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B2 Gynaecology > Contraception > Flashcards

Contraception Flashcards

1
Q

What is the drug and dose contained in Microgynon 20?

A

Ethinylestradiol 20 micrograms and levonorgestrel 100 mcg

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2
Q

What is the drug and dose contained in Mercilon?

A

Ethinylestradiol 20 micrograms and desogestrel 150 mcg

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3
Q

What is the drug and dose contained in Yaz?

A

Ethinylestradiol 20 micrograms and drospirenone 3 mg

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4
Q

What is the drug and dose contained in Microgynon 30 / Levlen ED / Ava 30 ?

A

Ethinylestradiol 30 micrograms and levonorgestrel 150 mcg

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5
Q

What is the drug and dose contained in Yazmin?

A

Ethinylestradiol 30 micrograms and drospirenone 3 mg

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6
Q

What is the drug and dose contained in Norimin / Brevinor?

A

Ethinylestradiol 35 micrograms and norethisterone 500 micrograms

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7
Q

What is the drug and dose contained in Brevinor-1?

A

Ethinylestradiol 35 micrograms and norethisterone 1 mg

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8
Q

What is the drug and dose contained in Estelle-35 / Ginet / Diane-35 ED?

A

Ethinylestradiol 35 micrograms and cyproterone acetate 2 mg

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9
Q

What is the drug and dose contained in Microgynon 50?

A

Ethinylestradiol 50 micrograms and levonorgestrel 125 mcg

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10
Q

What is the drug and dose contained in Cerazette?

A

Desogestrel 75 micrograms

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11
Q

What is the drug and dose contained in Microlut?

A

Levonorgestrel 30 micrograms

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12
Q

What is the drug and dose contained in Noriday?

A

Norethisterone 350 micrograms

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13
Q

What is the definition of UKMEC Category 1?

A

A condition for which there is no restriction for the use of the contraceptive method

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14
Q

What is the definition of UKMEC Category 2?

A

A condition for which the advantages of using the method generally outweighs the theoretical or proven risks

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15
Q

What is the definition of UKMEC Category 3?

A

A condition for which the theoretical or proven risks usually outweigh the advantages of using the method.
The provision of a method requires expert clinical judgement and/or refer all to a specialist contraceptive provider, since use of the method is not usually recommended unless other more appropriate methods are not available or acceptable

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16
Q

What is the definition of UKMEC Category 4?

A

A condition which represents an unacceptable health risk if the method is used

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17
Q

Why is injectable contraception (Depo) no longer considered a LARC, in the RANZCOG guideline?

A

It is less effective than IUC and implants, and is user-dependent

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18
Q

What are 8 advantages of using LARCs?

A
  1. Most effective reversible methods available
  2. High rates of user satisfaction; high continuation rates
  3. Set and forget methods that do not require daily adherence
  4. Require fewer visits to health services than other methods
  5. More cost effective for women and governments, including reduction in unplanned pregnancy
  6. Easily reversible
  7. Suitable for women of all ages, including nullips
  8. Do not affect fertility after removal
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19
Q

Which of the following carries the HIGHEST relative risk of ectopic pregnancy if the woman accidentally becomes pregnant?

A

Progesterone only pill

1:10

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20
Q

What is the estimated incidence of VTE per 10,000 women years of:
Young women not using combined hormonal contraception?

A

2-4 per 10,000

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21
Q

What is the estimated incidence of VTE per 10,000 women years of:
Pregnant or postpartum women

A

20-30 per 10,000

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22
Q

What is the estimated incidence of VTE per 10,000 women years of:
Women using low or standard dose estrogen COCP?

A

COCP with LNG or NET: 5-7 per 10,000.

COCP with 3rd or 4th gen progestins: 9-12 per 10,000

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23
Q

What is the estimated incidence of VTE per 10,000 women years of:
Women using high dose COCP (EE 50 microgram + LNG)?

A

9-12 per 10,000

Same as 3rd and 4th gen COCPs

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24
Q

What precautions must be taken if using POP for contraception and taking enzyme-inducing drugs at the same time?

A

Provided enzyme inducing drug use of short duratiom (<2 months):
- Use alternative contraception: barrier, depo-provera while using enzyme inducer and for 28 days after.

25
Q

An asymptomatic woman with an IUD in siture has a cervical smear with actinomyces seen.

What would you recommend?

A

Do nothing.

If asymptomatic correlates poorly with risk of PID.

26
Q

What systemic side-effects are associated with the Mirena?

A
  • Acne
  • Headache
  • Breast tenderness
27
Q 
Regarding vasectomy:
What is the mechanism of action?
What is the failure rate?
What are the complications?
How do you confirm procedure was successful?
A

Mechanism of action: interruption of vas deferens presents sperm secretion into semen.
Failure rate: 0.15%
Complications: haematoma, bleeding, infection, recanalisation/failure.

Perform post-vasectomy semen analysis 6 weeks after to exclude early failure:

  • Do not need further sample if azoospermia on first.
  • Need additional contraception until azoospermia.
  • Long-term failure rate following clearance reduced to 0.05% (1 in 2000).
28
Q

What long term benefit does tubal ligation confer?

A

Reduces risk of ovarian cancer.

29
Q

Regarding the copper IUD as a form of emergency contraception:

What is the pregnancy rate after this is given if used within 5 days of UPSI?

When can copper IUD be used as form of emergency contraception?

A

Pregnancy rate <1%.

Indications:

  • Up to 5 days post UPSI OR
  • Up to 5 days after ovulation if date can be estimated.
30
Q

Regarding LNG / Prostinor as a form of emergency contraception:

What is the pregnancy rate after this is given if used within 5 days of UPSI?

When can Prostinor be used as form of emergency contraception?

How does it prevent pregnancy?

A

Rate of pregnancy 2.2%.

Indications:
- Within 3 days (72 Hours) of UPSI

Mode of action: delays ovulation and causes luteal dysfunction for 5-7 days, allowing time for viable sperm in genital tract to die.
The closer it is given to ovulation, the less effective it is.
A higher dose is required for obese women.

31
Q

Regarding ulipristal acetate as a form of emergency contraception:

What is the pregnancy rate after this is given if used within 5 days of UPSI?

When can ulipristal acetate be used as form of emergency contraception?

How does it prevent pregnancy?

A

Pregnancy rate 1.4%. (Note: not available in NZ).

Indications: up to 5 days (120 hours) after UPSI.

Mode of action: selective progesterone receptor modulator.
Therefore efficacy is REDUCED by concurrent or subsequent use of progestogen containing drugs within 5 days.

32
Q

What are the requirements for providing emergency contraception to women?

A
  • Prompt and easy access
  • Advice on dosage and admin in a setting that preserves patient confidentiality, privacy and dignity.
  • Ongoing contraceptive advice as required.
  • STI screening
  • Medical review to exclude pregnancy if period is delayed.
  • Advice on what to do if method not successful and pregnancy occurs.
33
Q

What is the recommend interpregnancy interval following a normal vaginal delivery?

A

24 months

34
Q

A short interpregnancy interval (<12 months) is associated with what complications?

A
  • Preterm birth and PPROM
  • IUGR
  • Low birthweight
35
Q

Before prescribing postnatal contraception:

What risk factors are a contraindication to prescribing COC for before 6 weeks postpartum?

A
  • Immobility
  • Transfusion at delivery
  • BMI >=30
  • PPH
  • CS
  • PET
  • Smoker
36
Q

If a woman is breastfeeding but has no other risk factors for VTE, how soon can you prescribe COC for her?

A

After 6 weeks postpartum.

37
Q

When can a copper IUD be inserted postpartum?

What risks are associated with early postpartum insertion?

A

Within 48 hours OR after day 28 postpartum.
Mirena can be inserted after day 28.

Uterine perforation and IUD expulsion is increased.

38
Q

Outline Gillick competence for prescribing contraception to girls under the age of consent without parents’ consent or knowledge

A
  • Understands practitioner’s advice.
  • Cannot be persuaded to inform parents
  • Very likely to have sexual intercourse with or without contraception.
  • Physical or mental health likely to suffer unless contraception received
  • Best interests requires practitioner to give her contraception without parental consent.
39
Q

What are the absolute contraindication to IUD / S use?

A

Endometrial cancer
GTD with rising b-HCG

Current PID
Unexplained vaginal bleeding
Pregnancy
Insertion after puerperal sepsis or septic abortion
Distortion of uterine cavity from fibroids or congenital abnormality

40
Q

What is the only absolute contraindication to the implant / Jadelle?

A

Current breast cancer

41
Q

What is the risk of uterine perforation with Mirena insertion?
How is this affected by breastfeeding?

A

1.4/1000

RR 6 with Breastfeeding

42
Q

What is the risk of pelvic infection after Mirena insertion
A) in the first 20 days
B) After the first 20 days

A

A) In the first 20 days: 1/300. Mostly related to STIs (hence why screening is important)
B) After the first 20 days: same as general population

43
Q

WHat counselling is important for IUD insertion

A
  • Careful hx and exam ? Contraindications and STIs
  • Discuss effectiveness, failure rates, possible short and long term complications
  • Exclude pregnancy
  • Follow up visit at 3-6/52 OR advise women to present if abnormal bleeding, pregnant or can’t feel strings
44
Q

What are the complications in a pregnancy with a Mirena in utero?

A

Ectopic pregnancy
50% risk of miscarriage

TPTL
APH
Morbidly adherent placenta

Mirena should be removed

45
Q

If a Mirena is inserted at age 45+, how long can it be used until?

A

55

46
Q

If a Cu IUD is inserted at 40+years, how long can it remain in stud?

A

1 year after LMP if > 50

2 years after LMP if >45

47
Q

What is the UKMEC Category for Depo Provera use after the age of 45

A

2

48
Q

What is the UKMEC Category for COCP use after the age of 40

A

2

49
Q

At what age should COCP definitely be stopped by?

A

50

50
Q

What is the fertile window?

A

7 days before ovulation until 24 hours after

Serum is said to be viable for 7 days (likely an overestimate)
Ovary survival life of 24h

51
Q

What are the three criteria that need to be met for lactational amenorrhoea?

How effective is it?

A

< 6 months postpartum
Amenorrhoeic
Exclusively breastfeeding

If above criteria met, over 98% effective at preventing pregnancy

52
Q

For a postpartum who is not exclusively breastfeeding, how soon should she start contraception?

A

D21

Earliest expected ovulation is D28

53
Q

What are known predictors of regret with TL

A

Age < 30

Nulliparous, low parity
Single
Unhappy relationship, in conflict
Remarriage, change in partner, change in relationship status
Death of a child
Desire to have more children
Psychological, psychosexual problems
Coercion
Timing of procedure in relation to pregnancy. TL should not be performed at time of CS unless documented at least 2 weeks before
54
Q

What is the failure rate of Filshie Clip TL?

A

1: 300

If applied at CS, higher rate of failure

RANZCOG

55
Q

What are Filshie clips?

A

Non-absorbable titanium and silicone rubber clips

TL

56
Q

When should a TL be performed?

A

Ideally in early-mid follicular phase

To reduce risk of pregnancy at time of procedure

57
Q

When should a post-vasectomy semen analysis occur? And why?

A

12 weeks post-vasectomy

To confirm clearance of stored spermatoazoa downstream of the vasectomy site and to identify early failure to recanalisation

All men should be informed of the need to use additional contraception until PVSA has been undertaken and clearance given

58
Q

What contraceptive do PPIs, antacids and H2 receptor antagonists affect?

A

UPA (EC not available in NZ)

May reduce absorption and efficacy of this ECP

59
Q

Contraindications to DMPA

A

Those who wish to become pregnant in near future

Undiagnosed abN vaginal bleeding
Hx of breast cancer, stroke, IHD, impaired LFTs
>50, risk of osteoporosis, <18 not at peak bone mass

B2 Gynaecology (12 decks)

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