period for the traditional POP pills?

A

3hr window period

36
Q

What are the side effects of the POP?

A 
Appetite increase
Hair loss/gain
Mood change
Bloating/fluid retention
Headache
Acne
37
Q

What are there not risk of with the POP?

A

Venous/arterial thrombosis

38
Q

When should you avoid POP?

A

Current breast cancer

Previous liver tumour

39
Q

How often for the injectable progestogen contraceptive?

A

150mg 1ml deep IM injection every 13wks

40
Q

What does injectable progestogen do?

A

Prevents ovulation
Alters cervical mucus making it hostile to sperm
Makes endometrium unsuitable for implantation

41
Q

What are the advantages of injectable progestogen?

A

Need to remember every 13wks
70% amenorrhoeic after 3 doses
Estrogen-free so few contraindications

42
Q

What are the disadvantages of injectable progestogen?

A

Delay in return to fertility ~9mo
Reversible reduction in bone density
Problematic bleeding first 2 doses
Weight gain

43
Q

What is the brand name for the subdermal progestogen implant?

44
Q

How does the progestogen implant work?

A

Inhibition ovulation + effect on cervical mucus

45
Q

How long does the progestogen implant last?

46
Q

What are the side effects of the progestogen implant?

A

Prolonged/frequent bleeding

Mood change

47
Q

What is an example of a LARC?

A

IUC = intrauterine contraception

48
Q

How long can the IUC last?

49
Q

What age/parity for IUD?

A

Any age, any parity

50
Q

What are the risks with IUD?

A

Small infection risk
Perforation
Expulsion
Ectopic

51
Q

What is the mode of action of the copper IUD?

A

Toxic to sperm, may prevent implantation of fertilised egg

52
Q

What hormones are in the copper IUD?

A

Hormone free

53
Q

What are the side effects of the copper IUD?

A

Periods heavier/crampier

54
Q

How long can copper IUD last?

A

5-10yrs depending on type

55
Q

What is the mode of action of levonorgestrel IUD?

A

Affect cervical mucus and endometrium, stop fertilisation of egg, may prevent implantation
Most women still ovulate

56
Q

What hormones are in levonorgestrel IUD?

A

Progestogen

57
Q

What are the levels of progestogen like in Levonorgestrel IUD compared to pill/implant/injection?

A

Low circulating progestogen levels

58
Q

What are brand examples f Levonorgestrel IUD?

A

Mirena

Kyleena

59
Q

How long does Mirena Levonorgestrel IUD last?

60
Q

What is Mirena also licensed for?

A

Treat heavy menstrual bleeding

61
Q

What is menstrual bleeding like in Levonorgestrel IUD?

A

Reduced after up to 4mo, initial irregular

62
Q

What is the most effective emergency contraception option?

A

Copper IUD

63
Q

What are the 3 options for emergency contraception?

A

Copper IUD
Levonelle
Ellaone

64
Q

Within how long of unprotected sexual intercourse should a copper IUD be fitted for emergency contraception?

A

Within 120hrs (5 days)

65
Q

Within how long of unprotected sexual intercourse should Levonelle be taken as emergency contraception?

A

Within 72hrs (3 days)

66
Q

Within how long of unprotected sexual intercourse should Ellaone be taken as emergency contraception?

A

Within 120hrs (5 days)

67
Q

What are the contraindications of Ellaone?

A

Breast feeding
Enzyme inducing drugs
Acid reducing drugs

68
Q

When should contraception be started?

A

First 5 days of cycle = immediate cover

Other times in cycle = 7 days

69
Q

How long after delivery of baby can you get pregnant again?

70
Q

How long after miscarriage/abortion can you get pregnant again?

71
Q

How long is breast feeding a contraceptive for and under what conditions?

A

6mo
Feeding every 4hrs
Amenorrhoeic

72
Q

What can does female sterilisation reduce the risk of?

73
Q

Does female sterilisation have effect on periods/hormones?

74
Q

What happens in vasectomy?

A

Vas deferens divided and ends cauterised

75
Q

How long does a vasectomy take to be effective?

76
Q

What are the risks of vasectomy?

A

Long term testicular pain

If vas reconnected, anti-sperm antibodies

77
Q

What is the risk for testicular/prostate cancer with vasectomy?

A

No increased risk of either

78
Q

What act gives medical staff right to refuse participation in abortion?

A

1967 Abortion Act

79
Q

How many Drs to sign to support women request for abortion in 1967 Abortion Act?

80
Q

What are the conditions of the 1967 Abortion Act?

A

Grave risk if continued to women, physical or mental
Under 24wks
Substantial risk if child were born it would suffer physical/mental abnormalities

81
Q

What should be checked at abortion clinic?

A 
Scans
Medical Hx - risks
Circumstances
Methods of abortion
Contraception for after
FBC/Rhesus group
Vaginal swab for chlamydia/gonorrhoea
STI bloods
82
Q

What is the surgical procedure for abortion and at what time in pregnancy?

A

Cervical priming, GA/LA cervical block, transcervical suction catheter
5-12wks

83
Q

What are the two medications taken for medical abortion?

A

Mifepristone

Misoprostol

84
Q

What is the procedure for a medical abortion?

A

Mifepristone oral antiprogestogen tablet

36-48hrs later Misoprostol initiates uterine contraction which opens cervix and expels pregnancy

85
Q

How long does it take to expel medical abortion <12wks?

86
Q

If choosing home abortion which drug would be given?

A

Misoprostol

87
Q

What are non-hormonal barrier methods of contraception?

A

Diaphragm
Cervical cap
Male/female condoms
Spermicidal foams/sponges/film

Reproductive (20 decks)

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