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Phase 3a conditions list flashcards > Contraception + infertility > Flashcards

Contraception + infertility Flashcards

1
Q

What are the methods of contraception (9)?

A
  • Natural family planning
  • Condoms/ other barrier
  • COCP
  • Progestogen only pills (POP)
  • Coils
  • Progestogen injection
  • Progestogen implant
  • Surgical sterilisation
  • Emergency contraception pill
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2
Q

What guidelines outline the risks of using different contraceptions?

A

UK medical eligibility criteria (UKMEC)

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3
Q

What are the 4 levels of UKMEC?

A
  • 1 = no risk
  • 2 = benefits outweigh the risks
  • 3 = risks outweigh benefits
  • 4 = unacceptable risk, contraindicated
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4
Q

What should you be aware of when prescribing contraception for older women (5)?

A
  • Women < 50 + last period = contraception for 2 years
  • Women > 50 +last period = contraception for 1 year
  • HRT is not contraception (need another method)
  • COCP can’t be used after 50
  • Progesterone injection can’t be used after 50 (due to osteoporosis risk)
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5
Q

When are pregnant women considered fertile after birth?

A

21 days after

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6
Q

Can women get pregnant when breastfeeding?

A

Lactational amenorrhoea (breastfeeding and no periods) is 98% effective as contraception for first 6 months

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7
Q

What are some important things to note when giving contraception to women who have given birth (4)?

A
  • Progesterone only pill/ implant can be started at any time
  • COCP when breastfeeding is UKMEC 4 (contraindicated) if <6 weeks and UKMEC 2 if >6 weeks
  • COCP must be started at least 3 weeks after pregnancy if not breatfeeding
  • IUD/ IUS must be inserted within 48 hours or after 4 weeks
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8
Q

What contraception should be avoided in breast cancer?

A

Any hormonal contraception

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9
Q

What contraception should be avoided in Wilsons disease?

A

IUD

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10
Q

What is in the COCP?

A

Oestrogen and progesterone

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11
Q

How effective is the COCP?

A

99% with perfect use (91% with standard use)

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12
Q

What age can COCP be used until?

A

50 years

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13
Q

How does the COCP prevent pregnancy (3)?

A
  • Prevents ovulation (prevents LH surge)
  • Thickens cervical mucous
  • Inhibits proliferation of endometrium preventing implantation
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14
Q

How does COCP prevent ovulation?

A

Oestrogen and progesterone surpress LH and FSH preventing ovulation

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15
Q

How should the COCP be taken?

A

Traditionally taken for 21 days, the stopped for 7 to allow for breakthrough bleed, however there is no medical benefit to having a breakthrough bleed, so COCP can be taken continuously

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16
Q

What are the benefits of COCP (3)?

A
  • Decreased risk of endometrial + ovarian cancer
  • Rapid return to fertility after stopping
  • No menstruation
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17
Q

What are the disadvantages of COCP (6)?

A
  • May forget to take pill
  • Unscheduled bleeding
  • VTE risk
  • No STI protection
  • Increased risk of breast + cervical cancer
  • Mood changes, breast tenderness, headaches
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18
Q

What are some absolute (UKMEC 4) contraindications to the COCP (8)?

A
  • Uncontrolled hypertension (160/100)
  • Migraine with aura
  • History VTE
  • Over 35 + smoking (15 fags)
  • Major surgery with immobility
  • Vascular disease/ stroke/ IHD/ AF
  • Liver cirrhosis/ tumours
  • SLE/ APL
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19
Q

What is an important UKMEC 3 to be aware of for COCP (2)?

A
  • BMI > 35
  • Wheelchair user
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20
Q

What is the advice given when starting the COCP (2)?

A
  • If < day 5 of period = immediate protection
  • If > day 5 of period = barrier contraception for 7 days
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21
Q

What is the advice if 1 missed pill of COCP (i.e. their last pill was taken 48-72 hours ago) (2)?

A
  • Take missed pill as soon as possible even if 2 pills taken in 1 day
  • No additional contraception needed
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22
Q

What is the general advice if 2 or more pills of COCP are missed (i.e. their last pill was taken more than 72 hours ago) (2)?

A
  • Take missed pill ASAP even if this means 2 pills on one day
  • Barrier contraception needed for 7 days
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23
Q

What is the additional advice if 2 or more missed pills in day 1-7 of the packet?

A

They need emergency contraception if they have had sex

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24
Q

What is the additional advice if 2 or more missed pills in day 15-21 of the packet?

A
  • No emergency contraception
  • However need to skip pill free interval (7 days) - back to back with next box of pills
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25
Q

What is the additional advice if 2 or more missed pills in day 8-14 of the packet?

A

No emergency contraception, can still have pill free interval

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26
Q

What are two important things to make patients prescribed COCP aware of?

A
  • Vomiting < 2 hours after pill = equivalent to missed pill
  • Some antibiotics e.g. rifampicin inhibit COCP
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27
Q

What are the two types of progesterone only pill?

A
  • Traditional POP (levonorgestrel)
  • Desogestrel-only-pill
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28
Q

How do the progesterone only pills work (2)?

A
  • Thicken cervical mucous
  • Desogestrel = inhibit ovulation
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29
Q

What extra way does desogestrel work as a contraception?

A

Prevents OVULATION

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30
Q

What is the advice given when starting the POP (2)?

A
  • If < 5 days of cycle = immediate protection
  • If > 5 days of cycle = barrier for 48 hours
31
Q

Do women who take POP bleed (3)?

A
  • 1/3% amenorrhoea
  • 1/3% regular bleeds
  • 1/3% irregular bleeds
    if beyond 3 months –> needs investigation
32
Q

What are the side effects/risks of POP (8)?

A
  • Irregular bleeds
  • STI risk
  • Breast tenderness
  • Headaches
  • Acne
  • Breast cancer increased risk
  • Ovarian cysts
  • Ectopic pregnancy (due to fallopian tube cilia inhibition)
33
Q

What is classified as a missed pill for traditional POP and what should be done?

A
  • 3 hours late (more than 26 hours since last pill) = missed pill
  • Emergency contraception + 48 hours of barrier
34
Q

What is classified as a missed pill for desogestrel POP and what should be done?

A
  • 12 hours late (more than 36 hours since last pill) = missed pill
  • Emergency contraception + 48 hours of barrier
35
Q

What is the only absolute contraindication to POP?

A

Breast cancer

36
Q

How often is the injection (depot provera) given?

A

12 weekly

37
Q

What is in the depot provera?

A

A type of progestin

38
Q

How is depot provera injected?

A

IM injection

39
Q

What are some side effects of the depot provera (4)?

A
  • Osteoporosis
  • Mood changes
  • Weight gain
  • Delayed fertility return
40
Q

How often is the implant changed?

A

Every 3 years

41
Q

What are some side effects/ risks of the implant (3)?

A
  • Acne
  • Mood changes
  • Spotting
42
Q

What are the two types of coils used for contraception?

A
  • Copper IUD
  • IUS
43
Q

What are some contraindications to the coil (5)?

A
  • PID
  • Pregnancy
  • Unexplained bleeding
  • Endometrial cancer
  • Distorted uterus (large fibroids)
44
Q

What are some risks/ side effects of the coils (4)?

A
  • Bleeding + pain on insertion
  • PID
  • Vasovagal reaction
  • Uterine perforations
  • Ectopic pregnancy
45
Q

What is important to exclude if the threads of a coil cannot be seen (3)?

A
  • Pregnancy
  • Uterine perforation
  • Expulsion
46
Q

How frequently do the coils need to be changed?

A
  • IUS = every 5 years
  • IUD = every 5-10 years
47
Q

What are the two surgical sterilisations available (2)?

A
  • Vasectomy (snipping vas deferens)
  • Tubal occlusion (clipping, tying or snipping the fallopian tubes)
48
Q

What are 3 forms of emergency contraception available?

A
  • Levonorgestrol (within 3 days)
  • Ulipristal (within 5 days)
  • IUD (within 5 days)
49
Q

What percent of couples will get pregnant after 1 year of UPSI?

A

85%
1/7 couples struggle to get pregnant

50
Q

What are some causes for female reduced fertility (4)?

A
  • Reduced reserve (e.g. menopause)
  • Anovulation (PCOS, sheehans, hyperthyroid, high PRL)
  • Structural (endometriosis, fibroids, turners, ashermanns)
  • Tubular (PID)
51
Q

What are some causes of male reduced fertility (6)?

A
  • Reduced sperm quality
  • Reduced testosterone
  • High prolactin
  • CF
  • Haemochromatosis
  • Kallmans, noonans, kleinfelters
52
Q

What is some general advice given to couples trying to get pregnant to improve fertility and for a healthy pregnancy (5)?

A
  • 400 mcg folic acid
  • Healthy BMI
  • Avoid smoking + drinking
  • Intercourse 2-3/ week
  • Avoid timing intercourse as increases stress
53
Q

How is fertility investigated in primary care (4)?

A
  • BMI
  • STI screening (esp chlamydia)
  • Semen analysis
  • Hormone testing
54
Q

What is analysed about the semen in semen analysis (4)?

A
  • Volume
  • Concentration
  • Motility
  • Normal morphology
55
Q

What hormones are tested to investigate infertility (6)?

A
  • FSH + LH
  • Prolactin
  • Testosterone (in males)
  • Oestrogen + progesterone (female)
  • Anti-mullerian hormone - AMH (female)
  • Sex hormone binding globulin (female)
56
Q

What investigations are done in secondary care to investigate infertility (3)?

A
  • TV USS
  • Hysterosalpingogram
  • Laparoscopy + contrast
57
Q

What is looked for on a TV USS to investigate fertility (2)?

A
  • PCOS
  • Uterine structural abnormalities
58
Q

What is looked for on a hysterosalpingogram to investigate fertility?

A

Patency of fallopian tubes

59
Q

What is looked for on a laparoscopy + contrast to investigate fertility (2)?

A
  • Patency of fallopian tubes
  • Endometriosis + adhesions
    contrast injected into uterus and should spill out ends of fallopian tubes
60
Q

Who should be referred more urgently for fertility treatment?

A

Over 35 year olds
try for another 6 months if < 35

61
Q

How should anovulation be managed?

A
  • Weight loss + healthy lifestyle
  • Clomifene
  • Ovarian drilling (burning part of ovaries that produce testosterone)
  • Metformin
  • IVF
62
Q

How does clomifene work?

A

Selective oestrogen modulator - stops negative feedback of oestrogen on hypothalamus –> increases LH + FSH

63
Q

What are some side effects of clomifene (3)?

A
  • Flushing
  • Period pain
  • Blurred vision
64
Q

How can tubal fertility problems be managed?

A

Tubal cannulation during hysterosalpingogram

65
Q

How can structural uterine problems interfering with fertility be managed?

A

Surgical correction

66
Q

What general advice can men be given to increase sperm quality?

A
  • Avoid hot baths
  • Loose underwear
  • Stop smoking + alcohol + caffeine
  • Weight loss
67
Q

How can sperm problems causing infertility be managed (2)?

A
  • Surgical sperm retrieval + intrauterine insemination (IUI)
  • Surgical correction
68
Q

How many rounds of IVF are most couples entitled to?

A

3

69
Q

What is IVF vs IUI (intrauterine insemination)?

A
  • IVF = eggs removed + fertilised in petri dish
  • IUI = sperm injected into uterus
70
Q

What are the steps in INF?

A

Suppressing natural menstrual cycle –> ovarian stimulation –> oocyte collection –> insemination –> embryo culture –> embryo transfer

71
Q

What are the complications associated with IVF (4)?

A
  • Multiple pregnancy
  • Ectopic pregnancy
  • Failure
  • Ovarian hyperstimulation syndrome
72
Q

What is the pathophysiology of ovarian hyperstimulation syndrome?

A

High BhCG (given as part of IVF) –> high VEGF (vascular endothelial growth factor) –> increased vascular permeability –> fluid movement from intravascular to extravascular space –> ascites + oedema + hypovolaemia

73
Q

What are some signs/ symptoms of ovarian hyperstimulation syndrome (6)?

A
  • Abdo pain + bloating
  • N+V
  • Diarrhoea
  • Hypotension + hypovolaemia (tachycardia)
  • Ascites
  • Pleural effusion
74
Q

How is ovarian hyperstimulation syndrome managed (4)?

A
  • IV colloids (albumin)
  • LMWH (reduce VTE risk)
  • Monitor urine output
  • Encourage oral fluids

Phase 3a conditions list flashcards (29 decks)

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