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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
What are benefits of hormone and copper coils?
long lasting, very effective (<1% failure rate)
26
What are downsides of hormone and copper coils?
invasive and painful procedure, small risk of perforation (1:1500), PID (1:200) and malposition or expulsion (1:20)
27
Give two examples in which hormone and copper coils are unsuitable?
in women with submucosal fibroids and in uterine malformation
28
What is the main mechanism of contraception of hormone and copper coils?
Mainly prevent fertilisation but also prevent implantation
29
How long can copper coil last?
Up to 10years
30
If copper coil (IUD) is inserted >40 years it can be kept in until the menopause. True/false?
True
31
If copper coil (IUD) is inserted >40 years it can be kept in until the menopause. True/false?
True
32
In what scenario can copper coil be used as emergency contraception?
Up to 5 days after sex or 5 days after the earliest estimated date of ovulation
33
IUD is the only suitable method of for women after what illness?
Breast cancer
34
Why do IUDs make periods heavier, longer and more painful?
copper increases blood flow
35
Which is more effective - IUD or IUS?
IUS
36
Which IUS have 5 year license and which has 3? also which has silver ring?
Mirena, Levosert and Kyleena have 5 yr and Jaydess has 3 year and silver ring
37
Mirena coil is licensed to treat heavy periods and can be part of HRT. What additional therapeutic uses does it have?
therapeutic use in endometriosis and hyperplasia
38
What percent of patients with Mirena have amenorrhoea at 6/12?
50%
39
Why are hormonal side effects rarely a problem with IUS?
Systemic hormone levels are very low
40
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_.
Heavy - IUD | Irregular - IUS
41
What are the benefits of SDI?
``` most effective of all contraceptive methods, safe for most women, lasts 3 years, less hormonal side effects, progestogen only (safe for most comen) ```
42
What are downsides of SDI?
Invasive (cryospray can be used for insertion), side effect prolonged PV bleeding,
43
What are downsides of SDI?
Invasive (cryospray can be used for insertion), side effect prolonged PV bleeding,
44
What other DD must you exclude if bleeding due to SDI?
cervicitis/endometritis due to STI, pregnancy complicated, cervical ca, cervical polyp
45
What is potential treatment for bleeding with SDI?
CHC in addition
46
What do UKMEC Categories 1, 2, 3 and 4 mean?
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
Some big themes of UK MEC are VTE, CVD risk, liver problems hormone dependent cancers. When would you add points together?
Where there may be concern as to two risks that may mutually worsen overall risk, contribute to higher risk

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