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Obstetrics + Gynaecology > Contraception > Flashcards

Contraception Flashcards

1
Q

What are the methods of combined hormonal contraception?

A

COCP
Combined transdermal patch
Combined vaginal ring

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2
Q

How do the combined contraceptions work?

A 
Inhibit ovulation
(progesterone also inhibits endometrial proliferation and increases thickness of cervical mucus)
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3
Q

What are the guidelines on starting the COCP + condom use?

A

If started within first 5 days of cycle –> effective immediately
After day 5 –> condoms for 7 days

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4
Q

What are the guidelines on starting the COCP postpartum?

A

If started by day 21 post partum –> effective immediately

After day 21 –> condoms for 7 days

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5
Q

What should you do if taking the COCP and miss 1 pill?

A

Take the last pill, even if 2 taken in 1 day

No additional protection required

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6
Q

What should you do if taking the COCP and miss 2 pills?

A

Take last pill even if 2 taken in 1 day (omit any earlier missed pills)
Use condoms until pill has been taken 7 days in a row
If pill missed in week 1 –> emergency contraception

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7
Q

Which cancers are reduced by taking the COCP?

A

Ovarian
Endometrial
Colorectal

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8
Q

What are the negative effects of the COCP?

A 
Increased risk of:
- cervical + breast cancer
- VTE
- stroke + IHD
Interacts with anti-epileptics
Hormonal side effects:
- headaches
- nausea
- mood changes
- breast tenderness
- low libido
Irregular bleeding
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9
Q

What are the absolute contraindications for the COCP?

A

> 35 years old and smoking > 15 per day
Migraine with aura
History of thromboembolic disease or thrombogenic mutation
History of stroke or IHD
Uncontrolled HTN
Current breast cancer
Major surgery with prolonged immobilisation

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10
Q

What are the relative contraindications for the COCP?

A 
> 35 and smoking < 15 per day
BMI > 35
FHx of thromboembolic disease in 1st degree relative < 45 years
Controlled HTN
Immobility
BRCA 1/2
Ongoing gallbladder or liver disease
Complicated diabetes
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11
Q

What are the progesterone only methods of contraception?

A

Depo-provera injection
POP (desogestrel)
Nexplanon implant

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12
Q

How is Depo Provera administered and how does it work?

A

IM injection every 13 weeks

Inhibits ovulation + thickens mucus

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13
Q

Do condoms need to be used after Depo injection given?

A

Contraception effective immediately if given in first 5 days of cycle
After day 5 –> use condoms for 7 days

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14
Q

What are the negative effects of Depo Provera?

A 
Injection cannot be reversed once given
Delayed return to fertility (up to 12 months)
Irregular bleeding
Potential for weight gain
Risk of osteoporosis
Hormonal side effects
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15
Q

How does the POP work?

A

Prevents ovulation + thickens mucus

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16
Q

How is the POP taken?

A

Take at same time every day without a pill free break

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17
Q

Do condoms need to be used when commencing the POP?

A

If started in first 5 days of cycle –> effective immediately
After day 5 –> use condoms for 2 days

18
Q

What should you do if taking the POP and miss a pill?

A

If < 12 hours later than usual time –> take pill as normal
If > 12 hours –> take missed pill asap and continue with rest of pack
–> use condoms until pill has been taken for 24 hours

19
Q

What are the negative effects of POP?

A

Irregular bleeding
Diarrhoea + vomiting (assume missed pill)
Liver enzyme inducers may reduce effectiveness
Cannot be used if history of breast cancer or active liver disease

20
Q

How long does the Nexplanon implant last?

A

3 years

21
Q

What are the negative effects of the implant?

A

Irregular bleeding
Headache
Nausea
Breast pain
Skin changes
Efficacy reduced by enzyme inducers e.g. anti epileptic, rifampicin
Contraindicated in current breast cancer + active liver disease

22
Q

What is the IUS and how does it work?

A

Levonorgestrel-releasing coil (system)

Prevents endometrial proliferation + thickens mucus

23
Q

When does the IUS become effective?

A

After 7 days of insertion (immediate if within first 5 days of cycle)

24
Q

What are the negative effects of the IUS?

A 
Spotting after insertion
Uterine perforation
Increased risk of ectopic (but lower than if not on contraception)
Risk of PID in first 20 days
Risk of expulsion in first 3 months
25
Q

How long does the IUS last?

A

Mirena - 5 years

Jaydess - 3 years

26
Q

How does the copper IUD work and how quickly does it work?

A

Decreases sperm motility and survival

Effective immediately on insertion

27
Q

When can the IUD be used for emergency contraception?

A

If inserted within 5 days of UPSI

Or up to 5 days after expected day of ovulation in regular cycle

28
Q

What are the disadvantages of the IUD?

A

Heavier, longer, more painful periods within first 3-6 months
Spotting/bleeding between periods
Insertion related risks as with IUS

29
Q

What are the options for emergency contraception?

A

IUD (most effective)
Levonorgestrel
Ulipristal (EllaOne)

30
Q

What is the dose of Levonorgestrel?

A

Single dose 1.5mg

Should be doubled for BMI >26, over 70kg, taking enzyme inducing drugs

31
Q

When does Levonorgestrel need to be taken?

A

Within 72 hours of UPSI (efficacy reduces with time)

32
Q

What are the side effects of levonorgestrel?

A 
Disturbance of menstrual cycle
Nausea and vomiting --> repeat dose if within 3h of taking pill
Dizziness
Diarrhoea
Breast tenderness
33
Q

When can EllaOne be taken?

A

Within 120 hours of UPSI (no reduction in efficacy over time)

34
Q

When should EllaOne be avoided?

A

If already taken in this menstrual cycle
Severe asthma
If taking regular antacids

35
Q

What are the side effects of EllaOne?

A

Reduced effectiveness of hormonal contraception
Nausea + vomiting (repeat if within 3 hours)
Headache
Dizziness
Breast tenderness

36
Q

How do the oral emergency contraceptions work?

A

Inhibit/prevent ovulation

do not work in second half of cycle - ovulation has occurred

37
Q

What is Lactational Amenorrhoea Method (LAM) of contraception?

A

Breastfeeding as protection against unwanted pregnancy

- very effective if done properly

38
Q

What are the criteria for LAM to work effectively?

A
  • only effective up to 6 months postnatally
  • must be exclusively breastfeeding at least every 4 hours during day, every 6 hours at night
  • must be fully amenorrhoeic
39
Q

Which hormonal contraceptions can be used immediately after childbirth?

A

All except COCP (or other combined methods)

40
Q

When can the COCP be started after childbirth?

A

3 weeks postpartum

6 weeks if breastfeeding or other VTE risk factors

41
Q

Which method of progesterone only contraceptions shouldn’t be used if breastfeeding?

A

Depo provera

Obstetrics + Gynaecology (22 decks)

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