Contraception Flashcards
Which contraceptive method isn’t suitable for those breastfeeding/6 weeks post partum?
COCP
Which contraceptives are acceptable for use >4 weeks post partum?
Mirena IUS and Copper IUD
At what point should the COCP be discontinued before a major surgery?
What can be prescribed as an alternative?
4 weeks prior.
The POP can be used instead
At what point after starting the POP does it provide complete protection/contraception?
If commenced up to and including day 5 of the cycle it provides complete protection
If taken after this then barrier contraception should be used for 2 days.
What do you do if you miss a POP pill?
If <3 hours then take the pill when you remember and this should provide adequate protection
If >3 hours then take the pill when you remember and use barrier contraception for 48 hours
Nb: Cerazette (desogestrel) - a 12 hour allowance for taking pill is allowed
Do Abx have an effect on the POP?
No.
If a patient has breast cancer which form of contraception is acceptable for this patient?
Only the IUD (copper containing coil)
How often is the Depo provera (Injectable contraceptive) given?
Every 12 weeks - but can be given up to every 14 weeks after the last dose without extra precautions needing to be taken
How would you instruct a patient to use contraceptive patches?
Apply a patch once a week for 3 weeks and then have a weeks break (a withdrawal bleed will occur)
What does the contraceptive patch contain?
It is a combined contraceptive pill containing both synthetic oestrogen and progesterone
If a child <13 years old comes to the doctors for contraception, what should you do?
Contact the appropriate safeguarding lead. Any child <13 years old cannot be prescribed contraception even if they are Gillick competent as they are not deemed legally able to consent for sexual intercourse
What are the Fraser guidelines for contraception?
- The individual cannot be persuaded to talk to their parents
- The individual understands the doctors advice
- It is likely that if a contraceptive is not prescribed they are going to have sexual intercourse anyway
- If it is not prescribed their mental, physical (or both) health are likely to suffer.
- It is in the persons best interest to receive contraception without parental consent
What is the long acting contraceptive choice for younger patients?
The implant (Nexplanon)
What is a common side effect of the IUS that patients should be advised about?
Irregular bleeding is common for the first 6 months and following this most women become oligomennorhoeic or amenorrhoeic.
This benefits those who suffer with menorrhagia or do not wish to have periods.
For how long do urine pregnancy tests remain positive post termination/abortion?
4 weeks
What is the upper limit for a termination of pregnancy?
24 weeks gestation.
What methods are used to terminate a pregnancy at the following time scales:
- 9 weeks
- 9-13 weeks
- > 15 weeks
9 weeks: Mifepristone (An anti-progestogen) followed by prostaglandins 48 hours later (stimulates uterine contractions)
9-13 weeks: surgical dilatation and suction of the contents of the uterus
> 15 weeks: surgical dilatation and evacuation of uterine contents or late medical abortion (induces a mini labour)
What is the most effective form of emergency contraception?
The IUD
How is Levonorgestrel prescribing affected by BMI?
The dose of Levonorgestrel should be doubled in any patient with a BMI >26
How does taking the COCP affect the probability of a patient developing the following cancers:
- Breast cancer
- Cervical cancer
- Ovarian cancer
- Endometrial cancer
The COCP increases the likelihood of someone developing breast and cervical cancer.
It is protective against endometrial and ovarian cancer.
What forms of contraception are unaffected by CYP inducers?
- IUS and IUD
* Depo provera injection
On average how long does it take for fertility to return following cessation of Depo provera treatment?
12 months
How would you define postmenopausal?
When a female has not had a period for 12 months
When can a female stop contraception after menopause?
If the female is <50 years old then she can stop contraception 2 years following the cessation of periods
If the female is >50 years old then she can stop contraception 1 year following the cessation of periods
What is the primary action of the contraceptive implant?
Inhibits ovulation
How long does the implant provide effective contraception?
3 years
Which contraceptives are acceptable to use in a patient >50 years old?
Progesterone containing contraceptives only.
Implant, POP
IUS
Depo is contraindicated due to increased risk of osteoporosis
At what point can the IUD be used for emergency contraception?
Up to 5 days after intercourse
Or if the patient presents later than this it can be inserted for up to 5 days after the earliest estimated date of ovulation
What is the pearl index?
This is the method in which contraceptive efficacy is described to patients. The pearl index is how many women would get pregnant out of 100 taking that form of contraceptive.
Which contraceptive methods can be used with HRT?
The POP
What is the MOA of the COCP?
It inhibits ovulation
What is the MOA of the POP?
Thickens cervical mucus
What is the MOA of the IUD?
Decreases sperm motility and survival
What is the MOA of the IUS?
Prevents endometrial thickening and thickens the cervical mucus.
Name the three different types of emergency contraception?
Levonorgestrel
Ulipristal
IUD - Copper containing intrauterine device
What is the mechanism of action of Levonorgestrel?
An emergency contraception that acts to inhibit ovulation and implantation
What is the mechanism of action of Ulipristal?
It inhibits ovulation
When should Levonorgestrel be taken by a patient?
Within 72 hours of unprotected sex
When should Ulipristal be taken by a patient?
Within 5 days of unprotected sex
Can you breastfeed after taking emergency contraception?
You can breast feed following taking Levonorgestrel
You cannot breast feed for one week after taking Ulipristal
When can the POP be taken postpartum?
21 days post partum you can start to take the POP
additional contraception should be used for the first two days
When can you take the COCP postpartum?
At day 21 it can be started however additional contraception should be used for the first week
Absolutely contraindicated if breast feeding and <6 weeks postpartum
UKMEC2 6weeks - 6 months postpartum.
When can the IUS and IUD be inserted after exams?
48 hours after childbirth.
How long can the Lactational Amenorrhoea Method (LAM) be used for?
for up to 6 months postpartum.
