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Common conditions > Contraception advice > Flashcards

Contraception advice Flashcards

1
Q

What are barrier methods of contraception?

A

Barrier methods provide a physical barrier to semen entering the uterus

Male and female condoms - help prevent against STD’s

Diaphragms and cervical caps fit over cervix and used with a spermicide gel - need to be put in 3 hours before sex or 6 hours after sex

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2
Q

What is the COCP and first line example?

A

COCP contains progesterone and oestrogen. First line is Microgynon containing levonorgestrel (lowers risk of venous thromboembolism)

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3
Q

What is the mechanism of COCP?

A
  • Prevents ovulation
  • Increases cervical mucus (mechanical barrier to sperm)
  • Thins endothelium (reduces chance of implantation)
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4
Q

What are the two types of COCP and treatment course?

A

Monophasic - the same levels of hormones in each pill, 21 day pills followed by 7 days off

Multiphasic - varying levels of hormones in each pill to match hormonal cycle

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5
Q

Benefits of using COCP?

A
  • Reduces risk of ovarian, colon and endometrial cancer

- relieves premenstrual symptoms e.g. dysmenorrhoea and menorrhagia

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6
Q

CI of COCP?

A
  • Hypertensive
  • if suffering migraine with aura (stroke risk)
  • smoking and aged over 35
  • history of VTE (Hormones increases the risk of thrombotic diseases such as deep vein thrombosis, pulmonary embolism and stroke)
  • CVD
  • breast feeding
  • current breast cancer
  • liver disease
  • BMI >35
  • Pregnancy
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7
Q

Side effects of COCP?

A

Progestogens cause: headache and breast tenderness

Oestrogen: nausea and vomiting

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8
Q

What is POP?

A

Progesterone only pill, taken everyday (no break) e.g. cerazette.

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9
Q

2 types of POP and treatment course?

A

Take daily at same time each day with no breaks.

Traditional POP (3hour pill) - must be taken within 3 hour time frame each day

Desogestrel POP (12hour pill) - must be taken within 12 hour time frame each day

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10
Q

Benefits of POP?

A

-Can be taken by those breast feeding, CVS risk, smokers aged >35 years (in those CI to COCP)

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11
Q

Side effects of POP?

A
  • Unscheduled, irregular bleeding (oligomenorrhoea)
  • breast tenderness and acne
  • risk of ectopic pregnancy
  • risk of ovarian cysts
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12
Q

What is the contraceptive injection and example?

A

Progesterone only injection, example is Depo-Provera,

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13
Q

What is the mechanism of contraceptive injection, contraceptive implant, POP?

A
  • Thickens cervical mucus

- Thins endometrium

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14
Q

Two main side effects of of contraceptive injection?

A
  • Risk of osteoporosis so must be stopped before 50 years

- weight gain.

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15
Q

what contraception would you give to someone with risk of breast cancer?

A

Avoid hormonal contraception e.g. COCP can increase risk of breast cancer,

Give IUD e.g. copper coil

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16
Q

What is the progesterone implant and example?

A

Contains progestogen, small implant that goes into upper arm, example is implanon.

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17
Q

Benefits of contraceptive implant?

A
  • lasts for 3 years

- improves painful periods

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18
Q

Side effects of progesterone implants?

A
  • Minor surgery
  • bruising, infection
  • irregular menstrual bleeding
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19
Q

What is IUS and an example?

A

Intrauterine system that contains progestogen only, example is Mirena coil

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20
Q

Benefits of IUS over other types?

A
  • lasts for 5 years

- improves painful periods

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21
Q

Side effects of IUS?

A
  • coil insertion risk
  • spotting in first few months
  • risk of expulsion
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22
Q

What is the IUD and example?

A

Intrauterine device containing only copper, copper coil

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23
Q

Mechanism of IUD?

A

Copper is toxic to ovum and sperm, reduces likelihood of implantation

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24
Q

Benefits of IUD?

A
  • No hormone so can be used for women at risk of breast cancer
  • can be used for women at risk of VTE
  • lasts for 5 years
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25
Q

Side effects of IUD?

A
  • Can cause menorrhagia
  • can cause ectopic pregnancy if pregnant and on IUD
  • risk of expulsion
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26
Q

Examples of emergency contraception and time frames?

A

1st line - IUD is most effective (99%), must be taken within 5 days hours after sex or within 5 days of estimated ovulation (CYCLE LENGTH minus 14)

Levonorgestrel (containing only progesterone) - taken within 72 hours after sex (85%)

Ulipristal acetate (anti-progesterone) e.g. Ellaone - taken within 120 hours after sex, anytime before day 19 (on a 28day cycle).

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27
Q

What must be remembered for dosage of levonorgestrel?

A

BMI over 26 must double dose of patient.

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28
Q

What is the action of levonorgestrel?

A

Inhibits ovulation and sperm migration.

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29
Q

What are the side effects of levonergestrel?

A

Causes nausea and vomiting but no long term side effects.

30
Q

What contraception can be used post natal straight away?

A

Condoms, progesterone containing contraception e.g. contraceptive implant, POP and contraceptive injection

31
Q

Examples of sterilisation techniques?

A

Female sterilisation involves tubal occlusion where fallopian tubes are cut, this is permanent.

Male sterilisation involves vasectomy where vas deferens tube that carry sperm are cut.

32
Q

Contraception to women under 20 years?

A

COCP and POP are unaffected by age, POP implant is long-acting reversible contraception.

Coils will have risk of expulsion, contraceptive injection reduces bone density so not good for bone development.

33
Q

What is infertility definition?

A

Failure to conceive after regular sex for 2 years.

34
Q

Initial Mx for infertility?

A

Check day 21 progesterone and semen analysis

35
Q

Advice for infertility?

A

Stress management, 2-3 weekly intercourse, healthy BMI, avoid smoking and excess alcohol, 400mcg folic acid, OTC medication ibuprofen can interfere

36
Q

What is abortion?

A

Ending of pregnancy up to 24th week. Two medical practitioners must sign to declare abortion.

37
Q

What is the medication used for abortion?

A

Oral mifepristone followed by misoprostol.

38
Q

How to calculate EDD?

A

First day of LMP + 9 months and 7 days

39
Q

What is gravida and para?

A

Gravida - no. of pregnancies (gravidity)

Para - no. of pregnancies/children surpassing 24 weeks.

40
Q

What is the first stage of labour?

A

From the onset of labour (true contractions) until 10cm cervical dilatation, split into latent phase 0-3cm dilation and irregular contractions, active phase 3-7cm with regular contractions.

41
Q

What is the second stage of labour?

A

From 10cm cervical dilatation until delivery of the baby

42
Q

What is the third stage of labour?

A

From delivery of baby until delivery of placenta.

43
Q

What is placental previa?

A

Placental previa is placenta located in lower section of uterus overlying cervical os

44
Q

What are the causes of antepartum haemorrhage?

A

Placental abruption and placental previa

45
Q

What are the effects of maternal smoking?

A

Increased risk of miscarriage (loss before 20 weeks), pre-term labour, still birth (after 20 weeks)

46
Q

What are the effects of alcohol on smoking?

A

Foetal alcohol syndrome - learning difficulties

47
Q

How to Mx obstetric cholestasis?

A

LFT’s weekly monitoring and induction of labour at 37 weeks gestation.

48
Q

What is CI of hormonal replacement therapy (oestrogen or oestrogen and progesterone)?

A

HRT increases the risk of thrombotic diseases such as deep vein thrombosis, pulmonary embolism and stroke.

49
Q

What is an indication of HRT?

A

Relieve menopausal symptoms e.g. hot flushes

50
Q

What is the follicular phase?

A

From start of menstruation to ovulation where ovum leaves ovaries (day 1 - 14)

51
Q

Lifespan of sperm and ovum?

A

Ovum 24h, sperm 5 days.

52
Q

What is the luteal phase?

A

From ovulation to start of menstruation (day 15-28)

53
Q

What is the hormone FSH?

A

FSH stimulates development of follicles produced by a. pituitary gland

54
Q

What is the hormone LH?

A

LH triggers ovulation and LH causes a LH spike during ovulation, produced by A. pituitary gland.

55
Q

What is the action of levonergestrel - levonelle?

A

Levonorgestrel disrupts and delays ovulation, only effective if taken before ovulation, no effect on implementation must use within 72h of sex.

56
Q

What is the action of ulipristal acetate - ellaone?

A

Ulipristal disrupts and delays ovulation, effective taken before ovulation, must use within 120h of sex.

57
Q

What is benefit of using IUD over oral emergency contraception?

A

IUD has the benefit of ongoing contraception.

58
Q

How long can you be pregnant for and still have a positive pregnancy test?

A

3 weeks

59
Q

What is the framework for oral contraception in adolescenets?

A

Fraser framework

Understanding
Persuade parents 
Sexual intercourse
Suffer (patient will be at risk if not continuing)
Interest of patient
60
Q

What are the red flags during consultation with adolescents?

A
  • Sexual abuse
  • Non consensual sex
  • Age difference >5 years
  • Cannot give contraception <13 years
  • illicit drugs

Contact social services and safeguarding.

61
Q

What are the CI in POP pill?

A

Those with PMH of cyst or ectopic.

62
Q

What is the treatment course of Depo-Provera?

A

Lasts for 3 months

63
Q

What is the treatment course for implanon (progesterone implant)?

A

Lasts for 3 years

64
Q

What is the treatment course for IUS?

A

Lasts for 5 years

65
Q

What are the CI for mirena coil (IUS) and copper coil (IUD)?

A
  • Pelvic infection
  • recent PID
  • Malignancy
  • recent STD
  • Copper allergy in IUD
  • Wilsons disease in IUD (excess copper)
66
Q

What s the treatment course for IUD?

A

Lasts for 5 years.

67
Q

What is the CI of ella one?

A
  • Liver disease and asthma

- avoid during breast feeding until after a week of taking the medication

68
Q

What are the side effects of ellaone?

A

painful periods
mood swings
back pain

69
Q

What are the causes related to infertility that affect female ovulation?

A
  • PCOS most common
  • Age
  • Cushings syndrome (excess cortisol)
  • Premature ovarian failure
70
Q

What are the causes of infertility related to tubular, uterine, cervical problems?

A
  • PID secondary to chlamydia or gonnorhoea
  • Endometriosis
  • Uterine or cervical damage/abnormalities
71
Q

What are the causes of infertility related to male testicles?

A
  • Varicoceles

- Testicular cancer

Common conditions (13 decks)

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