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Repro > Contraception > Flashcards

Contraception Flashcards

1
Q

Forms of contraception [4]

A

Combined - pill (COCP), patch, ring
Progesterone - POP, DEPO, implant, IUS
Non-Hormonal contraception
Sterilisation

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2
Q

Whats in the Combined OCP? [2]
Preparations of third generation pills [2]
Dose [2]

A
  • Ethinyl Oestradial (EE)
  • Synthetic Progesterone (Progestogen)

3rd gen pills contain Gestogene (GSD) and Desogestrel (DSG)

Dose: 20-35microgram but 50 if on liver enzyme inducers

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3
Q

COCP Preparations [3]

A

o Monophasic: 21 pills with same amount of hormone then 7 day break
o Phasic: 21 pills contain different amounts of hormone and must be taken in correct order then 7 day break
o Everyday: 21 pills containing hormones and 7 placebo pills so NO BREAK

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4
Q

COCP MOA [3]

A
  • Prevents FSH/LH surge by -ve feedback on the GnRH producing hypothalamus
  • Also prevents implantation by providing an inadeqaute endometrium
  • Alters cervical mucous to Inhibit sperm penetration
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5
Q

COCP Directions

A
  • Taken for 21 days then a pill free week.
  • If start on day 1 of cycle (1st day of period), no barrier contraception required. If take on any other day require 7 days of barrier contraception
  • Can be taken for up to 3 months without a pill free week
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6
Q

COCP directions:

  • Missed pills [2]
  • Rest of pack after missed pills [2]
  • Vomiting or diarrhea [2]
  • Sex during pill free week
A

o Missed pills
 1 missed pill: take missed pill straight away and continue rest of pack normally. No emergency contraception required
 2 or more missed pills: take most recent pill straight away and leave any missed before then. Use condoms for next 7 days and if have had sex in last 7 days seek advice for emergency contraception
o Rest of pack after missed pills
 If 7 or more pills left: finish pack and have usual 7-day break
 If less than 7 pills left: finish pack and start new pack without 7-day break
o Vomiting or diarrhoea
 Sick within 2 hours of taking pill: take another when feel better
 Severe diarrhoea for more than 24h: take pill as if missed a pill and follow instructions until diarrhoea is no longer severe
o Sex only safe on pill free week if next pack is started on time

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7
Q

What are the non contraceptive benefits of the cOCP? [4]

Clue: name 4 chronic conditions that it can be used to reduce symptoms

A
  • Regular periods and ~reduces painful, heavy periods
  • Reduces functional ovarian cysts
  • 1/2s ovarian and endometrial cancer
  • Reduces acne, RA, Colon cancer and Osteoporosis
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8
Q

COCP
Disadvantages [3]

Interactions with other drugs [5]

A

Disadvantages:

  • Requires remembering to take at same time each day (user dependent)
  • Breakthrough bleeding and spotting
  • Not protective against STI

Interactions: enzyme inducers

  • HIV medications
  • St John’s wort
  • Epilepsy medications
  • Rifampicin
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9
Q

What are the major risks of cOCP? [4]

Risk of VTE in COCP

What are side effects of COCP? [4]

A

Very small increased risk of VTE and Ischaemic stroke
Small risk of breast cancer
Doubles Cervical cancer risk if used for 10yrs

The pill triples risk of VTE from 5 to 15 per 100,000.

Side effects: headaches, nausea, mood swings, breast tenderness

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10
Q

UKMEC categorises risk of COCP. Describe UKMEC 3 [6] and UKMEC 4 [7] contraindications

A

UKMEC 3: disadvantages generally outweigh the advantages
 >35 years old and smoking <15 cigarettes/day
 BMI > 35 kg/m^2*
 FMH thromboembolic disease in first degree relatives < 45 years
 controlled hypertension, current gallbladder disease
 immobility e.g. wheel chair use
 carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)

UKMEC 4: represents an unacceptable health risk
 >35yo smoking >15 cigarettes per day
 Migraine with aura
 History of thromboembolic disease, stroke or IHD
 Breastfeeding <6w post-partum
 Uncontrolled HTN
 Current breast cancer
 Major surgery with prolonged immobilisation

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11
Q

Combined contraceptive patch
Directions for use [2]
If patch change was delayed on week 1 or 2
If patch change was delayed at end of week 3
If patch change was delayed at end of free week

A

Directions:

  • patch worn every day for first 3w
  • changed every week; the 4th week is patch free
  1. Patch change delayed on week 1 or 2:
    o <48h delay: change immediately and no further action
    o >48h delay: change immediately and use condoms for 7d (if unprotected sex in extended patch free interval or last 5d then emergency contraception
  2. Patch change delay at end of week 3: remove patch ASAP and apply new patch at start of next cycle, even if having withdrawal bleed (no additional contraception rqd)
  3. Delay at end of patch free week: use condoms for 7d
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12
Q

Progesterone only pill
MOA
Preparations [3]
Contraindications [4]

A

MOA: thickens cervical mucus

Preparations: norethisterone, levonorgestrel, desogesterel

Contraindications:

  • pregnant
  • breast cancer
  • severe cirrhosis
  • liver tumours
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13
Q 
POP pros and cons
Pros [2]
Cons [2]
Risks [2]
SE [4]
A

Pros:

  • suitable for breastfeeding, migraine with aura, BMI >35, any age
  • improved period timings and menorrhagia

Cons:

  • User depedent
  • Irregular or more frequent periods in some women

Risks: ovarian cysts, breast ca

SE: acne, breast tenderness, mood changes, change in libido

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14
Q

POP directions [2]
Starting POP
Missed pills [4]

A

o Taken for 28 days with no breaks.
o Must be taken within 3-hour window (although desogesterel pills (CERELLE and CERAZETTE) have a 12h window)
o Can be started any time if not pregnant as long as use condoms for 1st 7 days

1 or more missed pills or new pack started more than 3 hours late:

  • take missed pill straight away (if missed over 1 just take 1)
  • take next pill at usual time
  • Need to continue to use condoms for next 2 days.
  • If have had sex in time missed pill, need to seek advice for emergency contraception
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15
Q

Depo-Provera injection
Dosing
SE [5]

A 
Given every 12w
SE:
- Irregular bleeding
- Weight gain
- Osteoporosis
- Fertility can take up to 1y to return in women >40
- Small loss in bone mineral density
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16
Q 
Implantable contraceptive
Define [3]
Starting
SE [3]
CI [4]
A

Etonogestrel (ENG) - a progestin. Coated in a rate controlling membrane of EVA. Lasts for 3y.

Starting: condom for 7d

SE:

  • Heavy or irregular bleeding
  • Headache, nausea
  • Breast pain

Contraindications:

  • IHD
  • Suspicious vaginal bleeding
  • Previous or current breast ca
  • Cirrhosis
17
Q 
Intrauterine system
Name
How long after insertion will it be effective?
Duration [2]
What happens to my period? [3]
Risks [3]
A

Levongestrel
Effective 7d after insertion
Duration: Jaydess lasts 3y, Mirena lasts 5y

Initially frequent bleeding and spotting > light menses > some amenorrhea

Risks: perforation, PID in 1st 20d, expulsion in first 3m

18
Q

Emergency contraception

A
  1. Levongestrel 1.5mg
  2. Ulipristal 30mg
  3. Intrauterine device
19
Q

Levongestrel
MOA [2]
Indication [2]
Directions [2]

A

MOA: acts to stop ovulation, inhibits implantation
Ind: can be taken within/up to 72h unprotected sexual intercourse; can be used more than once in same menstrual cycle if indicated

Should be taken ASAP as effectiveness decreases with time (84% effective if used within 72h UPSI)
If vomiting occurs within 2h must re-take dose

20
Q

Levongestrel
Contraindication [5]
Caution
Interaction

A 
Contraindication:
- ulipristal used in same cycle
- hypersensitivity
- acute poryphria
- severe liver disease
- severe malabsorption
Caution in ectopic pregnancy- unproven
Interactions: enzyme inducers
21
Q

Ulipristal
MOA
Indication [2]
Caution

A

MOA: Progesterone receptor modulator which inhibits ovulation
Indication:
- can be taken within/up to 120h unprotected sexual intercourse
- can be used more than once in same menstrual cycle if indicated
Caution: severe asthma

22
Q

Ulipristal
Contraindications
SE
Interactions [4]

A 
CI:
- Levongesterel used in same cycle, pregnancy, suspected pregnancy, breastfeeding
SE: same as levon
Interactions:
- Reduces effectiveness of hormonal contraception pill, patch or ring
- Enzyme inducers
- PPIs
- H2RAs
23
Q

Ulipristal instructions [2]

A

delay breastfeeding for one week after taking; pregnancy rate around 0.9-1.8% if taken within 120h; if vomiting occurs within 2h must re-take dose

24
Q

IUD
MOA
Indication [2]
Contraindication [5]

A

MOA: Inhibits fertilisation or implantation

Ind: up to 5d after unprotected sex or if after 5d then up to 5d after likely ovulation date

Pros:

  • 99% effective as soon as placed in
  • Not affected by BMI

CI:

  • Puerperal sepsis, septic abortion
  • PID, active chlamydia, gonorrhea
  • Copper allergy, Wilsons disease
  • Distorted uterine cavity
  • Cervical or endometrial ca
25
Q

Sterilisation methods

A

Laparascopic Tubal Ligation with Filshie clips

Vasectomy

26
Q

How are vasectomies done?

Complication

A

Permanent division of vas deferens under local anaesthetic

Complication:
Can get pain due to a sperm granuloma (Degenerating spermatozoa surrounded by macrophages)

27
Q

Conditions of legal termination of pregnancy [5]

A

• Pregnancy must not have exceeded 24th week AND:
o Continuing would involve risk greater than risk of termination to physical or mental health of pregnant women or any existing children of her family OR
o Termination necessary to prevent grave permanent injury to physical or mental health of pregnant woman OR
o Continuing would involve risk to life of pregnant woman, greater than that of termination OR
o Substantial risk that if child born would have severe physical or mental abnormalities as to be seriously handicapped

28
Q

Methods of TOP [4]

A
  • <9w: MIFEPRISTONE (anti-progesterone) followed 48h later with prostaglandins (MISOPROSTOL) to stimulate uterine contractions
  • <13w: surgical dilatation and suction of uterine contents (Cx: uterine perforation, cervical trauma)
  • > 15w: surgical dilatation and suction of uterine contents OR late medical abortion (Cx: uterine rupture)
  • Feticide required after 21w 6d to ensure no live birth
29
Q

Post-TOP management [2]

A
  • Anti-D prophylaxis required for unsensitised women within 72h of abortion
  • urine pregnancy test often remains +ve for up to 4w after abortion; if +ve beyond 4w, indicates incomplete abortion or persistent trophoblast
30
Q

Contraception and menopause:
Non-hormonal [2]
COCP [2]

A

Non-hormonal:

  • stop after 2y of amenorrhoea in women <50y/o
  • stop after 1 year of amenorrhea if >50y/o

COCP:

  • continued to 50y/o, then switch to non-hormonal
  • or progesterone only method
31
Q

Contraception and menopause:
Depo-provera [2]
POP, implant, IUS [3]

A

Depo-Provera:

  • can be continued to 50y/o, then switch to non-hormonal method and stop after 2y amenorrhoea
  • or switch to a progesterone only method

POP, implant, IUS:

  • can be continued until >50y/o
  • if amenorrhoea check FSH and stop after 1y if FSH >30u/L
  • or stop at 55y/o (if not amenorrhoeic by then consider ix of abnormal bleeding pattern)
32
Q

Post-partum contraception. How long is the recommended inter-pregnancy interval and why [2]
POP
COCP [1]
IUD, IUD
Describe what is Lactational amenorrhea method [2]

A

Inter-pregnancy interval of less than 12m between childbirth and conceiving again is assoc. w/ increased risk of preterm birth, LBW, and SGA babies

• POP:
- can be started any time post-partum (after day 21 condoms needed for 1st 2d)
• COCP:
- CI if breastfeeding <6w post-partum
- can be started from day 21 (need additional contraception for 7d after day 21)
• IUS or IUD:
- can be inserted within 48h of childbirth or after 4w
• Lactational amenorrhoea method (LAM):
- 98% effective providing woman is fully breastfeeding (no supplemental feeds)
- amenorrhoea and <6m post-partum

33
Q

What are recommended methods of contraception in patients taking lamotrigine? [3]
Contraception in young people: can we give to 13 yo?

A

Lamotrigine:

  • POP
  • Depo-provera
  • IUD, IUS
  • <13y/o: cannot consent; triggers child protection
  • > 13y/o: can be provided with advice and contraception if deemed competent
34
Q

Fraser guidelines [5]

A

o Understands advice
o Cannot be persuaded to inform parents
o Likely to begin or continue having sex with or without contraceptive mx
o Physical and/or mental health likely to suffer if not prescribed
o In best interests to be prescribed contraception without parental consent

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