contraception, breast and FGM Flashcards
fraser criteria
Contraception can be prescribed to a girl
under 16 yrs old if:-
The girl understands the doctors advice
The doctor has tried to persuade her to tell her parents or allow him to
She will begin or continue having intercourse without contraception
Her physical or mental health is likely to suffer if she does not receive contraceptive advice
Her best interests require the prescriber to give contraceptive advice +/- treatment without parental consent
Intrauterine Contraceptive Device (IUCD) what is it how long t lasts how it works problems
Contain copper (non-hormonal). can be used as emergency contraception
Last 5-10 years
Inhibit fertilization, implantation and sperm penetration of cervical mucus
Problems: • Expulsion • Pelvic inflammatory diease • Dysmenorrhoea / Menorrgagia • Ectopic Pregnancy • Infection • Not to be used with current pelvic infection / STD
Intrauterine Contraceptive System (IUS) mirena
how it works
how long it lasts
problems
contains progesterone, local effect of reversible endometrial atrophy. Makes implantation less likely, periods lighter and less painful.
Last up to 5 years
Can be used in breastfeeding CVD. Less risk of ectopic or PID.
Problems
• Spotting / heaving bleeding in first few weeks
Ullipristal acetate (EllaOne)
what is it
how it works
contraindications
emergency contraception, initiate within 120 hours of unprotected sex.
Progesterone receptor moderator, it inhibits / delays ovulation.
Contraindications
• Not to be taken if been on hormonal pill in the last 28 days, or if on antacids.
• Avoid breast feeding 36 hours after use.
• Can only be used once in one cycle.
Levonorgestrel (levonelle)
emergency contraception, initiate within 72 hours of unprotected sex.
Inhibits ovulation.
No medical contraindications.
COCP
avoid if …
stop if …
Venous Disease (VTE, various veins)
Arterial Disease (valvular or congenital heart disease, Hx of cardiovascular disease i.e.stroke)
Liver Disease (cirrhosis, viral hepatitis)
Breast Cancer
Previous Pregnancy Complications
Overweight, smoke, over 35
Sudden severe chest pain SoB Severe calf pain Unexplained leg swelling Headache, 1st seizure, collapse, visual loss, motor/sensory loss
combined oral contraceptive pill
what it contains
how it works
Oestrogen and progesterone
Prevents ovulation, as alters cervical mucus. makes periods lighter
progesterone only pill
how it works
SE
Cerazette
Thickens cervical mucus and reduces receptivity of the endometrium to implantation. makes periods lighter
Side Effects • Higher failure rates than COCP • Ectopic pregnancy • Depression • Weight gain • Acne
Cerazette - different type of progesterone stops ovulation 98-99% -12hour window
injectable contraception
what it contains
how it works
SE
Depo-Provera
IM injection of progesterone
Inhibits ovulation by suppressing LH and FSH
makes periods lighter
Side Effects
• Osteoporosis (effects bone density)
• Menstrual disturbance
• Amenorrhoea
implant
how it works
SE
Single rod contains progesterone, slow release
Easy insertion & removal
Side effects
can cause Irregular bleeding
female sterilisation
Surgical procedure
General anaesthetic
Not easily reversible (not reversible on NHS)
male sterilisation
Not easily reversible (not reversible on NHS)
Not immediately effective
safe and effective
breast cancer risk factors
Modifiable: Weight Exercise Alcohol Extrogenous oestrogens
Non-Modifiable Age of menarche and menopause Early parity and breast feeding Breast density Heredity (BRACA 1/2)
breast cancer diagnosis
Triple Assessment:
Clinical score 1-5 (1 is normal, 5 clearly malignant)
Imaging score 1-5 (mammogram)
Biopsy score 1-5
breast cancer symptoms and signs
Painless Lump (Irregular Hard Fixed) Skin tethering Indrawn nipple Painless lump, Nipple discharge, Nipple in-drawing
breast cancer treatment
Breast Conservation + Radiotherapy.
mastectomy
TNM staging of breast cancer
T0 No evidence primary T1 <2 cm T2 2-5 cm T3 >5 cm T4 Extends to chest wall or skin or inflammatory N0 No Nodes N1 Mobile Nodes N2 Fixed/matted nodes N3 Internal Mammary nodes M0, no Metastases/M1, Metastases
breast cancer endocrine therapy and SE
Tamoxifen - inhibits the oestrogen receptor on breast cancer cells.
SE - hot flushes, nauses
aromatase enzyme Inhibitors - responsible for conversion of androgens to oestrogens in post menopausal females.
SE - hot flushes, reduced bone density
poor prognosis of breast cancer indicated by
Her-2
monoclonal antibody given adjunct to chemotherapy in breast cancer
Trastuzumab
risk management of breast cancer
lifestyle advice
prophylactic SERM
mammograms
genetic screening - BRACA 1/2, TP53
gynae complications of FGM
Dyspareunia Sexual dysfunction with anorgasmia Chronic pain Keloid scar formation Dysmenorrhoea (including haematocolpos) Urinary outflow obstruction/ recurrent UTI PTSD
obsteteric complications of FGM
Fear of childbirth
Increased likelihood of caesarean section
Increased likelihood of postpartum haemorrhage
Increased likelihood of episiotomy
ETC
