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Reproduction and Sexual Health > Contraception and Unplanned Pregnancy > Flashcards

Contraception and Unplanned Pregnancy Flashcards

1
Q

What is an IUS/ Mirena?

A

Intra-uterine system: Plastic device put into the uterus that releases progesterone

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2
Q

How long does IUS/ Mirena last for?

A

most have a five year licence

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3
Q

What is mirena coil also licensed to treat?

A

heavy periods, can be part of HRT or has therapeutic uses in endometriosis or hyperplasia

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4
Q

What side effect is very common with the mirena/ IUS?

A

irregular spotting/ PV bleeding in the first few months after insertion but this usually settle to no periods

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5
Q

Are there usually hormonal side effects with the mirena?

A

systemic hormone levels are very and hormonal side effects are rarely a problem

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6
Q

With both IUS and IUD what are risks of actually having the device inserted?

A

It’s a quick but often painful insertion, there is a small risk of perforation, malposition and expulsion

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7
Q

IUS/ Mirena typical use fail rate?

A

0.2%

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8
Q

IUD typical use fail rate?

A

0.8%

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9
Q

How long can IUD/ copper coil last for?

A

can last up to 10 years depending on device

if inserted at age over 40 it can be kept until the menopause

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10
Q

Risk of hormonal side effects with copper coil/ IUD?

A

Non hormonal so no risk of hormonal side effects

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11
Q

Effect of IUD on periods?

A

as non hormonal you still get proper periods but it can make the periods heavier, longer and more painful particularly 3/12 months post insertion
NSAIDs like ibuprofen can help with pain and bleeding

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12
Q

Describe use of IUD as emergency contraception?

A

can be used as emergency contraception up to 5 days after sex

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13
Q

What might be the only suitable and reliable method for women with breast cancer?

A

the copper coil/ IUD

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14
Q

Subdermal contraceptive implant typical use fail rate?

A

0.05%

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15
Q

What is the most effective of all contraceptive methods?

A

subdermal contraceptive implant (nexplanon)

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16
Q

How long does the subdermal contraceptive implant (nexplanon) last for?

A

3 years

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17
Q

Hormonal side effects with subdermal contraceptive implant (nexplanon)?

A

low and stable level of hormones so less hormonal side effects

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18
Q

What hormone does subdermal contraceptive implant release, what does this mean?

A

progesterone only so safe for most women

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19
Q

What is the main side effect of subdermal contraceptive implant? How can this be controlled?

A

prolonged PV bleeding

can take COCP on top of this

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20
Q

What does CHC consist of?

A

combined hormonal contraception

consists of the COCP, the ring and the patch

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21
Q

Explain the way in which the COCP is licensed to be taken?

A

start in 1st 5 days of period (to work straight away) or any time in the cycle when reasonably sure not pregnant but then need to wait 7 days for it to work
it is licensed to be taken for 21 days followed by a 7 day break which causes a withdrawal bleed

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22
Q

Explain off licensed ways the COCP can be taken?

A

some tricycle where you take the pill for 9 weeks and then bleed for 1 week
some you can take continuously but if you start bleeding for 4 days or more you stop the pill for 4 days

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23
Q

What is the biggest factor that reduces the effectiveness of the pill?

A

people forget to take it

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24
Q

If you forget to take COCP what are the rules?

A

if missed 1 pill just take it, even if take 2 at a time (dont take more than 2 at a time)
if missed 2 pills or more then you need a condom for 7 days to be protected against pregnancy
if missed 2 pills or more in first 7 days of a pack and had unprotected sex in the last 7 days, then you may need emergency contraception

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25
Q

Name 2 other factors that can reduce the effectiveness of the COCP?

A 
impaired absorption (GI conditions)
being on enzyme inducing drugs e.g. carbamazepine
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26
Q

COCP increases risk of what?

A

risk of VTE slightly increased but only really a problem in those already with risk factors of VTE (risk increased in higher oestrogen pills)
COCP can increase BP
May be increased risk of MI and ischaemic stroke
small additional risk of breast cancer and cervical cancer

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27
Q

Explain COCP and blood pressure monitoring?

A

as it can increase BP you need to get BP taken initially, at 3 months and then annually

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28
Q

Why is COCP contraindicated in smokers particularly those over 35?

A

COCP increases risk of arterial disease so if older and have risk factors like smoking then even more at risk

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29
Q

Describe COCP and contraindication in migraine?

A

COCP increases risk of ischaemic stroke in those with migraine with aura so is contraindicated (although important to check migraine with aura diagnosis is correct as many misdiagnosed)

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30
Q

Describe cancer risks and COCP?

A

there is a small additional risk of breast cancer but this goes back to baseline in 10 years of stopping
small risk of cervical cancer with use of more than 5 years so important to talk about HPV etc
there is actually 20% reduction in ovarian cancer for every 5 years on the pill used to a max of 50% after 15 years
20-50% reduction in endometrial cancer
benefit for both ovarian and endometrial cancer reduction may last decades after stopping

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31
Q

All added together COCP causes ________

A

12% decrease in all cause mortality and no overall increase in cancer risk

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32
Q

Benefits of the COCP?

A

shown to be beneficial for acne, also decreased and more regular bleeding, fewer functional ovarian cysts, decreased PMS

33
Q

Hormonal side effects of COCP?

A

nausea, worsening of acne, breakthrough bleeding, breast tenderness

34
Q

COCP typical use fail rate?

A

9%

35
Q

POP typical use fail rate?

A

9%

36
Q

What is the main POP used now?

A

desogestrel which inhibits ovulation (older pills not used but they worked by thickening cervical mucus)

37
Q

When is POP generally used?

A

when COCP is not suitable

38
Q

How is POP taken?

A

days 1-5 of period for immediate protection
or anytime if not pregnant plus condoms for 2 days
the pill has to be taken at the same time every day and if more than 12 hours late the pill won’t work

39
Q

Only contraindication to POP?

A

current breast cancer

40
Q

Risks of POP vs COCP?

A

POP doesn’t carry the same risks of VTE, arterial disease etc

41
Q

Side effects of POP?

A

same as COCP but generally get irregular bleeding

42
Q

Depoprovera/ sayanapress typical use fail rate?

A

6%

43
Q

What is Depoprovera/ sayanapress?

A

a progesterone injection, lasts for 3 months

44
Q

Who is Depoprovera/ sayanapress good for?

A

those with epilepsy as it isn’t affected by enzyme inducing drugs

45
Q

Side effects of Depoprovera/ sayanapress ?

A

hormonal side effects similar to COCP and after 3 injections hope for amenorrhoea
also weight gain
and can affect bone mass due to oestradial suppression so tend not to give to teens (when building bone mass) or close to menopause (when losing bone mass)

46
Q

Typical use fail rate of the diaphragm?

A

12%

47
Q

Explain how the diaphragm works and what scenario it may be good in?

A

it is a barrier inserted by the female with spermicide put into the vagina before sex and must be left 6hrs after and then washed with soapy water
a good option if want to space out pregnancies but not bothered if got pregnant a bit early

48
Q

Typical use fail rate of a vasectomy?

A

0.15%

49
Q

Describe effectiveness of vasectomy and factors that need to be considered?

A

very effective but need counselling, involves operation, reversals dont always work
also sometimes sterilisation doesn’t work, do post vasectomy seminal analysis at 7 months, if still motile sperm then it hasn’t worked

50
Q

Typical use fail rate of female sterilisation?

A

0.5%

51
Q

Describe effectiveness of female sterilisation?

A

fail rates are relatively high usually try and encourage use of another method

52
Q

If someone is on enzyme inducing drugs what is the only safe contraceptives they can take?

A

IUS – mirena coil, IUD
DMPA

also can use barrier methods

53
Q

3 options for emergency contraception?

A

Copper IUD
Ella one
Levonelle

54
Q

What is the most effective emergency contraception?

A

copper IUD

55
Q

Criteria for fitting copper IUD as emergency contraception? Why is not always chosen if most effective method?

A

has to be fitted with 2 important criteria?
has to be within 5 days of earliest possible date of ovulation or 5 days after a single episode of sex (have to be sure no embryo implanted already)
although most effective it’s not always practical and people may not want an IUD fitted

56
Q

How does ella one work?

A

ullipristal acetate- a progesterone receptor modulator that blocks progesterone receptors stopping LH surge so delays ovulation

57
Q

What is ella one licensed for?

A

5 days after unprotected sex

58
Q

How effective is ella one?

A

if taken within 24 hrs it’s 90% effective but as time goes on efficacy goes down

59
Q

Big disadvantage of ella one?

A

because it blocks progesterone you cant have just taken progesterone or take it after (unable to quick start contraception in young people and cant give it to someone who wants emergency contraception because theyve missed their pills)

60
Q

Mechanism of action of levonelle?

A

a big dose of progesterone hormone aiming to inhibit ovulation

61
Q

What is levonelle licensed for?

A

72 hours after unprotected sex

if used in 24hrs it’s 90% effective

62
Q

Disadvantages and advantages of levonelle?

A

it doesn’t work as well as ella one and if > 70kg need a double dose
however can take contraception with progesterone straight after if wanted

63
Q

Do levonelle or ella one work with enzyme inducing drugs?

A

no

64
Q

When do levonelle and ella one not work as well?

A

in the second half of the cycle when ovulation has already taken place

65
Q

Under what act is abortion permitted in Scotland, England and Wales? How does this differ from NI?

A

Abortion is permitted under the 1967 abortion act but in NI this has only in 2020 come in line with rest of UK
Rather than making abortion legal the Act includes exceptions to the 1861 offences against the person act where abortion had previously been a punishable offence

66
Q

Explain how abortion is certified?

A

It is certified under a specific indication (5 clauses A to E) and certified on a HSA1 form (certificate A) and signed by 2 doctors

There are 2 emergency clauses (F and G) that only need signed by 1 doctor in situations to save the mothers life or prevent grave or serious injury

67
Q

All abortions need reported to ________

A

CMO via abortion notification form

68
Q

What are most abortions certified under? What is the second most common?

A

Most abortions (98%) in UK certified under Clause C which has gestational limit of 24 weeks
“Continuing the pregnancy would involve risk of injury to the physical or mental health of the pregnant women or her existing children/family (greater than if the pregnancy were terminated)”
The next most common certification is Clause E (1-2%) which has no gestational limit
“There is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped”

69
Q

Describe conscientious objection and the abortion act?

A

Clause within the 1967 Abortion Act allowing HCPs the right to refuse to participate in abortion care
Limits of CO:
Does not apply in emergency or life-threatening situations
Should not delay or prevent a patient’s access to care
Does not apply to ‘indirect’ tasks associated with abortion e.g. administrative, supervision of staff etc

70
Q

Describe how assessment of gestation in an abortion clinic can be done?

A

can be done clinically by estimating LMP +/- date of +ve UPT
if someone has a palpable uterus they are likely more than 12 weeks
ultrasound done in some people (used to be everyone but now cause COVID they risk assess), TV if under 6 weeks if not abdominal US is done

71
Q

Explain what medical abortion involves?

A

Involves 2 medications
MIFEPRISTONE 200mg PO
MISOPROSTOL 800mcg PV/SL (24-48 hours later)

< 12 weeks gestation
Can self-administer mife/miso at home
2nd 1/2 dose misoprostol if >10 weeks or if don’t experience any bleeding in the first four hours of taking the initial dose

> 12 weeks (late or mid-trimester)
Inpatient procedure
Repeated doses of PV misoprostol: 800mcg PV then 400mcg 3-hourly PV/PO/SL (up to 4)

72
Q

1st trimester MTOP has a success rate of _____

A

95%

73
Q

Why are women given low sensitivity pregnancy tests for 2 weeks later after abortion?

A

because it takes a while for HCG to fall so high sensitivity ones might pick up the low levels of HCG and think the person is pregnant even if the abortion has worked

74
Q

What is there small risk of in MTOP?

A

1/200 procedures can fail or person won’t pass the whole pregnancy

75
Q

Explain the process of surgical abortion?

A

Removal of pregnancy via surgical procedure (usually under anaesthesia)
Cervical priming via misoprostol or osmotic dilators (Makes it easier to pass instruments through cervix associated with fewer complications)
For later surgical abortion greater extent of cervical dilation is required

< 14wks
Electric vacuum aspiration (GA)
Manual vacuum aspiration (up to 10wks; LA)
> 14wks
Dilatation and evacuation
76
Q

Describe complications of abortion?

A

abortion is generally a safe procedure
small risk of haemorrhage, failed or incomplete abortion and infection
in surgical abortions also small risk of uterine perforation or cervical trauma
risks are lower in early abortion

77
Q

Describe what prophylaxis is given in those getting an abortion?

A

antibiotic prophylaxis is given to those undergoing STOP and some MTOP if increased risk of STI or have been unable to perform screening
usually 7 days doxycycline
if rhesus neg and STOP or late MTOP may give anti-D to reduce the chance of sensitising event
VTE prophylaxis as LMWH may be given to those identified as at risk

78
Q

Describe contraception after abortion?

A

fertility returns quickly after abortion- ovulation occurs in > 90% in 1st month as early as 8 days with early MTOP
should discuss contraception at the time
almost all methods can be started at the time or soon after abortion
immediately effective if started on day otherwise time till effective depends on method

79
Q

Ella one/ ullipristal acetate should be used in caution in those with ______

A

asthma

Reproduction and Sexual Health (20 decks)

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