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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
Serious Risks associated with CHC use? - when should you avoid it?
venous thrombosis- DVT IF BMI >34, reduced mobility, Increased risk arterial thrombosis- MI / ischaemic stroke - smokers >35 , focal migraines, hypertension
26
CHC - when would you not give it to someone (what conditions may they have)
if active gall bladder disease or previous liver tumour
27
CHC can increase the risk of? | what is not a contraindication for the risk of breast cancer?
cervical cancer- but data predates HPV vaccine - breast cancer - non BRCA family history
28
the risk of VTE increases from?
2 per 100,000
29
the use of the pill trebles what?
Risk of venous thromboembolism
30
How is the Progestogen-only pill (POP) ‘ mini-pill’ taken?
same time every day without a pill-free interval
31
When are the pills not a good choice?
GI upset
32
what has a 12 hour window period? | - what does this pill also affect?
Desogestrel pill - mucus, most are bleed free
33
the traditional LNG NET pills have what hour window? - 2/3 of the pill relies on? how is the period affected by these pills?
3 hours - a cervical mucus effect - 1/3 bleed free, 1/3 irregular, 1/3 regular
34
Bonus of the mini-pill?
Oestrogen free- so very few contraindications | Personal Hx Breast cancer / liver tumour
35
Progestogenic side effects? (6)
``` Appetite increase ACNE Hair loss/gain Mood change Bloating or fluid retention Headache ```
36
The contraceptive dose progestogens has no increased risk of?
venous or arterial thrombosis
37
When should you avoid the mini pill?
Breast cancer / liver tumour
38
What solution is inside the progestogen injection?
depomedroxyprogesterone acetate DepoproveraTM
39
How is the injection given?
150 mg 1ml deep intramuscular injection into the upper outer quadrant of the buttock every 13 weeks
40
What does the injection do? (3)
- prevents ovulation - It alters cervical mucus making it hostile to sperm - Makes endometrium unsuitable for implantation
41
3 positives of the injection?
- Only need to remember every 12-14 weeks - 70% women amenorrhoeic after 3 doses - Estrogen-free so few contraindications
42
Negatives of the injection? (4)
- 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
The injection has what 3 effects?
effect on weight gain , delayed return of fertility and bone density
44
What does the 'rod' contain? - what is the rod covered in?
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
4 features of the Progestogen Implant?
- 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
2 negative effects of the Progestogen Implant?
- 30% have prolonged / frequent bleeding | - 30% have prolonged / frequent bleeding
47
Intrauterine contraception 'The Coil’ has how many years of use?
5-10 years
48
what contraception method has an infection risk? | - WHAT SHOULD you offer?
IUD STO testing to those with new partner or under 25
49
How long does the IUD take to fit?
10 mins
50
with the IUD, there is a slight risk for? | - when is it not suitable? (2)
ectopic pregnancy - untreated pelvic infection or distorted endometrial cavity eg submucous fibroids/ bicornuate / previous ablation
51
How does the copper IUD work?
Toxic to sperm -stop sperm reaching egg- may sometimes prevent implantation of fertilised egg
52
The copper IUD is? | What can it negatively do?
Hormone free | May make periods heavier/crampier
53
Levonorgestrel IUS - what does it affect? | what can it stop/prevent?
cervical mucus and endometrium most women still ovulate Stop fertilisation of egg- may prevent implantation fertilised egg
54
How does Levonorgestrel IUS work? - what are the progestogen levels like? - what does it reduce?
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
What are the 3 | types of Levonorgestrel IUS - how long do they work?
Mirena TM- 5 years contraception KyleenaTM – 5 years and JaydessTM- 3 years (more likely to bleed but have less hormone)
56
What can be prescribed to treat heavy menstrual bleeding ?
Mirena
57
Emergency contraception - 3 types
Copper IUD most effective option - Levonorgestrel pill-’Levonelle’ - Ulipristal pill ‘ellaone
58
When should you take Levonorgestrel pill-’Levonelle’?
within 72 hrs | If 100 women use will be 2-3 pregnancies
59
When should you take ‘ellaone’ | - what are the contraindications?
within 120 hrs - breast feeding/enzyme inducing drugs/ acid reducing drugs If 100 women use will be 1-2 pregnancies
60
Copper IUD as Emergency contraception - when would you fit it?
within 120 hours or by day 19 of a 28 day cycle
61
When to start contraception. - when will you be covered? - if you start at other times in a cycle, you need to..?
first 5 days of cycle - need condoms /abstain for next 7 days and do pregnancy test after 4 weeks
62
When can you get pregnant after delivery, miscarriage or abortion
5 days
63
Breast feeding acts as a?
contraceptive only for first 6 months+ if feeding every 4 hours +amenorrhoeic
64
A breastfeeding woman can use ?
any type of contraception.
65
What drug interactions can reduce the effectiveness of combined pill, patch, ring and POP and implant? - how do they do this?
Enzyme inducing drugs eg carbamazepine, topiramate, rifampicin, St Johns Wort Increase the metabolism of progestogen and oestrogen
66
What is not affected by drug interactions? (2)
Injectable progestogens and Copper or Levonorgestrel IUD
67
Laparoscopic Sterilisation- what is this?
Filshie clips applied across tube to block tube lumen metal/silicone OK for MRI
68
Laparoscopic Sterilisation is? what does it have risks of? - what does it reduce the risk of?
Irreversible- risk regret - GA and laparoscopy ovarian cancer risk, has no effect on periods or hormones
69
when may a salpingectomy be performed?
planned caesarean section if baby seems | well and discussed in advance
70
Essure is
hysteroscopic sterilisation
71
What is divided in a vasectomy?
Vas deferens divided and ends cauterised small incision midline scrotum
72
How long does it take for a vasectomy to be effective?
4-5 months - sperm samples are sent in
73
A vasectomy is?
irreversible - -sperm antibodies even if vas reconnected
74
A vasectomy has no known effects on?
testosterone or sexual function | - risk testicular or prostate cancer
75
how many women will have an abortion? - most common age group? - when are most carried out?
1 in 3 1 in 6 in grampain 20-24 - 90% are carried out in under 12 weeks
76
Staff have a right to refuse participation in an abortion as long as?
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
Clinic consultation for abortion? - what to include
– 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
Termination of PregnancySurgical - 5-12 weeks
Cervical priming- misoprostol 3 hrs preop helps dilation and reduces risk perforation/ haemorrhage - GA or LA cervical block - Transcervical - 6-10mm suction catheter
79
Complications of abortion surgery?
infection - risks from GA - perforation, cervical injury
80
Termination of PregnancyMedical (MTOP)- 5-24 weeks - what is given?
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
Complications of Mifepristone oral antiprogestogen tablet | ?
Infection - rare but may need blood transfusion - can fail
82
Home Abortion - what is legal?
to supply misoprostol for woman to take away from clinic for home self administration
83
What is home abortion good for?
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
Women taking the abortion pill home need to take?
mifepristone in clinic/hospital
85
Longterm effects of Abortion? (3)
- 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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