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Year 3: Reproduction > Contraception > Flashcards

Contraception Flashcards

1
Q

What is the most commonly used contraceptive fertility control method?

A

Combined hormonal contraception

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2
Q

what contraception has low maintenance?

A

Implant or IUT

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3
Q

only male contraception?

A

condoms/vasectomy

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4
Q

what would be the most effective contraception

A

vasectomy followed by implant

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5
Q

what method of contraception has a delay in reversibility?

A

injections

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6
Q

what is the pearl index

A

the number of contraceptive failures per 100 women-years of exposure

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7
Q

Life Table Analysis provides ?

A

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

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8
Q

what does Long-Acting Reversible Contraception minimise

A

user input and so minimises user failure rates

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9
Q

Long-Acting Reversible Contraception can fail in what 2 ways?

A

Method failure

User failure

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10
Q

When can sex cause pregnancy ?

A

26-32 day cycle and not on hormonal contraception

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11
Q

sex causing pregnancy - ovulation time?

A

Likely ovulate day 12-18 ( 2 weeks before period)

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12
Q

How long does an egg survive

A

24 hours

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13
Q

average sperm survival time?

A

less than 4 days

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14
Q

highest chance of pregnancy is from sex on days?

A

8-19

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15
Q

what is in the combined hormonal contraception?

A

ethinyl estradiol (EE) and synthetic progesterone (progestogen

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16
Q

How does the the combined hormonal contraception work?

A

Stop ovulation, also affect cervical mucus and endometrium

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17
Q

standard procedure for Combined hormonal contraception?

A

21 days with a hormone free week

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18
Q

Different types of combined hormonal contraception

A

pill, patch and vaginal ring

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19
Q

What is tricycling?

A

3 packs of pills and one week off - only 5 bleeds per year instead of 13
- no need for uncomfortable inconvenient withdrawal bleed, avoids forgetting to restart after break

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20
Q

How is the combined pill taken?

A

daily anytime in 24 hrs- ? Phone app

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21
Q

How is the combined patch taken?

A

(EVRA TM) changed weekly- < 5% have skin reaction

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22
Q

How is the combined ring used?

A

changed every 3 weeks

can take out for 3 hrs in 24 so may prefer to take out for sex

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23
Q

Combined methods - Non-contraceptive benefits (6)

A

Regulate/reduce bleeding- help heavy or painful natural periods

Stop ovulation- may help premenstrual syndrome

Reduction in functional ovarian cysts

50% reduction in ovarian and endometrial cancer

Improve acne / hirsutism

Reduction in benign breast disease, rheumatoid arthritis, colon cancer and osteoporosis

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24
Q

Troublesome Side effects of combined contraceptive?

A
  • Breast tenderness
  • Nausea
  • Headache
  • Irregular bleeding first 3 months

Mood ? Causal or other life events

Weight gain- not causal

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25
Q

Serious Risks associated with CHC use? -

when should you avoid it?

A

venous thrombosis- DVT
IF BMI >34, reduced mobility,

Increased risk arterial thrombosis- MI / ischaemic stroke - smokers >35 , focal migraines, hypertension

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26
Q

CHC - when would you not give it to someone (what conditions may they have)

A

if active gall bladder disease or previous liver tumour

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27
Q

CHC can increase the risk of?

what is not a contraindication for the risk of breast cancer?

A

cervical cancer- but data predates HPV vaccine
- breast cancer

  • non BRCA family history
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28
Q

the risk of VTE increases from?

A

2 per 100,000

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29
Q

the use of the pill trebles what?

A

Risk of venous thromboembolism

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30
Q

How is the Progestogen-only pill (POP) ‘ mini-pill’ taken?

A

same time every day without a pill-free interval

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31
Q

When are the pills not a good choice?

A

GI upset

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32
Q

what has a 12 hour window period?

- what does this pill also affect?

A

Desogestrel pill

  • mucus, most are bleed free
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33
Q

the traditional LNG NET
pills have what hour window? - 2/3 of the pill relies on?

how is the period affected by these pills?

A

3 hours

  • a cervical mucus effect
  • 1/3 bleed free, 1/3 irregular, 1/3 regular
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34
Q

Bonus of the mini-pill?

A

Oestrogen free- so very few contraindications

Personal Hx Breast cancer / liver tumour

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35
Q

Progestogenic side effects? (6)

A 
Appetite increase
ACNE
Hair loss/gain
Mood change
Bloating or fluid retention
Headache
36
Q

The contraceptive dose progestogens has no increased risk of?

A

venous or arterial thrombosis

37
Q

When should you avoid the mini pill?

A

Breast cancer / liver tumour

38
Q

What solution is inside the progestogen injection?

A

depomedroxyprogesterone acetate DepoproveraTM

39
Q

How is the injection given?

A

150 mg 1ml deep intramuscular injection into the upper outer quadrant of the buttock every 13 weeks

40
Q

What does the injection do? (3)

A
  • prevents ovulation
  • It alters cervical mucus making it hostile to sperm
  • Makes endometrium unsuitable for implantation
41
Q

3 positives of the injection?

A
  • Only need to remember every 12-14 weeks
  • 70% women amenorrhoeic after 3 doses
  • Estrogen-free so few contraindications
42
Q

Negatives of the injection? (4)

A
  • Delay in return to fertility – average 9 months
  • Reversible reduction in bone density- discuss her other risks for osteoporosis
  • Problematic bleeding especially first 2 doses
  • Weight gain 2/3 women gain 2-3 kg
43
Q

The injection has what 3 effects?

A

effect on weight gain , delayed return of fertility and bone density

44
Q

What does the ‘rod’ contain?

  • what is the rod covered in?
A

68mg of the progestogen etonogestrel dispersed in a matrix of ethinylvinylacetate (EVA).

  • The rod is then covered in a rate controlling membrane made from EVA.
45
Q

4 features of the Progestogen Implant?

A
  • Inhibition of ovulation + effect on cervical mucus
  • Can last 3 years- or be removed at any time
  • No user input needed
  • No causal effect on weight
46
Q

2 negative effects of the Progestogen Implant?

A
  • 30% have prolonged / frequent bleeding

- 30% have prolonged / frequent bleeding

47
Q

Intrauterine contraception ‘The Coil’ has how many years of use?

A

5-10 years

48
Q

what contraception method has an infection risk?

- WHAT SHOULD you offer?

A

IUD

STO testing to those with new partner or under 25

49
Q

How long does the IUD take to fit?

A

10 mins

50
Q

with the IUD, there is a slight risk for?

- when is it not suitable? (2)

A

ectopic pregnancy

  • untreated pelvic infection or distorted endometrial cavity eg submucous fibroids/ bicornuate / previous ablation
51
Q

How does the copper IUD work?

A

Toxic to sperm -stop sperm reaching egg- may sometimes prevent implantation of fertilised egg

52
Q

The copper IUD is?

What can it negatively do?

A

Hormone free

May make periods heavier/crampier

53
Q

Levonorgestrel IUS - what does it affect?

what can it stop/prevent?

A

cervical mucus and endometrium most women still ovulate

Stop fertilisation of egg- may prevent implantation fertilised egg

54
Q

How does Levonorgestrel IUS work?
- what are the progestogen levels like?

  • what does it reduce?
A

Slow release progestogen on stem
Low circulating progestogen levels compared with pill/implant/injection

Reduce menstrual bleeding after up to 4 months initial irregular bleeding

55
Q

What are the 3

types of Levonorgestrel IUS - how long do they work?

A

Mirena TM- 5 years contraception

KyleenaTM – 5 years and JaydessTM- 3 years (more likely to bleed but have less hormone)

56
Q

What can be prescribed to treat heavy menstrual bleeding ?

A

Mirena

57
Q

Emergency contraception - 3 types

A

Copper IUD most effective option

  • Levonorgestrel pill-’Levonelle’
  • Ulipristal pill ‘ellaone
58
Q

When should you take Levonorgestrel pill-’Levonelle’?

A

within 72 hrs

If 100 women use will be 2-3 pregnancies

59
Q

When should you take ‘ellaone’

- what are the contraindications?

A

within 120 hrs
- breast feeding/enzyme inducing drugs/ acid reducing drugs
If 100 women use will be 1-2 pregnancies

60
Q

Copper IUD as Emergency contraception - when would you fit it?

A

within 120 hours or by day 19 of a 28 day cycle

61
Q

When to start contraception. - when will you be covered?

  • if you start at other times in a cycle, you need to..?
A

first 5 days of cycle

  • need condoms /abstain for next 7 days and do pregnancy test after 4 weeks
62
Q

When can you get pregnant after delivery, miscarriage or abortion

A

5 days

63
Q

Breast feeding acts as a?

A

contraceptive only for first 6 months+ if feeding every 4 hours +amenorrhoeic

64
Q

A breastfeeding woman can use ?

A

any type of contraception.

65
Q

What drug interactions can reduce the
effectiveness of combined pill, patch, ring and POP and implant?

  • how do they do this?
A

Enzyme inducing drugs eg carbamazepine,
topiramate, rifampicin, St Johns Wort

Increase the
metabolism of progestogen and oestrogen

66
Q

What is not affected by drug interactions? (2)

A

Injectable progestogens and Copper or Levonorgestrel IUD

67
Q

Laparoscopic Sterilisation- what is this?

A

Filshie clips applied across tube to block tube lumen metal/silicone OK for MRI

68
Q

Laparoscopic Sterilisation is?
what does it have risks of?

  • what does it reduce the risk of?
A

Irreversible- risk regret
- GA and laparoscopy

ovarian cancer risk, has no effect on periods or hormones

69
Q

when may a salpingectomy be performed?

A

planned caesarean section if baby seems

well and discussed in advance

70
Q

Essure is

A

hysteroscopic sterilisation

71
Q

What is divided in a vasectomy?

A

Vas deferens divided and ends cauterised small incision midline scrotum

72
Q

How long does it take for a vasectomy to be effective?

A

4-5 months - sperm samples are sent in

73
Q

A vasectomy is?

A

irreversible - -sperm antibodies even if vas reconnected

74
Q

A vasectomy has no known effects on?

A

testosterone or sexual function

- risk testicular or prostate cancer

75
Q

how many women will have an abortion?

  • most common age group?
  • when are most carried out?
A

1 in 3
1 in 6 in grampain

20-24
- 90% are carried out in under 12 weeks

76
Q

Staff have a right to refuse participation in an abortion as long as?

A

it does not affect any duty to participate in treatment which is necessary to save the life or to prevent grave permanent injury to the physical or mental health of a pregnant woman

77
Q

Clinic consultation for abortion? - what to include

A

– reasons for considering abortion- see alone
language line , check no coercion or gender based violence

Discuss methods of abortion

  • contraception afterwards
  • STI swabs / tests
78
Q

Termination of PregnancySurgical - 5-12 weeks

A

Cervical priming- misoprostol 3 hrs preop helps dilation and reduces risk perforation/ haemorrhage

  • GA or LA cervical block
  • Transcervical - 6-10mm suction catheter
79
Q

Complications of abortion surgery?

A

infection

- risks from GA - perforation, cervical injury
80
Q

Termination of PregnancyMedical (MTOP)- 5-24 weeks - what is given?

A

Mifepristone oral antiprogestogen tablet
36-48 hours later Misoprostol initiates uterine contraction which opens cervix and expels pregnancy
- Average 4-6 hours to pass pregnancy under 12 weeks
- Mifepristone helps Misoprostol work better

81
Q

Complications of Mifepristone oral antiprogestogen tablet

?

A

Infection

  • rare but may need blood transfusion
  • can fail
82
Q

Home Abortion - what is legal?

A

to supply misoprostol for woman to take away from clinic for home self administration

83
Q

What is home abortion good for?

A

women who are under 10 weeks gestation and prefer a home procedure and and ‘healthy’. Analgesia supplied. Phone advice 24/7. Follow up low sensitivity pregnancy test at 2 weeks.

84
Q

Women taking the abortion pill home need to take?

A

mifepristone in clinic/hospital

85
Q

Longterm effects of Abortion? (3)

A
  • No effect on future fertility or pregnancy or delivery
  • No effect on cancer risks
    Emotional effects depend on reasons for abortion/ pre-existing mental health issues

Year 3: Reproduction (40 decks)

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