Contraception Flashcards

(50 cards)

1
Q

What classifications do the UKMEC use for contraceptive safety?

A
1 = A = always use
2 = B = benefits outweight risk
3 = C = caution
4 = D = do not use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the short acting contraceptives?

A

Pills
Patches
Rings

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

What are the benefits of the COCP?

A

Treats benign gynaecological conditions
Reduced risk of benign breast disease and benign ovarian cysts
Reduced risk of ovarian and endometrial cancer

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

What are the risks of the COCP?

A

VTE
Ischaemic stroke
Increased risk of breast and cervical cancer

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

What are some of the contraindications to the COCP?

A
Smoking + 35+y/o
BMI 35+
BP >140/90
Previous thrombotic event
1st degree relative with VTE
IHD
Previous ischaemic event
Breast cancer (personal hx)
BRCA carrier
Migraine with aura
Liver disease
Complex congenital heart disease
AF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When should the POP be offered?

A

When pill taking is desired by patient but CHC is contraindicated

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

What are the two types of progesterone only pill and what are their windows for pill-taking accuracy?

A

Low dose mini pill - 3 hours

Desogestrel - 12 hours

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

What are the contraindications to the POP?

A

Current or personal history of breast cancer

Liver disease

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

What are the long acting reversible contraceptives?

A

Mirena IUS (LNG-IUS)
Copper IUD
Depo-Provera
Implant

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

What are the primary and secondary modes of action of the copper IUD?

A

Primary: copper ion toxicity on sperm
Secondary: makes the endometrium unfavorable for implantation

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

Describe the bleeding pattern in the Cu-IUD?

A

Heavier but regular periods.

Initially there may be some intermenstrual spotting.

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

How long can the Cu-IUD be used for?

A

5-10 years depending on brand.

If fitted over 40y/o, it can remain inserted until the menopause is complete.

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

What hormone is present in the LNG-IUS (Mirena)?

A

Levonorgestrel

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

What is the mode of action of the LNG-IUS?

A

Thickens cervical mucus
Prevents endometrial proliferation
Prevents ovulation in SOME women
Local effect of foreign body in uterus

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

What is the bleeding pattern in the LNG-IUS?

A

Irregular bleeding initially

Eventually, most women are amenorrhoeic

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

How long can the different types of LNG-IUS be used for?

A

Mirena: 5 years
Levosert: 5 years
Jaydess: 3 years
Kyleena: 5 years

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

What are the contraindications to IUD and IUS fittings?

A
Pregnancy
Undiagnosed bleeding
Cervical or uterine cancer (pre-treatment)
Active PID
Asymptomatic chlamydia
Uterine fibroids
Molar pregnancy
Long QT syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the most important factor when timing an IUD or IUS insertion?

A

Exclude a possible pregnancy

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

When should an IUD or IUS be inserted?

A

Currently menstruating
Abstinence following LMP
Using another reliable method of contraception
No sex in last 3 weeks and PT is negative

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

What are the complications of IUDs and IUS?

A

Vasovagal during insertion process
Expulsion
Perforation

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

What is expulsion of IUD/IUS more likely to occur?

A

In first 3/12 after fitting

With heavy menstruation

22
Q

When is perforation with IUD/IUS most likely to occur?

A

Post-natal period in lactating women

23
Q

Does the IUD cause pelvic infections?

A

NO - the risk of contracting a pelvic infection is higher ONLY in the 3/52 following insertion

24
Q

What are the risks with IUD and IUS?

A

Ectopic pregnancy - if a pregnancy does occur it is more likely to be ectopic

25
What happens if an intrauterine pregnancy occurs with an IUD or IUS in-situ?
The pregnancy can continue There is a higher risk of miscarriage The IUD/IUS can be removed if the strings can be seen prior to 12wks gestation
26
What are is the mnemonic which should be used when counselling a patient about IUD and IUS insertion and use?
``` E and 6P's Expulsion Pregnancy (failure rate and risk of ectopic) Perforation Periods PID Procedure Progestogenic side effects (for IUS only; acne, mood changed) ```
27
What is Nexplanon?
Progestogen implant
28
What is the mode of action for the progestogen implant?
Prevents ovulation Thickens cervical mucus Reduces endometrial receptivity
29
What is the bleeding pattern with the implant?
Variable: from spotting to amenorrhoea.
30
What are the side effects of the implant?
Progestogenic side effects: acne, mood swings.
31
What are the contraindications to the implant?
Current or active breast cancer Current use of enzyme inducers Liver disease
32
What are the types of progestogen only injection called, how are they given and how long do they last?
Depo-Provera - IM injection - Given every 12 weeks, effective for up to 14 weeks Sayana Press - SC injection - Given every 13 weeks, effective up to 14 weeks
33
What is the bleeding pattern of the progetogen injection?
Irregular bleeding at first | 70% of women will be amenorrhoeic by 1yr
34
What are the side effects of the progestogen injection
Progestogenic side effects Weight gain (3kg in 2 years) Effect on bone mineral density - if use is less than 5 years, will recover
35
What are the contraindications for the progestogen injection?
Breast cancer Multiple RF for CV disease Liver disease RF for osteoporosis
36
Describe male sterilisation, the procedure and failure rate
Occlusion of the vas deferens, done under LA | Failure rate 1/2000
37
Describe female sterilisation, the procedure and failure rate
Blocking or sealing of the fallopian tubes. Laparascopic - under GA Hysteroscopic - under LA Failure rate 1/200
38
When does implantation occur?
Between 6 and 12 days post-fertilisation
39
Define post-coital contraception
Intervening between 120hrs (day 5 of fertilisation)
40
What are the indications for emergency contraception?
UPSI on any day of natural menstrual cycle UPSI from day 21 post-partum UPSI from day 5 after termination, miscarriage or ectopic management Compromisation of regular contraception
41
What are the three emergency contraceptives?
Copper IUD Levonorgestrel Ullipristal acetate (aka EllaOne)
42
When can the copper IUD be fitted as an emergency contraception?
5 days after earliest expected ovulation OR First UPSI in the cycle
43
How does levonorgestrel work as emergency contraception?
Inhibits ovulation
44
What is the dose of levonorgestrel as an emergency contraceptive?
1500mcg
45
What is the efficacy period of levonorgestrel as an enzyme inducer?
Licensed up to 72hrs post UPSI | Can be effective up to 96hrs (4 days)
46
What type of drug is ulipristal acetate?
Selective progesterone receptor modulator (SPRM)
47
What is the correct dose of EllaOne for emergency contraception?
30mg
48
What is the mode of action for EllaOne?
Inhibition or delay of ovulation - even if ovulation has already begun
49
What is the efficacy period of ulipristal acetate as an emergency contraceptive?
Up to 120hrs post UPSI
50
What drugs may affect the efficacy of EllaOne?
Oestrogens, if taken 7 days prior to or 5 days post emergency contraception