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CONTRACEPTION AND STERILIZATION Flashcards

1
Q

What are the different types of contraception used today?

A

Natural methods

Barrier methods

Hormonal contraception

Intrauterine devices and Mirena intrauterine system

Emergency contraception

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2
Q

What are the different natural methods used as contraception?

A

Rhythm method

Coitus interruptus

Breast-feeding

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3
Q

What are the fertility indicators used to make the rhythm method of contraception more effective?

A

A menstrual calendar

Chart basal body temp - rises by 0.2 - 0.4 ˚C when progesterone is released

Recognise changes in cervical mucus

Ovulation predictor kits eg Persona

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4
Q

What are the different barrier methods of contraception?

A

Male condom

Diaphragm
Cervical cap
Female condom

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5
Q

How can barrier methods of contraception be increased in effectiveness?

A

The addition of nonoxynol-9 which is a spermicidal

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6
Q

What are the advantages of method barriers compared to oral contraceptives?

A

Protection against STIs

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7
Q

What are the components of the combined oral contraceptive pill? What are the modes of action of the combined oral contraceptive pill?

A

Ethinyl oestradiol with levonorgestrel or norethisterone

Inhibits ovulation

Prevents LH surge

Thins endometrium

Thickens cervical mucus to prevent sperm reaching uterus

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8
Q

What are the absolute contraindications to prescribing the COCP?

A

Pregnancy

Arterial or venous thrombosis (MI or stroke)

Undiagnosed vaginal bleeding

History of oestrogen-dependent tumour

Recent hydatidiform mole

Breast feeding less than 6 weeks post partum

Migraine with aura

Age over 35 and smoking more than 15 a day

BP of more than 160 systolic or 95 diastolic

Major surgery with prolonged immobilisation

Diabetes diagnosed over 20 years old

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9
Q

What are the relative contraindications to prescribing the COCP?

A

Family history of thrombosis - consider investigations for thrombophilia

Hypertension

Varicose veins

Breast feeding 6 weeks - 6 months post partum

Migraine without aura and over 35 years old

BMI over 35

Immobilty - eg wheelchair use

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10
Q

What are the advantages of the COCP?

A

Reliable if taken correctly

Reduces menorrhagia, dysmenorrhoea and premenstrual syndrome

Controls functional ovarian cysts

Reduces risk of ovarian and endometrial carcinoma

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11
Q

What are the main risks of the COCP?

A

Cardiovascular complications

VTE

Increased risk of cervical cancer

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12
Q

What are the side effects of the COCP?

A

Weight gain

Decreased libido

Breast discomfort

Mood disturbance

Breakthrough bleeding

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13
Q

What should patients be warned about when prescribing the COCP?

A

Reduced efficacy with some antibiotics ( amoxicillin, ampicillin, erythromycin and tetracycline) and other liver-enzyme inducing drugs

Will not take effect for 7 days so use barrier contraception until then

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14
Q

Who would you choose to prescribe the progesterone-only pill for rather the COCP?

A

In those in whom oestrogen is contraindicated
This includes women over 35 who smoke

Those who are breast feeding

Nulliparous women

Women who have had an abortion

Women with diabetes

Women with migraine with aura

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15
Q

What are the advantages of the progesterone only pill versus the COCP?

A

Very few side effects

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16
Q

What is the cut off time for missing a progesterone only pill beyond which action must be taken? What action must be taken?

A

Traditional POPs: 3 hours (i.e. more than 27 hours since the last pill was taken)

Cerazette (desogestrel): 12 hours

Take missing pill. Then take next pill at what would have been usual time. Use condoms for 48 hours. Continue rest of pack.

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17
Q

What are the main risks of the progesterone only pill?

A

Very small risk of ectopic pregnancy

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18
Q

What are the injectable methods of contraception and how often do they need to be given?

A

Intramuscular injections of medroxyprogesterone acetate given every 3 months (Depo-provera)

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19
Q

What are the disadvantages of the injectable progesterones (Depo-provera) as contraception?

A

Cannot be removed and any side effects must be tolerated for 3 months

Can have heavy unpredictable bleeding patterns

Delay to return to full fertility of up to 12-18 months

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20
Q

What are the main side effects of the injectable progesterones (Depo-provera)?

A

Slight weight gain

Osteoporosis with long term use

Amenorrhoea in 50% by 1 year and 70% by 2 year

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21
Q

What is the main risk of the injectable progesterones (Depo-provera)?

A

Prolonged used has been associated with osteoporosis

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22
Q

Other than oral methods of hormonal contraception, what systemic methods of hormonal contraception are widely used?

A

Injectable progesterones (Depo-provera)

Progestin implant

Transdermal combined contraceptive patch

Combined contraceptive vaginal ring

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23
Q

What is the drug contained in the implantable contraceptive and how often does the implant have to be changed?

A

Etonogestrel

Every 3 years

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24
Q

What are the advantages of the progestin implant over the depo preparation (injectable)?

A

Quicker return to fertility

Regular menses once discontinued

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25
Q

What are the main side effects and contraindications of the progestin implant?

A

Side effects:

Irregular periods

Headache, nausea, breast pain

Small risk of increase in acne

Contraindications:

Breast cancer in the last 5 years

Unexplained vaginal bleeding

Hepatitis

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26
Q

What are the different intrauterine methods of contraception?

A

IUCD - intrauterine contraceptive device - copper coil

IUS - MIRENA intrauterine system - contains progesterone

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27
Q

What are the contraindications to the intrauterine device?

A

Pregnancy

Undiagnosed uterine bleeding

Active or past history of PID

Previous ectopic pregnancy

Previous tubal surgery

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28
Q

How long can an IUCD or IUS remain in place for before it needs to be changed?

A

IUCD: 5 to 10 years

IUS: 3 to 5 years

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29
Q

What are the risks and side effects of intrauterine contraceptive devices?

A

Both types:

Infection - PID

Uterine perforation

Ectopic pregnancy

Expulsion of IUCD/IUS

IUCD:

Menorrhagia

IUS:

Oligomenorrhoea / amenorrhoea

Spotting

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30
Q

What is the most common method of female sterilization?

A

Application of Falope rings or Filshie clips to each fallopian tube laparoscopically

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31
Q

What must a female patient do before having a sterilizing procedure?

A

Ensure she has completed her family and considered all other methods of contraception.

Go through a course of counselling.

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32
Q

What is the most common method of male sterilization?

A

Vasectomy - vas deferens is ligated via bilateral incisions in the scrotum

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33
Q

What are the complications of vasectomy?

A

Chronic testicular pain

Develop anti-sperm antibodies

34
Q

What are the two forms of oral emergency contraceptive?

A

Levonorgestrel

Ulipristal acetate

35
Q

What is the first line form of emergency contraceptive?

A

Levonorgestrel (Levonelle)

36
Q

What is the time window within which levonorgestrel must be taken after UPSI?

A

ASAP - maximum 72 hours

37
Q

What is the dose of levonorgestrel used as emergency contraception?

A

1.5 mg stat

38
Q

What hormone is contained in levonorgestrel, the emergency contraceptive pill?

A

Progesterone

39
Q

What is the success rate of levonorgestrel if used within 72 hours of UPSI?

A

84%

40
Q

What are the side effects of levonorgestrel?

A

Vomiting occurs in 1%: Remember that if vomiting occurs within 2 hours of taking, then dose must be repeated, possibly with domperidone.

Early or late periods

41
Q

Can levonorgestrel be used more than once per cycle as emergency contraceptive?

A

Yes

42
Q

What is the market name for ulipristal acetate?

A

EllaOne

43
Q

What is the time window within which ulipristal acetate (EllaOne) must be taken after UPSI?

A

ASAP - 120 hours

44
Q

What are the side effects of using ulipristal acetate?

A

Reduces effectiveness of hormonal contraception for the rest of that cycle so barrier methods of contraception should be used.

45
Q

How long after a dose of ulipristal acetate (EllaOne) can hormonal contraception be restarted?

A

5 days

46
Q

Can levonorgestrel be used more than once per cycle as emergency contraceptive?

A

No

47
Q

What are the contraindications to using ulipristal acetate as emergency contraception?

A

Severe asthma

Breast feeding

48
Q

Is levonorgestrel safe in breast feeding?

A

Yes

49
Q

Is ulipristal acetate safe in breast feeding?

A

No - should be delayed for one week

50
Q

What are the non oral forms of emergency contraception?

A

Insertion of IUD

51
Q

What is the time window within which IUD must be inserted after UPSI?

A

5 days

May be fitted within 5 days of likely ovulation date if outside 5 day window post UPSI.

52
Q

How effective is the IUD when used as emergency contraception?

A

99%

53
Q

If the client wants the IUD removed having used it as emergency contraception, how long must she wait?

A

Kept in until next period

54
Q

What can be prescribed for short term cessation of menses, eg for going on holiday?

A

Norethisterone 5 mg TDS

55
Q

If a patient misses two COC pills in the third week of the pill packet, what should they be advised to do?

A

Omit the pill interval, ie carry straight on with the next packet once she has finished this packet.

Also she should use another method of contraception for 7 days.

56
Q

How long do each of the methods of contraception take to have a contraceptive effect?

COCP?
POP?
IUS?
IUD?
Implant?
Injection?
A

Instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS

COCP: 7 days
POP: 2 days
IUS: 7 days
IUD: instant
Implant: 7 days
Injection: 7 days
57
Q

If a woman chooses not to breastfeed, how long postpartum will she naturally be covered before needing contraception?

A

21 days

58
Q

How long after delivery is the earliest point that the IUD be inserted?

A

28 days

59
Q

How many pills of the COCP must a woman miss to be under threat of conception if she has UPSI?

A

2 or more (so at least 48 hours since she last took the pill)

If less than this then she should take the missed pill and continue as normal

60
Q

What is the failure rate per year of use of the following method of contraception when used alone and in (a) an average typical way (rather than the perfect way) and (b) a perfect way?

Spermicides

A

(a) 29%

(b) 18%

61
Q

What is the failure rate per year of use of the following method of contraception when used alone and in (a) an average typical way (rather than the perfect way) and (b) a perfect way?

Withdrawal method

A

(a) 27%

(b) 4%

62
Q

What is the failure rate per year of use of the following method of contraception when used alone and in (a) an average typical way (rather than the perfect way)?

Calendar

A

(a) 9%

63
Q

What is the failure rate per year of use of the following method of contraception when used alone and in (a) an average typical way (rather than the perfect way) and (b) a perfect way?

Cap - parous women

A

(a) 32%

(b) 9%

64
Q

What is the failure rate per year of use of the following method of contraception when used alone and in (a) an average typical way (rather than the perfect way) and (b) a perfect way?

Cap - nulliparous women

A

(a) 16%

(b) 6%

65
Q

What is the failure rate per year of use of the following method of contraception when used alone and in (a) an average typical way (rather than the perfect way) and (b) a perfect way?

Diaphragm

A

(a) 16%

(b) 6%

66
Q

What is the failure rate per year of use of the following method of contraception when used alone and in (a) an average typical way (rather than the perfect way) and (b) a perfect way?

Female condom

A

(a) 21%

(b) 5%

67
Q

What is the failure rate per year of use of the following method of contraception when used alone and in (a) an average typical way (rather than the perfect way) and (b) a perfect way?

Male condom

A

(a) 15%

(b) 2%

68
Q

What is the failure rate per year of use of the following method of contraception when used alone and in (a) an average typical way (rather than the perfect way) and (b) a perfect way?

COCP

A

(a) 8%

(b) 0.3%

69
Q

What is the failure rate per year of use of the following method of contraception when used alone and in (a) an average typical way (rather than the perfect way) and (b) a perfect way?

Combined hormonal patch

A

(a) 8%

(b) 0.3%

70
Q

What is the failure rate per year of use of the following method of contraception when used alone and in (a) an average typical way (rather than the perfect way) and (b) a perfect way?

Combined hormonal ring (NuvaRIng)

A

(a) 8%

(b) 0.3%

71
Q

What is the failure rate per year of use of the following method of contraception when used alone and in (a) an average typical way (rather than the perfect way) and (b) a perfect way?

Copper IUD

A

(a) 0.8%

(b) 0.6%

72
Q

What is the failure rate per year of use of the following method of contraception when used alone?

Mirena IUS

A

0.1%

73
Q

What is the failure rate per year of use of the following method of contraception when used alone?

Implant

A

0.05%

74
Q

What is the failure rate per year of use of the following method of contraception when used alone?

Female sterilisation

A

0.5%

75
Q

What is the failure rate per year of use of the following method of contraception when used alone?

Male sterilisation

A

0.15%

76
Q

How does the copper IUD work as a method of contraception?

A

Prevents fertilisation and inhibits implantation

77
Q

How does the Mirena IUS work as a method of contraception?

A

Prevents implantation and sometimes fertilisation

78
Q

How does the progesterone only injection work as a method of contraception?

A

Prevents ovulation

79
Q

How does the progesterone only subdermal implant work as a method of contraception?

A

Prevents ovulation and alters the quality of cervical mucus

80
Q

How does the transdermal contraceptive patch work as a method of contraception?

A

Much in the same way as COCP:

Inhibits ovulation

Prevents LH surge

Thins endometrium

Thickens cervical mucus to prevent sperm reaching uterus

81
Q

How does the progesterone only pill work as a method of contraception?

A

Traditional POPs: alters cervical mucus to sperm penetration, may prevent ovulation.

Cerazette (desogestrel): Main method is inhibit ovulation. May also affect mucus.

o&g (34 decks)

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