Contraception, Infertility, genital infections and STI Flashcards
what types of combined hormonal contraception exist?
pill
patch
ring
what types of progesterone only contraception exist?
mini-pill
implant
injection
what intrauterine contraception devices are there?
copper coil
hormonal coil
name some side effects of combined hormonal contraception
- headaches
- nausea
- breast tenderness
- mood swings
what does combined hormonal contraception put women at more risk of?
- venous and arterial thrombosis
- liver/gallbladder damage if underlying disease
- slightly higher risk of certain cancers (cervical, breast)
what is the mechanism of action of combined hormonal contraception?
maintain low levels of hormone causing a negative feedback to pituitary/hypothalamus
no ovulation as result
name a few benefits of the combined pill
- reduces heavy bleeding
- hormonal control (acne, hirsutism)
- reduces certain cancers (ovarian, endometrial, colon)
- reduces RA, osteoporosis
name some side effects of progestogen only contraception methods
- increased appetite
- weight gain
- headache
- acne
- mood changes
- bloatedness
- hair changes
what is the mechanism of action of progestogen contraception?
reduces ovulation
thickens cervical mucus
what are the two types of intrauterine contraception devices?
- copper (non hormonal) coil
- hormonal coil
how long after UPSI can the Levonorgestrel pill (Levonelle) be taken?
72 hours
how long after UPSI can the ulipristal pill (Ellaone)
120 hours
what is the incidence of pregnancy after taking emergency contraception measures?
0-2%
what is the most effective option for emergency contraception, and when can it be taken?
copper coil
- 120 hrs after UPSI
- by day 19 of 28 day cycle
how does the copper coil promote contraception?
copper is toxic to sperm
can stop fertilisation of egg
can stop implantation of egg
which type of progestogen only contraception has a direct causal side effects, and what are the side effects?
progestogen injection
- weight gain
- delayed return of fertility
- reduced bone density
what is an important downside to choosing progestogen injections for contraception?
it can delay return of fertility for about 9 months
what is the window of gestation during which medical termination of pregnancy can be carried out?
week 5 to 24
what is the window of gestation during which surgical termination of pregnancy can be carried out?
week 5 to 12
how is medical termination of pregnancy carried out?
- mifepristone (antiprogesterone) is given to stop its effect on endometrium
- 36-48 hours later misoprostol (prostaglandin) is given to induce uterine contractions
how is surgical termination of pregnancy carried out?
misoprostol (prostaglandin) given to initiate uterine contractions, under local or general anaesthetic
what is the contraception option for males?
vasectomy
what are the sterilisation options for women?
sterilisation:
- tube clipping
- salpingectomy
how long after delivery, miscarriage or abortion can a woman get pregnant again?
21 days after delivery
5 days after miscarriage/abortion
which type of contraception is progestogen only but doesn’t stop ovulation?
levonorgestrel (hormonal) coil
levonorgestrel is used in which types of contraception?
hormonal coil and emergency contraception pill
if a woman starts contraception at any given point of her cycle, when will she be covered?
after 7 days
if a woman starts contracaeption within first few days of her cycle, when will she be covered?
immediately
what is the legal document that describes the guidelines for termination of pregnancy?
1967 Abortion Act
who is eligible for home abortion?
healthy women who are under 10 weeks gestation
name a few possible symptoms that can present in genital infections
- ulcers
- rashes
- discharge
- pain
- lumps
- dysuria
- itch
if symptomatic, what is vulvovaginal candidosis called?
thrush
what are typical symptoms of vulvovaginal candidosis?
thick “cottage cheese” discharge
itch
what causes vulvovaginal candidosis?
candida albicans
what investigations are done to diagnose vulvovaginal candidosis?
microscopy and culture
how is vulvovaginal candidosis treated?
antifungals (azoles):
clotrimazole or fluconazole
what kind of discharge is seen in bacterial vaginosis?
thin, grey/white discharge
how is bacterial vaginosis treated?
metronidazole
clindamycin
how is ovulation assessment carried out in an infertility clinic?
serum progesterone measured halfway through luteal phase of cycle
if ovulation assessment needs to be carried out for a woman with irregular periods, what test is carried out instead of serum progesterone?
- serum gonadotrophins (FSH and LH)
- prolactin
- testosterone
- TSH
what type of imaging is carried out in an infertility clinic to assess for fallopian tube occlusion?
HyCoSy - hysterosalpingo contrast sonography
what investigations are carried out in women who have been referred to the infertility clinic?
- abdominal/pelvic exam
- rubella immunity
- STI (chlamidia) screen
- ovulation assessment
what investigations are carried out in men who have been referred to the infertility clinic?
- abdominal/inguinal/genital exam
- semen testing
if a couple presents to the GP because they are struggling to conceive, how long should they keep trying until they are referred to the infertility clinic?
one year, unless there are signs that point to infertility
what are the three groups of ovulatory disorders?
Group 1: hypothalamic-pituitary dysfunction
Group 2: hypothalamic-pituitary-ovarian dysfunction
Group 3: primary ovarian insufficiency
how are women with Group 1 ovulatory disorder managed?
- advice on BMI, intense exercise, stress reduction
- gonadotrophins/gonadotrophin releasing hormone agonist
what group of ovulatory disorders does PCOS belong to?
Group 2
what group of ovulatory disorders does primary ovarian insufficiency belong to?
Group 3
what medications are used to help induce ovulation in women with ovulatory disorders?
- clomifene
- gonadotrophins
- gonadotrophin-releasing hormone
what is the drug clomifene used for, and what is its mechanism of action?
it’s used to induce ovulation, by blocking oestrogen receptors in the pituitary and promoting FSH and LH release
when are gonadotrophins given to a woman with an ovulatory disorder?
when clomifene has not resulted in ovulation/pregnancy
what is the main disadvantage of using gonadotrophins in ovulatory disorders?
- high risk of multifollicular recruitment
- increased risk of ovarian hyperstimulation syndrome
what genetic condition can result in azoospermia, infertility and small testicles?
Klinefelter’s syndrome
what investigations are done to identify the cause of azoospermia in a man?
- FSH/LH/testosterone/prolactin
- karyotype for Klinefelter’s syndrome
- CF screen
how long should women with unexplained infertility keep trying to conceive before they can receive fertility treatment?
2 years
can women with unexplained infertility get clomifene to help them ovulate?
no
what is a tubal cause of infertility in women?
hydrosalpinx
what is the difference between IVF and ICSI?
in IVF egg and sperm fertilise on their own
in ICSI one sperm is injected directly into the egg with a needle
what is the difference between Gillick competence and Fraser guideline?
Gillick competence is used to assess the capacity of a person under 16 years of age regarding any medical decision
Fraser guideline is specific for girls under 16 who seek contraception
