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Repro > contraception > Flashcards

contraception Flashcards

1
Q

forms of combined hormonal contraception (CHC)

A

pill, patch, vaginal ring

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2
Q

what hormones are in CHC

A

ethinyl estradiol

progestogen

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3
Q

how does CHC work

A

stops ovulation, also effects cervical mucous and endometrium

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4
Q

standard regime of CHC

A

21 days with hormone free week

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5
Q

tricyclic/continuous use CHC

A

no need for inconvenient withdrawal bleed and avoids forgetting to restart after break

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6
Q

when is CHC patch changes

A

weekly

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7
Q

when is CHC ring changed

A

every 3wks (can take out for 3hrs every day so may want to do that for sex)

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8
Q

non-contraceptive benefits of CHC

A

regulate/reduce bleeding - help heavy, painful periods
stop ovulation - help prementrual syndrome
reduction in functional ovarian cysts
50% reduction ovarian and endometrial cancer
improve acne/hirsutism
reduction in benign breast disease, rheumatoid arthritis, colon cancer and osteporosis

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9
Q

side effects of CHC

A 
tender breasts
nausea
headache 
irregular bleeding first 3mo 
mood? casual or other live events 
weight gain - not causal
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10
Q

serious risks associated with CHC

A

venous thrombosis - PT, DVT (avoid if BMI>34, prev VTE)
arterial thrombosis - MI, stroke (avoid smokers >35, Hx, Age>50, BP >140/90)
risk cervical ca
risk breast ca (aviooid if Hx)

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11
Q

when is the progestogen only pill (POP) not a good idea

A

if they have frequent GI upset

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12
Q

how is progestogen only pill to be taken

A

same time everyday without a pill-free interval

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13
Q

desogestrel POP

A

12hr window
nearly all cycles no ovulation, also affects mucus
most bleed free

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14
Q

traditional LNG/PET POP

A

3hr window
1/3 anovulant, 2/3 rely on cervical mucus effect
1/3 bleed free, 1/3 irregular bleeds, 1/3 regular period

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15
Q

POP contraindications

A

personal history of breast cancer or liver tumour

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16
Q

POP side effects

A 
increased appetite
hair loss/gain
mood change 
bloating or fluid retention 
headache 
acne
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17
Q

how is ‘the jag’ given

A

150ml 1mg IM injection into upper quadrant buttock every 13wks

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18
Q

how does ‘the jag’ work

A

prevents ovulation
alters cervical mucus making it hostile to sperm
makes endometrium unsuitable for implantation

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19
Q

pros of injectable progestogen

A

only need to remember every 12-14wks
70% amenohorrhoeic after 3 doses
oestrogen free so few contraindications

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20
Q

cons of injectable progestogen

A

delays in return to ferility - avg 9mo
reversible reduction to bone density
problematic bleeding esp 1st 2 doses
weight gain

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21
Q

pros of intrauterine contraception (the coil)

A

little user input after fitting
used for any age + parity
(side) effects immediately reversible upon removal

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22
Q

cons of the coil

A

1:1000 risk perforation
5:100 risk expulsion: check threads after period
not suitable if untreated pelvic infection or distorted endometrial cavity e.g. submucus fibroids

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23
Q

how does copper IUD work

A

toxic to sperm
stop sperm reaching egg
may sometimes prevent implantation of fertilised egg

24
Q

con of copper IUD

A

may make periods heavier/crampier

25
Q

does copper IUD contain hormones

A

no it’s hormone free

26
Q

how long does copper IUD last

A

5/10yrs depending on type

27
Q

how does levonorgestrel IUD work

A

affects cervical mucus and endometrium, most women still ovulate
stop fertilisation of egg and may prevent implantation of fertilised egg

28
Q

hormones with levonorgestrel IUD

A

slow release progestogen on stem, low circulating progestogen levels compared with pill, implant, injfection

29
Q

levonorgestrel IUD effect on menstrual bleeding

A

reduce menstrual bleeding after up to 4months initial irregular bleeding

30
Q

what does the rod contain

A

68mg of the progestogen etonogestrel dispersed in a matrix of EVA
then covered in a rate controlling membrane made frmo EVA

31
Q

how does subdermal progestogen implant (rod) work

A

inhibition of ovulation and effect on cervical mucus

32
Q

how long can rod last

A

3yrs but can be removed at any time

33
Q

pros of the rod

A

no user input needed

no casual effect on weight

34
Q

cons of the rod

A

60% almost bleed free but 30% have prolonged/frequent bleeding
may cause mood change more often than other progestogen only methods

35
Q

forms of emergency contraception + pregnancy chances

A

copper IUD (most effective) <1 in 100
levonorgestrel pill - levonelle 2-3 in 100
ulipristal pill - ellaone 1-2 in 100

36
Q

when does copper IUD need to be fitted for emergency contraception

A

before implantation - within 120hrs UPSI

37
Q

when does levonorgestrel pill need to be taken

A

within 72hrs

38
Q

when does ulipristal pill need to be taken

A

within 120 hours

39
Q

contraindications of ulipristal pill

A

breast feeding
enzyme inducing drugs
acid reducing drugs

40
Q

when in cycle to start contraception

A

if first 5 days of cycle then have immediate cover

if start another time of cycle need condosms/abstain and pregnancy test after 4wks

41
Q

when can u get pregnant after giving birth

A

21 days after

42
Q

when can you get pregnanct after misscarriage/abortoin

A

5 days after

43
Q

when is breast feeding contraceptive

A

1st 6mo + if feeding every 4hrs + amenorrhoeic

44
Q

what forms of contraception do enzyme inducing drugs e.g. carbamazepine, topiramate reduce effectiveness

A

CHC pill, patch and ring and POP + implant

45
Q

how do enzyme inducing drugs reduce effectiveness of some contraceptives

A

increase metabolism of progestogen and oestrogen

46
Q

female sterilisation procedure

A

laparoscopic sterilisation: usually filshie clips applied across tube to block lumen
metal/silicone ok for MRI

47
Q

vasectomy procedure

A

vas deferens divided and ends cauterised, small incision midline scrotum
local anaesthetic - mostly done in primary care

48
Q

how long does vasectomy take to be effective

A

4-5months

2 sperm samples sent in by post after 4 and 5 months to check

49
Q

is vasectomy reversible

A

no, anti-sperm antibodies even if vas reconnected

50
Q

when can surgical (STOP) abortion be carried out

A

5-12wks

51
Q

surgical abortion procedure

A

cervical priming: misoprostol 3hrs pre-op helps dilation and reduce risk perforation/haemorrhage
GA or LA cervical block
trans-cervical 6-10mm suction catheter

52
Q

surgical abortion complications

A

1-4:1000 perforation
<1:100 cervical injury
infection
risks from GA

53
Q

medical (MTOP) abortion when can it be performed

A

5-24wks

54
Q

medical abortion procedure

A

mifepristone oral anti-progestogen tablet
36-48hrs later misoprostol initiates uterine contraction which open cervix and expels pregnancy

mifepristone helps misoprostol work better

55
Q

how long does MTOP take to pass pregnancy

A

average 4-6hrs under 12wks

56
Q

MTOP complications

A

failure in 1 in 100<8wks, 8 in 100 >12 weeks need surgery for incomplete abortion
infection - test and prophylactic antibiotics
<1 in 100 need blood transfusion

57
Q

CHC contraindications

A 
BMI >34
prev Hv VTE, arterial thrombus, breast cancer
smoker >35ys
BP 140/90
age >50
migraine w aura

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