Contraception and Abortion Flashcards by Laura Lazzari

What is a LARC?

Long Acting Reversible Contraception

Requires administration less than once per month

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What are examples of LARC?

Implant:
- progesterone only implant

IU:

Cu IUD
LNG-IUS

Injection

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Without contraception, what percentage of couples will conceive in a year?

85%

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What criteria are used for suitability to contraception?

MEC criteria

Medical Eligibility Criteria

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What are the MEC categories?

1 - no contraindication
2- benefit outweigh risk
3 - risk outweigh benefit
4 - ABSOLUTE CONTRAINDICATIPN

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What are side effects to hormonal contraceptive methods?

Unexpected bleeding 
Weight gain 
Headache 
Mood swing 
Loss of libido

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What should you do if a woman has headaches in pill free week on COCP?

Tell her to run the packs together

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What should you do if COCP causes migraines?

STOP AND CHANGE

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What are formulations of combined hormonal contraception?

Pill
Transdermal patch
Vaginal ring

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How do combined hormonal contraceptive methods work?

Inhibit ovulation via negative feedback of oestrogen and progestogen on the pituitary, causing suppression of LH, FSH

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What is the main form of oestrogen contained?

ethinyl estradiol

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What are most pill preparations like?

21 pills followed by 7 days pill free interval OR 7 placebo tablets

preparations are monophonic (same dose of hormone)

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How does the patch / ring work?

Patch:; change every week for 3 weeks (21 days), then break for 7

Ring: keep for 21 days, then break for 7

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What do you do if you missed ONE Pill?

Take it as soon as you remember

Continue remaining pills at usual time

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What do you go if you missed TWO or MORE pills in 48h?

Take most recent one as soon as you remember, continue with the rest

If pills missed were in first week, you need EC
If pills were in last week, omit pill free interval and start the new pack right away

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When should additional precaution be taken with the patch?

If patch was NOT APPLIED for 48h

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When should additional precautions be taken with the ring?

If ring was NOT INSERTED for 3h

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What is the cancer risk like for COCP user?

INCREASED breast cancer (for 10 years after stopping, then normal)

REDUCED colorectal, endometrial, ovarian cancer

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What are two absolute contraindications for CHC?

> 35 years AND smoker

Migraine with aura

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How does the progesterone only contraceptive methods work?

Desorgestrel: Inhibit ovulation

All others: thicken cervical mucous

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How does the LNG-IUS work?

It causes endometrial atrophy (prevents endometrial proliferation and implantation)

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How often does the POP need to be taken?

Every day, no breaks

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What are side effects of the POP?

Irregular bleeding

Acne

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What must you do if you forget to take the POP?

Emergency contraception

Use protection

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What is the progesterone implant called?

Nexplanon

How long does Nexplanon last?

3 yearsq

Where is nexplanon inserted?

8cm above the medial epicondyle in the non dominant arm | SUBCUTANEOUS

What is the progesterone only injectable called?

IM depoprovera | SC Sayana press

What is the injection interval for progesterone only injectable

12-14 weeks

What occurs if you want to have a baby right after the injectable?

DELAY in FERTILITY of up to 1 year after discontinuation

What are SE of the progesterone only injectable?

Weight gain | Osteoporosis

What is the LNG-IUS called?

Mirena

How long does mirena last?

5 years

What are side effects of mirena?

acne breast tenderness mood disturbance headache

What is a unique benefit of Cu IUD?

Can be used as CONTRACEPTION if within 5 days from UPS

What is the bleeding pattern with LNG-IUS?

lighter, less painful

What is the bleeding pattern with Cu-IUD?

heavier, painful

What medication can you give to help reduce blood loss in Cu-IUD?

Tranexamic acid

When must you remove an IUD if a woman is pregnant?

BEFORE 12 week gestation

What are potential risks of IUD?

Perforation Expulsion infection

What types of female sterilisation are available?

Laparoscopic sterilisation - occlude the Fallopian tubes using Filshie clips Hysteroscopic sterilisation - expanding springs inserted in the tubal ostia via hysteroscope, infusing fibrosis

What are the types of oral Emergency Contraception?

Levonorgestrel 1.5mg | Ulipristal 30mg

How long after UPS is levonorgestrel used for?

72h

How long after UPS is ulipristal used for?

5 days (120 h)

WHAT IS THE effectiveness of oral EC methods?

2/3 | Cu IUD is WAY MORE EFFECTIVEq

What are the two medications given for a medical abortion?

Mifepristone (progesterone receptor modulator) FOLLOWED BY Misoprostol (prostaglandin analogue)

How do mifepristone and misoprostol work?

Mifepristone increases uterine contractility and sensitises uterus to prostaglandins Misoprostol causes the expulsion

When is the effect of mifepristone maximal, so when should misoprostol be administered?

Mifepristone is max at 48 h | So give misoprostol at 24-48 h

How does medical abortion change based on gestation?

<9 weeks: give medications at home with oral analgesia will bleed for about 2 weeks 9-21 weeks: same drugs, but give misoprostol every 3 hours until expulsion occurs. Should be done in clinical setting as increased discomfort, bleeding, passage of larger foetus.

How long is the average abortion time for medical abortion in second trimester?

7hours

How do you abort a foetus medically after 21 weeks?

Intracardiac injection of potassium chloride

What are methods of surgical abortion based on gestation period?

Vacuum aspiration < 14 weeks | Dilatation and evacuation > 14 weeks

How does vacuum aspiration occur?

Consider pre-treatment misoprostol in nulliparous /adolescent / previous cervical cancer or past 12 week gestation This will dilate the cervix Then gently dilate the cervix with gradual dilators Evacuate the cavity with gentle suction

How long does vacuum aspiration take'

less than 10 mins

Whart medication should you give after vacuum aspiration

Prophylactic antibiotics - reduce risk of postabortal infection

How does dilatation and evacuation work?

Use osmotic dilators, misoprostol and mifepristone Remove contents of uterus with aspiration and extraction of foetal tissues Perform ultrasound to confirm evacuation

What are complications of abortion

failure to end pregnancy Incomplete abortion requiring evacuation Haemorrhage Infection

How soon after abortion should you start postabortal contraception?

IMMEDIATELY

Why does the. COCP cause a withdrawal bleed?

Oestrogen and progestogen cause a slight thickening of the endometrium During the pill free week, the lack of progestogen causes the breakdown of th endometrium

What are thee types of LNG-IUS

Mirena -52 mg progestogen Jaydess - 13.5mg Kyleena - 19mg

How long do the three LNG IUS last for

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

What is the benefit of Mirena over the other two?

High dose of progestogen | Good for PCOS, endometriosis, STIs

How long can a Copper IUD last for?

``` 5 years (if copper only on stem - usual one) 10 yrs (if copper also on arms ) ```

How does the Copper IUD work?

Copper causes aseptic inflammation of the endometrium, so implantation cannot occur Inflammation however also means that blood vessels in the uterus become hyperaemic > increased bleeding

What are the risks of perforation. of an IUD?

1:1000

What are the kinds of infection that can be caused by an IUD?

Ascending infection So if the patient has an STI in the Lower genital tract, insertion of the IUD will push it up into the upper genital tract

What is advice you should give for emergency contraception=?

If vomiting/diahrroea within 2 hours, you need to take another one Period could be delayed/anticipated by a week If next menstrual period is delayed by >2 weeks take a pregnancy test

What is the prandf name for levonorgestrel 1.5 emergency contraception?

Levonelle

What is the brand name for Ulipristal 30mg emergency contraception?

EllaOne

What are MEC3 criteria for the COCP

``` >35 yo and smoker (<15xday) migraine, no aura FH DVT/PE <45 Controlled HTN Immobility e.g. wheelchair ```

What are MEC4 criteria for COCP

``` >35yo and smoker (>15xday) migraine with aura PMH DVT/PE <45 PMH stroke /IHD Uncontrolled HTN Breast cancer Breast feeding & <6 weeks PP recent major surgery with prolonged immobilisation ```