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Repro > Contraception LARC > Flashcards

Contraception LARC Flashcards

1
Q

Approx. what percentage of pregnancies in UK are unplanned?

A

40%

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2
Q

What is the main mechanism of most hormonal methods, how does it do it and what is the one exception?

A

Main mechanism is prevention of ovulation by suppressing FSH and LH by negative feedback on hypothalamus/pituitary and the exception is the hormonal coil

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3
Q

By what shared mechanism do IUS, DMPA, POP, SDI prevent pregnancy?

A

thickened cervical mucous so prevention of fertilisation

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4
Q

By what shared mechanism do CHC, DMPA, SDI, LAM, Desogestrel-containing POP, (IUS) prevent pregnancy?

A

ovulation suppression

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5
Q

By what shared mechanism do IUD (copper) and spermicides prevent pregnancy?

A

Direct toxic effect so prevent fertilisation and implantation

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6
Q

By what shared mechanism do female sterilisation and vasectomy prevent pregnancy?

A

Tubal occlusion so prevents fertilisation

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7
Q

By what shared mechanism do condoms, diaphragms and cervical caps prevent pregnancy?

A

By creating a mechanical barrier preventing fertilisation

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8
Q

By what shared mechanism do IUS, IUD, SDI, DMPA, POP, CHC prevent pregnancy?

A

Endometrial changes/thinning so prevent implantation

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9
Q

List some non-contraceptive benefits of hormonal contraception i.e. other reasons to take it

A 
Helps with: 
period pain, 
heavy bleeding, 
irregular PV bleeding, 
ovulation pain, 
PMS, 
cyclical breast tenderness, 
ovarian cysts, 
endometriosis, 
ovarian cancer, 
acne/hirsutsim
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10
Q

What contraceptives help with irregular PV bleeding?

A

CHC, IUS and DMPA

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11
Q

What contraceptive is mainly used to treat PMS?

A

CHC

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12
Q

What is the only contraceptive that helps with acne/hirsutism?

A

CHC

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13
Q

What does DMPA stand for? List 2 brand names.

A

Depot medoxyprogesterone acetate. Depoprovera and sayanapress

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14
Q

List 7 factors to consider in deciding best contraceptive method.

A 
personal preference, 
non-contraceptive benefits, 
medical eligibility,
 age, 
accessibility of method, 
acceptability of side effects, 
life situation
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15
Q

What is a common brand name for SDI - subdermal implant?

A

Nexplanon

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16
Q

What is common brand name for combined hormonal ring?

A

Nuvaring

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17
Q

What is common brand name for combined hormonal patch?

A

Evra

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18
Q

What is common brand name for combined hormonal patch?

A

Evra

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19
Q

What is the difference between LARC and non-LARC contraceptive methods and give examples.

A

LARC (long acting reversible contraceptive) have very similar failure rates with typical and perfect use whereas non-LARC have higher failure rates with typical use in comparison to their rates with perfect use. Examples of LARC are implant, sterilisation, IUS and IUD

20
Q

What is the difference between LARC and non-LARC contraceptive methods and give examples.

A

LARC (long acting reversible contraceptive) have very similar failure rates with typical and perfect use whereas non-LARC have higher failure rates with typical use in comparison to their rates with perfect use. Examples of LARC are implant, sterilisation, IUS and IUD

21
Q

List some reasons for user failure with CHC, POP and DMPA.

A

poor compliance, wrong use, wrong storage (ring), drug interaction with OTC drugs (e.g. St. John’s Wort), no extra precaution when quickstarting

22
Q

What are 2 common brand names for copper coil?

A

Nova T IUD and T-safe IUD

23
Q

What are 3 brand names for intra-uterine systems and which has silver ring (IUS)?

A

Mirena, Kyleena and Jaydess (has silver ring)

24
Q

What is in the stem of IUS?

A

Levonorgestrel

25
Q

What are benefits of hormone and copper coils?

A

long lasting, very effective (<1% failure rate)

26
Q

What are downsides of hormone and copper coils?

A

invasive and painful procedure, small risk of perforation (1:1500), PID (1:200) and malposition or expulsion (1:20)

27
Q

Give two examples in which hormone and copper coils are unsuitable?

A

in women with submucosal fibroids and in uterine malformation

28
Q

What is the main mechanism of contraception of hormone and copper coils?

A

Mainly prevent fertilisation but also prevent implantation

29
Q

How long can copper coil last?

A

Up to 10years

30
Q

If copper coil (IUD) is inserted >40 years it can be kept in until the menopause. True/false?

31
Q

If copper coil (IUD) is inserted >40 years it can be kept in until the menopause. True/false?

32
Q

In what scenario can copper coil be used as emergency contraception?

A

Up to 5 days after sex or 5 days after the earliest estimated date of ovulation

33
Q

IUD is the only suitable method of for women after what illness?

A

Breast cancer

34
Q

Why do IUDs make periods heavier, longer and more painful?

A

copper increases blood flow

35
Q

Which is more effective - IUD or IUS?

36
Q

Which IUS have 5 year license and which has 3? also which has silver ring?

A

Mirena, Levosert and Kyleena have 5 yr and Jaydess has 3 year and silver ring

37
Q

Mirena coil is licensed to treat heavy periods and can be part of HRT. What additional therapeutic uses does it have?

A

therapeutic use in endometriosis and hyperplasia

38
Q

What percent of patients with Mirena have amenorrhoea at 6/12?

39
Q

Why are hormonal side effects rarely a problem with IUS?

A

Systemic hormone levels are very low

40
Q

Heavy bleeding is common with IU_ for first few months after insertion and irregular spotting/PV is very common in first few months with IU_.

A

Heavy - IUD

Irregular - IUS

41
Q

What are the benefits of SDI?

A 
most effective of all contraceptive methods, 
safe for most women, 
lasts 3 years, 
less hormonal side effects, 
progestogen only (safe for most comen)
42
Q

What are downsides of SDI?

A

Invasive (cryospray can be used for insertion), side effect prolonged PV bleeding,

43
Q

What are downsides of SDI?

A

Invasive (cryospray can be used for insertion), side effect prolonged PV bleeding,

44
Q

What other DD must you exclude if bleeding due to SDI?

A

cervicitis/endometritis due to STI,
pregnancy complicated,
cervical ca,
cervical polyp

45
Q

What is potential treatment for bleeding with SDI?

A

CHC in addition

46
Q

What do UKMEC Categories 1, 2, 3 and 4 mean?

A

1: Always usable - no risk.
2: B - broadly useable, advantages > risk associated with condition.
3: C - Counsel/caution, risks due to condition > advantages of method, need expert opinion.
4: D - do not use! contraindicated.

47
Q

Some big themes of UK MEC are VTE, CVD risk, liver problems hormone dependent cancers. When would you add points together?

A

Where there may be concern as to two risks that may mutually worsen overall risk, contribute to higher risk

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