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Sexual Health > Contraception > Flashcards

Contraception Flashcards

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
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2
Q

What are the short acting contraceptives?

A

Pills
Patches
Rings

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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

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4
Q

What are the risks of the COCP?

A

VTE
Ischaemic stroke
Increased risk of breast and cervical cancer

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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
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6
Q

When should the POP be offered?

A

When pill taking is desired by patient but CHC is contraindicated

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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

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8
Q

What are the contraindications to the POP?

A

Current or personal history of breast cancer

Liver disease

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9
Q

What are the long acting reversible contraceptives?

A

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

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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

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11
Q

Describe the bleeding pattern in the Cu-IUD?

A

Heavier but regular periods.

Initially there may be some intermenstrual spotting.

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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.

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13
Q

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

A

Levonorgestrel

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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

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15
Q

What is the bleeding pattern in the LNG-IUS?

A

Irregular bleeding initially

Eventually, most women are amenorrhoeic

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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

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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
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18
Q

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

A

Exclude a possible pregnancy

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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

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20
Q

What are the complications of IUDs and IUS?

A

Vasovagal during insertion process
Expulsion
Perforation

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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
Q

What happens if an intrauterine pregnancy occurs with an IUD or IUS in-situ?

A

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
Q

What are is the mnemonic which should be used when counselling a patient about IUD and IUS insertion and use?

A 
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
Q

What is Nexplanon?

A

Progestogen implant

28
Q

What is the mode of action for the progestogen implant?

A

Prevents ovulation
Thickens cervical mucus
Reduces endometrial receptivity

29
Q

What is the bleeding pattern with the implant?

A

Variable: from spotting to amenorrhoea.

30
Q

What are the side effects of the implant?

A

Progestogenic side effects: acne, mood swings.

31
Q

What are the contraindications to the implant?

A

Current or active breast cancer
Current use of enzyme inducers
Liver disease

32
Q

What are the types of progestogen only injection called, how are they given and how long do they last?

A

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
Q

What is the bleeding pattern of the progetogen injection?

A

Irregular bleeding at first

70% of women will be amenorrhoeic by 1yr

34
Q

What are the side effects of the progestogen injection

A

Progestogenic side effects
Weight gain (3kg in 2 years)
Effect on bone mineral density - if use is less than 5 years, will recover

35
Q

What are the contraindications for the progestogen injection?

A

Breast cancer
Multiple RF for CV disease
Liver disease
RF for osteoporosis

36
Q

Describe male sterilisation, the procedure and failure rate

A

Occlusion of the vas deferens, done under LA

Failure rate 1/2000

37
Q

Describe female sterilisation, the procedure and failure rate

A

Blocking or sealing of the fallopian tubes.
Laparascopic - under GA
Hysteroscopic - under LA
Failure rate 1/200

38
Q

When does implantation occur?

A

Between 6 and 12 days post-fertilisation

39
Q

Define post-coital contraception

A

Intervening between 120hrs (day 5 of fertilisation)

40
Q

What are the indications for emergency contraception?

A

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
Q

What are the three emergency contraceptives?

A

Copper IUD
Levonorgestrel
Ullipristal acetate (aka EllaOne)

42
Q

When can the copper IUD be fitted as an emergency contraception?

A

5 days after earliest expected ovulation
OR
First UPSI in the cycle

43
Q

How does levonorgestrel work as emergency contraception?

A

Inhibits ovulation

44
Q

What is the dose of levonorgestrel as an emergency contraceptive?

A

1500mcg

45
Q

What is the efficacy period of levonorgestrel as an enzyme inducer?

A

Licensed up to 72hrs post UPSI

Can be effective up to 96hrs (4 days)

46
Q

What type of drug is ulipristal acetate?

A

Selective progesterone receptor modulator (SPRM)

47
Q

What is the correct dose of EllaOne for emergency contraception?

A

30mg

48
Q

What is the mode of action for EllaOne?

A

Inhibition or delay of ovulation - even if ovulation has already begun

49
Q

What is the efficacy period of ulipristal acetate as an emergency contraceptive?

A

Up to 120hrs post UPSI

50
Q

What drugs may affect the efficacy of EllaOne?

A

Oestrogens, if taken 7 days prior to or 5 days post emergency contraception

Sexual Health (5 decks)

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