Contraception Flashcards

1
Q

What are the circumstances around breastfeeding being an effective contraception

A

if a woman is <6 months post-partum, amenorrhoeic and regularly breastfeeding there is a 98% effectiveness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

when is emergency contraception required in the period after pregnancy

A

21 days+ you consider it, <21 days it is not required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the advice around the COCP with breastfeeding

A

avoid within first 6 months as affects breast milk volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

when can you start progesterone only contraception post partum

A

6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

when can the IUD be inserted post partum

A

4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how should you deal with contraception in the perimenopausal stage

A

<50 stay on contraception for at least 2 years after LMP

>50 same but 1 year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how does the COCP act as contraception

A

Exerts a negative feedback loop on gonadotrophin causing ovulation to cease

Thin the endometrium and thicken cervical mucus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the regular regime for the COCP

A

take for 3/52 then skip for 1/52

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what may occur if the COCP is taken back to back with no gaps

A

not much but some light spotting may occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the success rate for the COCP with a proper usage

A

99.8%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are some uses outside of contraception for the COCP

A

Menstrual cycle control in primary dysmenorrhoea

Menorrhagia

Endometriosis protection

Recurrent simple ovarian cysts

Acne

PMS

Reduces risk of PID

Reduced risk of bowel/endometrial/ovarian CA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what factors affect the absorption of the COCP

A

diarrhoea
vomiting
oral Abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the standard advice for missing 1-2 doses of the COCP, or 1 of the reduced dose pill

A

1-2 doses is fine, and 1 of the reduced one is fine, but any more and it should be a concern. if this happens you should use condoms for 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the major complications for the COCP and how rare are they

A

Venous thrombosis

Myocardial infarction

Cerebrovascular accidents

Focal migraine

Hypertension

Jaundice

Liver,breast,cervical carcinoma

2-5 per million excess deaths per year in <35

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are some side effects of the COCP

A

Nausea

Breakthrough bleeding

Suppressed lactation

Contraindicated <6 weeks post partum

Headache

Breast tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are some absoloute contraindications of the COCP

A

Clotting disorders (e.g factor V leidans)

> 35 years old smoking >15 day

Migraine with aura

Personal history of thrombotic disease

History of stroke or ischaemic disease

Breast feeding

Uncontrolled hypertension (Syst >160,Diast >95)

Current breast cancer

Major surgery with prolonged immobility

Any hepatic disorders

Any nephropathy

Any neuropathy

Uncontrolled diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the combined transdermal patch

A

delivers oestrogen and progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

how is the combined transdermal patch delivered

A

same as COCP, put on for 3 weeks and take off for a week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

how does the combined vaginal ring work

A

latest ring the releases synthetic oestrogen and progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

how is the combined vaginal ring administered

A

same as COCP/patch, put in for 3 weeks and taken out for a week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

should the combined vaginal ring be removed for intercourse

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the maximum the combined vaginal ring can be removed for

A

3 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

when should the daily progesterone pill be taken

A

same time of day +/- 3 hours

24
Q

how does the progesterone-only pill work

A

makes cervical mucus hostile to sperm

25
Q

what is the effectiveness of the progesterone-only pill

A

99% (0.8% worse)

26
Q

what are the side effects of the progesterone-only pill

A

Premenstrual symptoms

Spotting

Weight gain

Mastalgia - tender breasts

Functional ovarian cysts `

27
Q

what patient population gains the most from the progesterone-only pill

A

Lactating mothers

Older women

Those with a higher VTE score – there is no thromboembolic side effects

28
Q

what should you do if progesterone-only pill has been taken outside the 3-hour window, or not at all

A

should take one immediately and condoms should be used for 2 days

29
Q

is the progesterone-only pill affected by antibiotics

A

no

30
Q

what are examples of LARCS (long acting reversible contraceptives)

A

depot injections of progesterone (depot-provera, noristerat, sayana press)

Nexplanon implant

31
Q

what are some counselling points for the depot provera

A

<1 per 100 woman years failure rate

Cause irregular bleeding for a few months then amenorrhoea

Bone density decreases for 2-3 years then stabilises therefore contraindicted In women with osteoperosis and teenagers

IM injection every 3 months

32
Q

what are side effects of the nexplanon implant

A

irregular bleeding for up to a year

33
Q

what are the 2 types of the morning after pill

A

levonelle

ulipristal (ellaONE)

34
Q

what is the levonelle pills mechanism of action

A

selevtive progesterone receptor modulator

35
Q

when is the levonelle pill effective

A

up to 72 hours post intercourse (58%) but most effective within 24 hours (95%)

36
Q

what are some side effects of the levonelle pill

A

vomiting

menstrual disturbance next cycle

37
Q

what is the mechanism of action of the ellaONE pill

A

selective progesterone receptor modulator

38
Q

when is the ellaONE pill effective

A

up to 120 hours after intercourse, but condoms should be used to prevent transmission until their next period

39
Q

what is the most effective measure of emergency contraception

A

IUS

40
Q

what is the risk of pregnancy with condom use only

A

2-15 per 100 woman years depending on proper use

41
Q

what are all the options for barrier contraception

A

male condom
female condom
diaphragm and caps
spermicides

42
Q

what are examples of the intrauterine copper devices

A

copper coil

IUS

43
Q

when should the IUS be replaced

A

3-5 years

44
Q

what is the failure rate for the IUS

A

<0.5 per 100 woman years failure

45
Q

what are complications for the IUS

A

Pain/cervical shock

Expulsion

Perforation of the uterine wall

Heavier, more painful menstruation

Infection (20% risk)

Ectopic pregnancy

46
Q

what is the most common female sterilisation technique and whats an alternative

A

filshie clips - clips applied laproscopically under a GA

alt: transvercial sterilisation (hysteroscopic placements of microinserts into the proximal fallopian tube which expand causing tube occlusion)

47
Q

what are the failure rates of female sterilisation

A

0.5%

48
Q

whats an important counselling point for female sterilisation

A

sterilisation is on the NHS but reversal is not

49
Q

what is more effective, female sterilisation or male

A

male

50
Q

what is the male sterilisation procedure

A

ligation and removal of a small section of the vas deferens

51
Q

how is male sterilisation confirmed

A

2 counts of azoospermia from semen analysis, may take up to 6 months

52
Q

what are the complications of male sterilisation

A

Failure

Post operative haemoatomas

Infection

Chronic pain

53
Q

is male sterilisation reversible

A

yes but fertility is often affected due to antisperm antibody foundation

54
Q

what is the effectiveness of male sterilisation

A

> 99%

55
Q

what are some examples of natural contraceptions

A

lactation
rhythm methods (mentrual period)
pull out method