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Yr4 - O&G > Contraception > Flashcards

Contraception Flashcards

1
Q

Types of barrier contraception

A

Male condoms
Female condoms
Diaphragms
Cervical caps

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2
Q

Advantages of male condoms

A

Not contraindicated by any condition exception latex allergy, in which other materials (such as polyurethane) can be used, with similar efficiency rate
It is the only contraceptive method mentioned that is controlled by the male
Widely available and simple to use, and only need to be used immediately before intercourse
Are protective against many STIs

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3
Q

Advantages of female condoms

A

No contraindications
Less likely to tear than the male condom
May protect against some STIs
Can be inserted up to 8 hours before intercourse

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4
Q

Advantages of the diaphragm/cap

A

Can be inserted up to 3 hours before intercourse

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5
Q

Disadvantages of male condom

A

Perfect use is rarely achieved – may tear or couple may lack motivation to use them every time
Can reduce sensitivity and/or arousal

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6
Q

Disadvantages of female condom

A

Perfect use is rarely achieved – may become dislodged or couple may lack motivation to use them every time
Penis may be inserted between condom and vaginal wall
Can be noisy and/or uncomfortable for the woman during intercourse

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7
Q

Disadvantages of diaphragm/cap

A

Perfect use is rarely achieved – may tear or couple may lack motivation to use them every time
They require prior planning and careful insertion
They require measuring and fitting to find the correct size – any weight gain or pregnancy mandates a refitting
They are associated with a higher risk of urinary tract infections - due to the position of the diaphragm/cap putting pressure on the urethra
STI transmission not reduced

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8
Q

Method of action of combined hormonal contraception

A 
Inhibit ovulation
- negative feedback on hyothalamo-pituitary axis
- prevents LH surge
Progesterone also
- inhibits proliferation of endometrium
- increases thickness of cervical mucus
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9
Q

Types of COCP

A

Monophasic - every pill contains same levels of oestrogen and progesterone
- Microgynon 30
- Brevinor
Phasic pills - level of oestrogen and progesterone in pills change throughout cycle
- Qlaira
- BiNovum

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10
Q

Types of contraceptive transdermal patch

A

5x5cm patch stuck onto upper arm, abdomen, buttock or back
Ortho Evra
- applied and changed every 7 days for 3 weeks then 7 patch free days
Can be used whilst swimming/bathing

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11
Q

Types of contraceptive vaginal ring

A

NuvaRing

  • plastic ring inserted into vagina
  • sits in for 21 days then 7 free days before inserting new ring
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12
Q

Advantages of combined hormonal contraception

A

Non invasive
More effective than barrier methods if taken correctly
Sex doesn’t need to be interrupted to use contraception
Menses tends to become regular, lighter and less painful, also allowing for control over timing of menses
Reduced risk of cancer of the ovary, uterus and colon
Reduced risk of functional ovarian cysts
Normal fertility returns immediately after stopping usage

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13
Q

Disadvantages of combined hormonal contraception

A

User dependent
Some temporary adverse effects such as headaches, breast tenderness and mood changes can be experienced by some women
Blood pressure may increase
Women may experience breakthrough bleeding and spotting for the first few months
Increased risk of venous thromboembolism
Small increase in risk of myocardial infarctions and strokes
Small increase risk of breast and cervical cancer

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14
Q

Contraindications of combined hormonal contraception

A

BMI greater than 35
Breast feeding
Smoking over the age of 35
Hypertension
History of or family history of venous thromboembolisms
Prolonged immobility due to surgery or disability
Diabetes mellitus with complications e.g. retinopathy
History of migraines with aura
Breast cancer or primary liver tumours

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15
Q

UKMEC Categories

A

Category 1 - no restriction
Category 2 - condition where advantages generally outweigh theoretical or proven risks
Category 3 - risks outweigh advantages
Category 4 - unacceptable health risk

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16
Q

Category 3 for COC

A

Postpartum 0 to 6 weeks without VTE risk factors
Postpartum 3-6 weeks with other VTE risk factors
Smoke < 15 cigarettes/day or stopped smoking < 1 year ago
BMI > 35
Complicated organ transplant

17
Q

Category 4 for COC

A

Postpartum 0-3 weeks with other VTE risk factors

18
Q

Indications for emergency contraception

A

Sexual intercourse without contraception

Contraceptive method has failed

19
Q

Types of emergency contraception

A 
Emergency hormonal contraception
- Levonorgestrel - synthetic progesterone
     - delays ovulation for 5-7 days
     - licensed for use within 72 hours
- Ulipristal acetate - progesterone receptor modulator
     - delay ovulation for 5-7 days
     - licensed for use within 120 hours
IUD
- inserted within 5 days
20
Q

Contraindications of levonorgestrel

A

No absolute contraindications
Efficacy may be reduced by
- diseases of malabsorption - Crohn’s
Enzyme inducing drugs - rifampici

21
Q

Contraindications of ulipristal acetate

A

Diseases of malabsorption e.g. Crohn’s
Hypersensitivity to Ulipristal Acetate
Severe hepatic dysfunction
Enzyme inducing drugs e.g. rifampicin
Breast feeding – avoid breastfeeding for 7 days after taking UPA
Asthma insufficiently controlled by corticosteroids
Drugs increasing gastric pH e.g. omeprazole, ranitidine

22
Q

Contraindications of copper IUD

A

Uterine fibroids with distortion of the uterine cavity
Documented or suspected PID
Documented or suspected STI

23
Q

Follow up for emergency oral contraception

A

Seek help if vomiting occurs within 2-3 hours

24
Q

Adverse effects of emergency hormonal contraception

A

Nausea
Dizziness
Menstrual disturbance
Abdo pain

25
Q

Follow up for IUD

A

Increased risk of ectopic pregnancy - alert if next period is > 5 days late

26
Q

Adverse effects of IUD

A

Pelvic infections
Expulsion of IUD
Bleeding
Pelvic pain

27
Q

Types of progesterone only contraceptives

A

Progesterone only pill
Implant
Injections

28
Q

Method of action of progesterone only pill

A

Thicken cervical mucus

  • inhibit ovulation
  • thinning of endometrium
29
Q

Advantages of POCP

A

More effective than barrier methods when taken correctly
Sex doesn’t need to be interrupted to use contraception
Can be used in many patients for whom the combined oral contraceptive is contraindicated
May reduce risk of endometrial cancer

30
Q

Disadvantages of POCP

A

User dependent and has to be taken at the same time each day
Can produce irregular menstruation (4 in 10 women) or amenorrhoea (2 in 10 women)
Some adverse affects, such as headaches, breast tenderness and skin changes, may be experienced when POCP’s are first started
30% increased risk of ovarian cysts
Small increased risk of breast cancer

31
Q

Contraindications of POCP

A

Current or past history of breast cancer
Liver cirrhosis or tumours
Lower efficacy in women over the weight of 70kg
Stroke or coronary heart disease

32
Q

Mechanism of action of implant

A

Inhibit ovulation

  • thickening of cervical mucus
  • thinning of endometrium
33
Q

Advantages of implant

A

Extremely effective
Can be used in women for whom the combined oral contraceptive pill is contraindicated
Users don’t have to think about contraception for 3 years
Can be used when breastfeeding
Normal fertility returns as soon as implant is removed
Effective in women of all body mass (although earlier replacement recommended in women with high BMI)
May reduce the risk of endometrial cancer

34
Q

Disadvantages of implant

A

About 50% of women experience changes in menstrual bleeding and bleeding patterns are likely to remain irregular
Fitting and removing the implant may cause some pain, bruising and irritation
Small increased risk of breast cancer
The implant can sometimes bend or break in situ

35
Q

Contraindications of implant

A 
Pregnancy
Unexplained vaginal bleeding
Liver cirrhosis or tumours
History of breast cancer
Stroke or transient ischaemic attacks whilst using the implant
36
Q

Mechanism of action of injectables

A

Inhibition of ovulation and cervical mucus

37
Q

Advantages of injection

A

A very effective form of contraception
Users don’t have to think about contraception for as long as the injection lasts
No known interactions with any drugs
It can be used when combined hormonal contraceptives are not recommended such as in women with migraine and who are breast feeding
Can be used in women with a BMI < 35
May reduce the risk of endometrial cancer

38
Q

Disadvantages of injection

A

Not rapidly reversible – can take up to a year to return to normal fertility and menstruation can take several months to return to normal
Up to 50% of women stop usage within a year due to altered bleeding patterns including persistent bleeding
Increase in body weight, up to 2-3kg over a year
May be a slightly increased risk of breast cancer
Loss of bone mineral density with long term use (over a year of use), although there is no evidence that it increases the risk of fracture

39
Q

Contraindications of injection

A

Current Breast cancer (within 5 years)
History of severe arterial disease or very high risk factors
Pregnancy
Diabetes with any vascular disease e.g. retinopathy
People who will want to return to fertility in the near future

Yr4 - O&G (19 decks)

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