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General Practice YR3 > Contraception and Sexual Health pre-work > Flashcards

Contraception and Sexual Health pre-work Flashcards

1
Q

What contraception can be used in women with idopathic menorrhagia?

A
  • All hormonal and intrauterine methods can be used
  • Consider recommending levonorgestrek intrauterine system 1st line and COCP 2nd line and POP/progesterone injection third line
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2
Q

In women with abnormal vaginal bleeding, which contraception?

A
  • Do not recommend progesterone only implant or injectable - risks outweight benefits
  • All other hormonal contraception can be used
  • Additonal investigations may be indicated prior to IUD insertion but if already fitted should be ok
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3
Q

If have previous ectopic pregnancy, which contraception?

A
  • All hormonal and IUD can be used
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4
Q

If fibroids, which contraception?

A
  • All hormonal and IUDs can be used
  • Unless distortion to uterine cavity, if so do not use IUC
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5
Q

Contraception for women with PID

A
  • Past infection - can have any
  • Current infection - cannot have copper IUD or LNG-IUS but can be left in place if already there
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6
Q

Chlamydia, purlent cervicitis or gonorrhoea - which contraception?

A
  • Current symptomatic and asymptomatic - cannot have copepr IUD or LNG-IUS, but if already fitted can be left
  • Can have any other hormonal contraception
  • For vaginitis including trich and BV can have any inc IUDs
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7
Q

Diabetic patients - which contraception?

A
  • If no vascular disease can have any
  • If micro or macrovascular disease cannot have COC pill, patch or vaginal ring
  • Previous gestational diabetes any can be used
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8
Q

Headaches - which contraception?

A
  • Non migrainous - any
  • Migraine without aura - CHC pill, patch and ring can be used but if develops in woman already using, alternative should be sought
  • Migraine with aura - cannot have any CHC
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9
Q

Contraception for multiple CVD risk factors (eg smoking, diabetes, HTN, obese and dyslipidaemia)

A
  • Cannot have CHC pill, patch or vaginal ring or progesterone only injectables
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10
Q

Women who are obese contraception?

A
  • If BMI 30 or more but less than 35 - can have any
  • If 35 or higher - cannot have CHC pill, patch or vaginal ring
  • Patch should be avoided in women over 90kg due to reduced efficacy, implant may need to be replaced sooner and PO injectable could cause further weight gain
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11
Q

Women with HTN contraception

A
  • Do not use CHC (pill, patch or ring) if BP 160/100 or higher consistently
  • Do not use in adequately controlled HTN, systolic more than 140-159 or diastolic 90-99
  • Do not use PO injectable if HTN and CVD
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12
Q

VTE contraception

A
  • Do not use CHC - pill, patch or vaginal ring if:
  • history of VTE
  • current VTE
  • major surgery with prolonged immobilisation
  • Family history of VTE in first degree relative less than 45yrs old
  • immobility unrelated to surgery eg wheelchair use
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13
Q

Women who smoke contraception

A

Do not use CHC if:
* Age 35yrs or older and smokes 15 cigarettes or more daily
* Age 35 years or older and smokes less than 15 a day
* Age 35 years or older and stopped smoking less than 1yr ago

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14
Q

Post-partum and breastfeeding contraception

A
  • Copper IUD or LNG-IUS can be used freely if less than 48hrs post partum
  • From 48hrs-4 weeks postpartum copper IUD and LNG-IUS is not reccomended
  • From 4 weeks these can be used freely
  • If post-partum sepsis do not initiate either IUDs

If hormonal:
* Less than 6 weeks post partum do not use CHC
* From 6 weeks to 6 months and onwards all hormonal methods can be used

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15
Q

Post partum and not breastfeeding contraceotion

A

IUD rules:
* Same as breastfeeding

Hormonal:
* If less than 3 weeks postpartum with other risk factors for VTE do not use CHC, also not recommended if no risk factors
* From 3-6 weeks CHC not recommended if other VTE risk factors but can be used if no other risk factors present
* From 6 weeks any hormonal can be used

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16
Q

Taking drug treatments contraception

A

Women/partners taking teratogenic meds:
* Long ARC should be used eg copper IUD, progesterone implant or LNG-IUS
* Progesterone only injection can be considered highly effective
* Ensure PPP is in place
* If wishes to use CHC or POP additional method such as condoms should be used

If liver enzyme inducing drugs
* Avoid hormonal contraception - offer copper IUD, injection or LNG-IUS

If lamotrigine:
* Avoid CHC and POP

17
Q

Mode of action of each contraception

A
  • CHC - inhibits ovulation, thickens cervical mucus, reduces endometrium receptibility to implantation
  • POP - thickens cervical mucus, reduced cilia activity in fallopian tube
  • High dose progesterone (implant or injection) - inhibits ovulation, thicken cervical mucus, thins endometrial lining
  • IUS - ovulation continues, prevents implantation by reducing endometrial proliferation and thickens cervical mucus
  • Copper IUD - toxic to ovum and sperm, cervical mucus changes, inflammation in endometrium reduces implantation
  • Barrier contraception - physical barrier +/- chemical to kill sperm
18
Q

Disadvantage of each contraceptive method

A
  • IUD - periods can become heavier, longer or more painful
  • IUS - irregular bleeding/spotting common in first 6 months
  • Injection - can’t be removed from body, side effects continue
  • Sterilisation - permanent, should not be used if any doubt
  • Patch - can be seen and cause skin irritation
  • Ring - comfortable with inserting and removing it
  • COCP - missing pills, vomitting or severe diarrhoea can make is less effective
  • POP - late pills, V&D can make less effective
  • External condom - slip off/split
  • NO STI PROTECTION for any other than condoms
19
Q

Contraindications for each contraception

A

Also read scenarios above on when you would prescribe

20
Q

Use of each contraception

A
  • Implant - works for 3 years, incision under upper arm
  • IUD - 5 or 10 years depending on type but can come out sooner
  • IUS - 3,4 or 5 years but can be taken out sooner, ligher shorter and less painful periods
  • Injection - works for 8 or 13 weeks then another IM dose
  • Patch - small patch stuck to skin, change every week for 3 weeks then have 1 week break
  • Ring - one ring for 3 weeks then change
  • COCP - can take 21 days with 7 day break or continiously with 3 breaks per year sometimes
  • POP - take same time every day with no break
21
Q

Rules on missed doses of pills - COCP

A

COCP:
* if miss one, take that one now even if it means 2 in one day and continue as normal
* If missed 2-7 or started 2 days late, pregnancy protection may be affected
* If in week 1 may need emergency contraception if had sex, take last pill you missed and use contraception for 7 days
* If week 2 or 3, do not need emergency contraception but use contraception for 7 days
* If week 3, do not have 7 day break

22
Q

Rules on missed pill - POP

A

Less than 3 hours late or less than 12 for desogestrel:
* Still protected against pregnancy
* Take pill as soon as remeber

More than 3 hrs or more than 12 for desogestrel:
* You are not protected against pregnancy
* Take the pill - only take one even if missed more than 1
* Take next pill at usual time
* Use extra contraception for next 2 days

23
Q

Side effects contraception - hormonal

A
24
Q

Sickness/diarrhoea and rules of pills

A
  • If you’re sick (vomit) within 3 hours of taking a combined pill, or within 2 hours of taking a progestogen-only pill, it probably will not have been absorbed by your body.
  • You should take another pill straight away.
  • As long as you’re not sick again, you’re still protected against pregnancy.
  • Take your next pill at the usual time.
  • If you continue to be sick or have diarrhoea for more than 24 hours, this can mean your protection against pregnancy is affected.
25
Q

3 options of post-coital contraception

A

Levonorgestrel
Ulipristal acetate (EllaOne)
Copper IUD

26
Q

Levonorgestrel - Levonelle when can it be used

A
  • Up to 72hrs following UPSI
  • High dose progesterone - inhibits ovulation
  • Pointless if already ovulated
27
Q

Ulipristal acetate - EllaOne

A
  • Can be used up to 120hrs (5 days) following UPSI
  • Selective progesterone receptor modulator - inhibits ovulation/delays
28
Q

Copper IUD - when can it be used for UPSI

A
  • Up to 5 days post ovulation
  • Prevents implantation
29
Q

G6PD and pregnancy

A
  • Haemolytic anaemia caused by G6PD deficiency may occur during pregnancy #
  • This can lead to haematological but also serious obstetrical complications such as infertility, fetus malformations and even its death.
30
Q

Male and female options sterilisation

A
  • Male - vasectomy (cut and seal off)
  • Female - tubal ligation/clipping (severe and tie off or clip)
31
Q

Contraception to avoid if wants to start family shorter term

A
  • IUD/IUS - procedure to insert and remove, risk of infection, more for longer term but still recommended
  • Depot - can take months for fertility to return
32
Q

What is Gillick competence and Fraser guidelines?

A
  • Gillick competence - medical advice usually, considered if person is under 16 and would like treatment without parental consent or if parents disagree
  • Fraser guideline is specific about sexual health and contraception if under 16
33
Q

How is someone deemed Gillick competent?

A
  • How old are they? How mature are they?
  • What’s their mental capacity?
  • Does the child understand what the treatment entails, including the pros, cons and long-term impact?
  • Does the child understand the risks, implications and consequences that could result from their decision?
  • Has the child understood the advice and information they’ve been given?
  • Is the child aware of alternative options, if available?
  • Does the child possess the ability to explain the rationale behind their decision making?
34
Q

Fraser guidelines points

A
  • Is the child mature and intelligent enough to understand the nature and implications of the treatment proposed?
  • Is it impossible to persuade the child to tell their parents, or let the Doctor tell them?
  • Are they likely to begin or continue having sexual intercourse with or without contraception?
  • Is their physical or mental health likely to suffer unless they get the advice or treatment?
  • Is the advice or treatment in their best interest?
35
Q

Capacity and consent amongst patients with learning disabilities?

A
  • Must be able to understand information
  • Weight up risks and benefits
  • And communicate back - may be issues with this, may need to use non-verbal approaches etc
36
Q
A

General Practice YR3 (31 decks)

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