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Contraception and HRT Flashcards

1
Q

What is the purpose of contraception?

A

To prevent pregnancy either by preventing ovulation, fertilisation or implantation.

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2
Q

Why are birth rates changing?

A 
Family planning
Better health and reduced infant mortality
Raised living standards
Education
Employment
Migration
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3
Q

What is the ideal contraceptive?

A

Reversible, simple, painless, easy to use, cheap, 100% effective.

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4
Q

What should be considered when deciding on a contraceptive form?

A

Pt preferences, hormones, compliance, menstrual cycle problems, fertility options, FHx, contraindications, age

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5
Q

What does the pearl index show?

A

The measurement of failure of a contraceptive to show its effectiveness.
For every 100 women in a years use of the contraceptive, how many get pregnant.

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6
Q

What is the rate of fertility in young women compared to at 40 and 45years and why?

A

Natural decline in fertility:
Young = 80/100
40yrs = 40/100
45yrs = 20/100

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7
Q

What is the average age of menopause?

A

51.5 years

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8
Q

What is the definition of infertility?

A

Failure to get pregnant after 18-24mnths of regular unprotected intercourse.

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9
Q

What features of intercourse favour fertility?

A

Instinct, drive, pleasure, timing, raised pH in vagina from vaginal transudate, thinning of cervical mucus, fertility window

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10
Q

When does ovulation occur?

A

14 days PRIOR to next period

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11
Q

What does natural family planning include?

A

Rhythm method - ovulation window
Changes in cervical mucus - thin in follicular phase
Changes in cervix - higher and softer during ovulation
Changes in body temp - increases at ovulation
Coitus interrupts
Lactational amenorrhoea (PI 2/100)

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12
Q

What are the advantages and disadvantages of family planning?

A

+no s.e.
+under couples control
-not reliable
-messy and clinical

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13
Q

What barrier methods are available?

A
  • Condom and femidom (2-15/100)
  • Diaphragm and cap
  • Spermicides
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14
Q

What is the disadvantage of barrier methods?

A

User dependent

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15
Q

What is the Combined hormonal contraceptive? How does it work?

A

Oestrogen and progesterone used for 21 days with a 7 day break. Aim to prevent ovulation through -ve feedback, thicken mucus and change endometrium and fallopian tube.

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16
Q

What are the forms of CHC?

A

COC
Evra patch
Nuva ring

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17
Q

What are the advantages of CHC?

A

+Highly effective, convinient and reversible
+Prevents ovulation pain
+controls bleeding
+prevents ovarian cysts
-reduces risk of ovarian and endometrial cancer
+Missed pill window of 24hrs

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18
Q

What are the disadvantages of CHC?

A
  • User dependent
  • Affected by enzyme inducers, vomiting and diarrhoea
  • Headaches
  • weight gain
  • leg cramps and bloating
  • post pill amenorrhoea
  • increased risk of breast cancer
  • risk of venous thromboembolism and arterial wall disease
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19
Q

Which hormone causes the increased risk of circulatory disease?

A

Oestrogen.

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20
Q

Who is CHC contraindicated in?

A 
Smokers
FHx of blood clots
Migraines
Hypertension
Increased age
Overweight
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21
Q

What is the aim of the progestrone only pill?

A

Taken throughout cycle with no break to cause changes in mucus, endometrium and anovluation. (0.3-4/100)

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22
Q

What are the advantages of POP?

A

+Used when CHC is contraindicated
+no increased risk of circulatory disease
+For lactating mothers, smokers, >35, hypertensive, antibiotics

23
Q

What are the disadvantages of POP?

A
  • Requires regular dose = user dependent and theraputic window of 12hrs
  • Irregular cycles
  • Ovarian cyst
  • Migrains, depression, weight gain
24
Q

Who is POP contraindicated in?

A

Pregnancy, undiagnosed genital tract bleeding, migraines

25
Q

What are LARCs? What are the options available?

A

Long acting reversible contraceptives

  • Injection
  • Implant
  • IUS/mirena
  • IUD
26
Q

Describe the injection.

A

0.1-1/100 PI which has the same actions as POP. Given every 8-12 weeks.

27
Q

What the advantages of the injection?

A

+highly effective and convenient
+Reduces bleeds so treats anaemia
+reduced pain and pelvic infection

28
Q

What are the disadvantages of injection?

A
  • cannot be removed
  • menstrual irregularities
  • delayed return of fertility
  • reduced bone mineral density
  • migraines, depression, weight gain
29
Q

What is the implant and its mode of action?

A

A subdermal implant that inhibits ovulation and increase viscosity of mucus. Last 3 years. PI 0.07/100.
Implanon or nexplanon
Has a barium coating to check location on Xray

30
Q

What are the advantages and disadvantages of implant?

A 
\+highly effective
\+User independent
\+reversible
-requires surgical removal under local anaesthetic
-Migraine, weight gain, depression
-irregular bleeds
-risk of migrating through venous system
31
Q

What is mirena?

A

IUS - a T shaped plastic device that releases hormones from its steroid reservoir around the stem. It lasts 5 years with PI 0.1/100.
Different sizes have a different dose.

32
Q

What are the advantages and disadvantages of IUS?

A

+Reduces menstrual bleeds so treats anaemia
+reduces pain, PID and ectopic
+Treat endometriosis or endometrial hypersplasia
-Irregular bleeds
-Hormonal side effects

33
Q

Who is the IUS contraindicated in?

A

Pregnancy, liver tumour, undiagnosed vaginal bleeding, pelvic infection, artificial heart valve, hormone dependent tumours

34
Q

What is the IUD and its mode of action?

A

A copper device with varying duration of 2-10 years depending on size. PI 0.2-1/100.
It induces a foreign body response in the uterus and is spermicidal. It prevents implantation (anti-abortive)

35
Q

What are the advantages and disadvantages of IUD?

A

+Highly effective and reversible
+No unwanted s.e. as no hormone involvement
+independent of intercourse
-Increased risk of ectopic and miscarriage should pregnancy occur
-anti-abortive = ethical objections
-PID, pain, abnormal bleeding
-Uterine perforation or expulsion

36
Q

What is sterilisation?

A

An irreversible method of contraception.
Males = vasectomy - risk of prostate and testicular cancer increases
Females = Tubal occlusion - risk of menstrual problems

37
Q

Why is counselling required before sterilisation?

A

Risk of failure at 1 in 20 and it is irreversible.

38
Q

What is emergency contraception? What types are available?

A

Post coital contraception to prevent ovulation or implantation. It can be hormonal:
-Levonelle
-ellaOne
or copper IUD.

39
Q

When can Levonelle be used?

A

Within 72 hours. Efficacy decreases with time. A progesterone agonist
84%<72hrs 63%>72hrs

40
Q

What is the risk with levonelle?

A

May cause nausea and vomiting. If vomiting occurs within 2hrs of taking it requires another dose or an alternative method.

41
Q

When can ellaOne be used and what is it?

A

Within 5 days (120hrs). A synthetic progesterone receptor modulator to inhibit ovulation. 60% effective

42
Q

How can the copper IUD be used as emergency contraception?

A

Can be inserted upto 5 days after with an efficacy of 99.9% as it prevents implantation.

43
Q

What is the risk with IUD?

A

Pain, bleeding, infection and requires a procedure.

44
Q

What are the 3 methods of termination?

A

Medical <9 wks using antiprogesterone drugs and PGs (95%)
Surgical 9-14 wks via vacciuum or uterus lining scrape and cervical dialtion.
Medical + dilation and evacuation at 14-24 wks. Evacuation via vaccuum, forceps or curettage

45
Q

What is menopause?

A

The cessation of menses for >1yr due to the transition into a non-reproductive phase of life. No more eggs available

46
Q

Why are symptoms experienced as menopause commences and what are they?

A

Due to reduced oestrogen and progesterone levels.

Hot flushes, night sweats, skin dryness, lethargy, loss of libido, urgency and nocturia

47
Q

Which hormone is used to diagnose menopause?

A

FSH as gonadotrophin levels increase to to gonadal insufficiency and lack of sex hormone production.

48
Q

What is HRT?

A

Used to help with symptoms and to reduce risk of osteoporotic fractures, AD, insulin resistance and CVD

49
Q

What types of HRT are there?

A

Combined - Only if uterus present to prevent endometrial hyperplasia
Oestrogen HRT - For pt with hysterectomy

50
Q

What is a red flag for endometrial cancers?

A

Postmenopausal bleeding

51
Q

When does bone density begin to fall?

A

At 28 yrs as fertility begins to decline, dramatically falls at 48yrs.

52
Q

What is the risk of combined HRT?

A

Breast cancer, CA disease, dementia, stroke (cancer risk due to progesterone)

53
Q

What is the advantage of oestrogen HRT?

A

no increased risk of breast cancer and may delay onset of AD

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