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GYNAECOLOGY > Contraception > Flashcards

Contraception Flashcards

1
Q

Non-hormonal contraception - Barrier methods:

Condoms:

  • How often does it need to be changed?
  • What should it not be used with an oil-based lubricant?
  • Why are female condoms not popular?

Diaphragm and cervical caps:

  • What is the difference between the 2?
  • Up to how many hours before sex does it need to be inserted?
  • What must it be used with?
  • How long after sex does it need to stay in for?

–

What does barrier methods protect against?

A

Each episode of sexual intercourse

It destroys the latex

The penis can go alongside it instead of in
They can be pushed up and fall out
Noisy
–
D - stretches from pubic bone to posterior fornix
C - fit over the cervix

3 hrs

Spermicide (E.g. Nonoxynol-9)

STIs

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2
Q

Non-hormonal contraception - Natural Methods:

What is coitus interruptus?

Fertility awareness:

  • What is it?
  • How many days before ovulation is a woman fertile?
  • How many days after ovulation is a woman fertile?
  • What would happen to the mucus prior to ovulation?

What might the mother do for her baby after birth to delay the return of her menses?

A

Withdrawal of penis before ejaculation

Monitoring mucus and temperature for signs of ovulation

6 days before (life of a sperm)
2 days after (life of ovum)

Breastfeeding - lactational amenorrhoea - look up!

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3
Q

Non-hormonal contraception - Natural Methods:

High-technology natural methods:
- What do they do?

A

Use urine test sticks to measure hormones around ovulation

It learns the variability over time

It gives women the green/red light for unprotected intercourse

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4
Q

Intra-uterine contraceptive devices (IUCD):

2 types:

  • Non-hormonal - what is it more commonly known as?
  • Hormonal - what is it more commonly known as?
A

Copper coil

Mirena - Intra-uterine system (IUS)

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5
Q

Intra-uterine contraceptive devices (IUCD) - Copper Coil:

  • What is it?
  • How does it work?
  • What are women advised to do to make sure it is still there?
  • How long does it take to begin working?
  • How long does it last?
  • What else can it work as aswell?
A

3cm plastic device with copper wire and trailing thread

Inhibits implantation and sperm migration

Immediately
5-10 yrs

Emergency contraception***

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6
Q

Intra-uterine contraceptive devices (IUCD) - Copper Coil:

Insertion:

  • What must be screened for before?
  • What must you make sure is negative?
  • What meds are women advised to take before insertion?

What if the woman falls pregnant?

Side effects:

  • How may it make periods worse?
  • Post-insertion risks?
  • Why are STI’s screened for?
A

STD

A preg test - they should not be preg

Analgesia - may cause cramps 
--
Remove immediately to reduce the risk of miscarriage 
--
Increased pain and bleeding

Cramps and perforation

PID post-STI and insertion if they have a current STI

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7
Q

Intra-uterine contraceptive devices (IUCD) - Mirena:

What is it?

How does it prevent pregnancy?

Advantages:

  • How long does it last?
  • Why does it help periods?
  • What can it also be used as a treatment for? - 2

Side effects:
- What to warn about in the first few wks?

A

A device that releases levonorgestrel

5 yrs

Reduced pain and bleeding, therefore, can be used for dysmenorrhoea and menorrhagia.

Spotting
Heavy bleeding

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8
Q

Combined Oral Contraception (COCP):

Mechanism:

  • What is it made of? - 2
  • How does it work?

Use:

  • What 2 ways can it be taken?
  • It should be started on the 1st day of cycle. What do they need to use as a backup if they want to start it at any time?
A

Oestrogen - ethinylestradiol
Progesterone - norethisterone

  • ve feedback on HPO system, therefore, prevents ovulation
  • -
    (1) 3 wks on, 1 wk off for withdrawal bleed
    (2) Taken back to back - skipping wk off to avoid period (e.g. for holiday)

Condoms for 7 days + checking not pregnant

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9
Q

Combined Oral Contraception (COCP):

Missing pills/severe diarrhoea:
- What should be done if they miss 1 pill (>24 hrs)?

  • What should be done if they miss 2 pills (>48 hrs)? - 2
  • What should be done if they miss 2 pills (>48 hrs) in wk 1?
  • What should be done if they miss 2 pills (>48 hrs) in wk 3 (<7 days left of a pack)?
  • What should be done if they vomit within 2 hrs of taking a pill?
  • Where should they look for most accurate advice non the less?
A

Take it ASAP the next day

Forget there 1st but take the 2nd ASAP
Use condoms for 7 days (+ days of diarrhoea)

Offer emergency contraception if she has unprotected sex

Continue to next pack without a wk off

Take another

The advice in the packs themselves

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10
Q

Combined Oral Contraception (COCP):

Advantages:

  • Why does it make the period better?
  • What does it reduce the risk of?
  • What else dermatologically can it improve?

Side effects which settle after 2-3 months:
- Most common side effect?

Oestrogenic effects:

  • Breast
  • GI - 2
  • Weight
  • Vagina
A

Reduced pain, bleeding, PMS

Reduced risk of benign breast disease
Reduced risk of ovarian and endometrial cancer

Breakthrough bleeding, mainly spotting

Oestrogen:

  • breast tenderness**
  • nausea**
  • bloating
  • cyclical weigh gain
  • vaginal discharge (usually dry without)
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11
Q

Combined Oral Contraception (COCP):

Progetogenic effects:

  • Mood
  • Vagina
  • Weight

Another main side effect?

A

Mood swings
Vaginal dryness
Sustained weight gain

HEADACHE** especially if migraines with aura

That is why you shouldn’t have COCP if you have a history of migraines

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12
Q

Combined Oral Contraception (COCP):

What does it increase the risk of?

Contraindications:

NO PILLS CHUM mneumonic

A

VTE
HTN and CVD - check BP every 6 months

Neoplasia PMH - breast/gynae
Obesity

Pressure - HTN or history of CVD
Insulin deficient - DM
Late in life 
Lactating - currently breastfeeding
Smoking

Clotting - VTE PMH
Hydatidiform mole pMH
Undiagonosed PV bleeding
Migraine with aura

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13
Q

Combined Oral Contraception (COCP):

Drug interactions reducing COC effectiveness:

  • Why are epileptics denied this?
  • A herbal Rx for low mood
  • Antibiotics - R
A

Interaction wtih anticonvulants

St. Johns Wart

Rifampicin

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14
Q

Progesterone only pill (POP):

3 examples of what they could contain? - N, L, D

Mechanism - 2

A

Norethisterone
Levonorgestrel
Desogestrel - +/- 12hrs

Thickens cervical mucus
Inhibition of ovulation
THINK OF SAME EFFECTS PROGESTERONE HAS IN PREGNANCY

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15
Q

Progesterone only pill (POP):

Use:

  • How should it be taken?
  • It should be started on the 1st day of their cycle. What should be done if it is started at any time?
  • What should they do if they miss a pill? - 2
  • Do you have any breaks?

Side effects:

  • Changes to period
  • Breast
  • GI
  • Head
  • Mood
  • Sex
  • Weight
  • Derm

Why is this a good alternative to the COC pill?

A

Taken daily at the same time +/- 3 hrs

2 days of condom use

Take it ASAP 
Condom use for 2 days 
----
Irregular periods and spotting 
Breast pain 
Headache 
Nausea
Low mood 
Reduced libido 
Weight gain 
Acne

It has very few contraindications but does have a slightly higher failure rate

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16
Q

Non-oral hormonal contraceptives:

Name the different types? - 3

A

Depot injection

Implant

Patches and rings

17
Q

Non-oral hormonal contraceptives - Depot injection:

Route?
How often?

How does it work?

Advantages:
- How does it affect periods?

Side effects:

  • Weight
  • Derm
  • What can it increase the risk of, which needs monitoring every 2 yrs?
  • How long does it take to regain fertility after stopping?
A

IM - gluteal or deltoids

Every 12 wks

The contraceptive injection works by preventing the ovaries from releasing an egg each month. It also thickens the fluid around the cervix (opening to the uterus/womb). This helps to prevent the sperm from entering - Basically from PROGESTERONE.

Initially irregular bleeding but later mostly amenorrhoeic
--
Weight gain 
Acne 
Osteoporosis - recovers when stopped 
18 months
18
Q

Non-oral hormonal contraceptives - Implant:

What is it?

Where is it placed?

Advantages:

  • How long does it last?
  • What does it decrease in most cases?
  • Why is it preferred by young women?
A

Sub-dermal implant that releases etonogestrel, a progestogen

3 yrs
Decreased bleeding - can become amenorrhoeic

Long-acting and doesn’t carry the potential osteoporosis risk of Devo-Provera

19
Q

Non-oral hormonal contraceptives - Patches and ring:

What is it?

How is it taken?

Side effects?

A

Combined hormonal contraception - same as COCP BUT NOT ORAL

Combined so both OESTROGEN & PROGESTERONE
3 wks in
1 wk out
Then replace

Breast pain
Breakthrough bleeding
Expensive

20
Q

Sterilisation:

Option for men

Option for women

A

Vasectomy

Tubal ligation

21
Q

Sterilisation - Vasectomy:

Risks?

How long does it take to be effective?

What is done to confirm it has been successful?

Sterilisation - Tubal Ligation:

Risks?

Can both V and TL be reversible?

A

Bleeding
Infection
Sperm granuloma
Chronic testicular pain

4-5 months

2 confirmatory semen analysis 
---
Bowel/bladder perforation 
Bleeding
Infection
Ectopic pregnancy

50% are reversible

22
Q

Emergency Contraception:

Indications:

How many POP pills are missed before this is needed?

How many COC pills are missed in the first before this is needed?

A

1 missed POP

2 missed COC

23
Q

Emergency Contraception:

Options:

What is given within 3 days?
Dose?

What is given within 5 days which is more effective?

A

Levonorgestrel 1.5 mg - SINGLE DOSE

Copper IUCD

24
Q

Postpartum Contraception Advice:

How long postpartum should this be discussed?

How long does natural contraception last if
breastfeeding?

If not breastfeeding, how long after birth is contraception needed?

A

6 wks in the postpartum app with GP

6 months

3 wks

25
Q

Prescribing contraception to girls under 16:

What guidelines are used?

What is used to assess competency?

What should you do if you suspect they are being abused?

What if they are under 12?

A

Fraser guidelines

Gillick competence

Delve into detail of partner

Prescribe but breach confidentiality and discuss with relevant services.

GYNAECOLOGY (35 decks)

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