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Repro and Sexual Health > Contraception; LARC and Non-LARC > Flashcards

Contraception; LARC and Non-LARC Flashcards

1
Q

What affects the choice of contraception?

A 
Effectiveness
Control
Long/short term
Non-contraceptive benefits
Procedure
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2
Q

What are the different forms of CHC?

A

Pill
Patch
Vaginal ring

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3
Q

What is the failure rate of CHC?

A

Perfect = 0.3%

Typical - 9%

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4
Q

How should the COC be taken?

A

Start in first 5 days of period; this will provide immediate contraceptive cover
OR
At any time in cycle when sure not pregnant BUT need condom use for 7 days

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5
Q

What is a tailored COC regimen?

A

Used continuously or have a pill free interval for less than 7 days

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6
Q

What is tricycling?

A

Off use COC use
Run 3 packets then withdrawal
May have breakthrough bleeding

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7
Q

What is continuous COC use?

A

Continually use pill

When breakthrough bleeding occurs; stop for 4 days and then start again

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8
Q

What factors affect the effectiveness of CHC?

A

Impaired absorption; GI conditions such as crohn’s or US
Enzyme inducing drugs
Forgetting

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9
Q

What are the 3 main risks of CHC?

A

Venous thrombosis
Arterial thrombosis
Adverse effects on breast ca

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10
Q

What is the increased risk assoc with COC and VTE?

A

Increased according to EE dose and progesterone type
Non-pregnant; 2 per 10,000 women per annum
3rd generation progesterone (gestodene, desogesterol); around 9-12 per 10,000 women

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11
Q

What is the VTE risk in pregnancy per 10,000 per annum?

A

21-30

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12
Q

What is the VTE risk in the first few weeks postnatally per 10,000 women per annum?

A

13-140

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13
Q

What advice is there surrounding VTE and COC?

A

Prescribe most effective CHC with lowest risk

Tell patients signs and symptoms of VTE (hot, swollen leg, breathlessness, chest pain etc)

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14
Q

What circulatory arterial effects can CHC have?

A

Systemic hypertension

Small increase in BP therefore must check initially, at 3 months then annually

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15
Q

Is there an increased risk of MI in CHC use?

A

Slightly, particularly smokers
Increased risk of ischaemic stroke
Hypertensive COC (systolic >160 mmHg or diastolic <95 mmHg) are at higher risk

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16
Q

What is an absolute contraindication to CHC use?

A

Migraine with aura ; massively increases risk of ischaemic stroke

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17
Q

What is an aura?

A 
Change occuring 5-20 mins before onset of headache
May be visual, typical scotoma
Altered sensation 
Smell or taste
Hemiparesis
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18
Q

Should you prescribe CHC in those over 35?

A

Relative CI; benefits still outweigh risk but consider something else

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19
Q

What cancer’s can CHC increase the risk of?

A

Breast
1.24 increased relative risk whilst using, reducing to baseline 10 years after stopping
If there is a family history of breast cancer, think about it
Small increased risk of cervical cancer with long term use

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20
Q

What can be done to reduce the risk of cervical cancer?

A

HPV (16 and 18) vaccine

Up to date with cervical screening

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21
Q

What examination is performed before prescription of CHC?

A

BP and BMI
Smear status if relevant
Discuss risk factors; family history of VTE or inherited thrombophilia, breast or cervical cancer, hypertensive, migraine with aura

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22
Q

What cancers will CHC be protective against?

A

20% reduction in ovarian cancer for every 5 years with a maximum 50% reduction after 15 years use
20-50% reduction in endometrial ca
12% reduction in all-cause mortality and no overall increased risk of ca

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23
Q

Which pill has the greatest effect on acne?

A

EE/cyproterone acetate which is an antiandrogen/progestagen and antiglucocorticoid

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24
Q

What is the downfall with dianette?

A

Higher risk of blood clot

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25
What other non-contraceptive benefits can be seen from CHC aside from acne?
Less bleeding Fewer functional ovarian cysts Premenstrual syndrome PCOS
26
Common side effects of CHC?
Nausea Spots Breast tenderness Bleeding
27
What is the difference between COC and POP?
POP you take EVERY DAY with no break, even if you start to bleed you continue to take
28
How can progesterone only methods be administered?
POP Subdermal implant DMPA
29
When should you start progesterone only methods?
Day 1-5 of period | Anytime if reasonably certain not pregnant plus condoms for 7 (2 for POP) days
30
What are the risks assoc with POP and subdermal implant?
Little effect on metabolism Can be given in most circumstances Safer than pregnancy UKMEC4 in current breast ca
31
How frequently is depot progesterone given?
Every 3 months | High change of amenorrhoea
32
What are the downsides to depo provera?
Lowers estradiol and suppresses FSH Can result in osteopenia/ osteoporosis If on POP for a long time, consider DEXA scan Advice weight bearing exercises and high calcium intake
33
Are condoms a good method for contraception?
No; high failure rate | Use for STI prevention
34
What is the effectivity rate for the diaphragm?
71-88% with typical use
35
How is a diaphragm used?
Spermicide on rim and entered into vagina | Dome sits underneath the pubic bone
36
What are the 2 rules assoc with the diaphragm?
Must be kept in for 6 hours after sex; spermicide kills sperm and vaginal pH kills sperm If you place it and don't have sex within 3 hours then you will need to reapply spermicide
37
What counselling should be offered before sterilisation?
Risks vs benefits | Regret - reversal
38
How can a vasectomy be performed?
Local or GA | No scalpel technique
39
Complications post vasectomy?
``` Anaesthetic risk Pain Injection Bleeding/ haematoma Failure Post vasectomy seminal analysis will show motile sperm at 7 months ```
40
What is the failure rate post female sterilisation?
2-3/1000 | Many LARCs will have a better contraceptive profile
41
What are the different methods for female sterilisation?
Removal Band Clip Essure
42
What is the effectiveness of natural family planning?
76%
43
Who is family planning good for?
People who want to get pregnant at some point - spacing in family Therefore don't really care if they get pregnancy
44
What does natural family planning encompass?
``` Basal body temp Cervical mucous Cervical position "Standard days" Breast feeding ```
45
What is the cervical mucous like post ovulation?
Thick and sticky
46
In a standard 28 day cycle, what days are most fertile?
8 to 18
47
What is the criteria for lactational amenorrhoea?
Exclusively breast feeding Less than 6/12 post natal Amenorrhoeic
48
What is the mode of action of CHC?
Primarily inhibits ovulation Effect on cervical mucous Effect on endometrium
49
What is the mode of action of POP?
Inhibits ovulation Effects on cervical mucous Effects on fallopian tube transport Effects on endometrium
50
How long will the contraceptive implant last?
3 years
51
What is the mode of action of the IUS?
Effect on implantation | Will also effect cervical mucus and pre-fertilization effects
52
What is the mode of action of IUD?
Prevention of fertilization | Inflammatory response in endometrium
53
What can indicate you to being reasonably certain a woman is not currently pregnant?
No sex since last period Consistently using reliable contraception < 7 days since last normal period < 4 wks post partum (not breastfeeding) Fully breastfeeding, amenorrhoeic and < 6/12 post partum Neg preg test AND > 3 weeks since UPSI
54
What is quick-starting contraception?
Starting contraception when patient presents i.e. not waiting until next period
55
What can you not quick start with?
IUD | Pills containing cyproterone acetate
56
When is emergency contraception required in terms of contraception failure?
More than one COC missed Patch/ ring has been off/ out for more than 48 hours Implant filled out with first 5 days of cycle and UPSI within first 7 days of use
57
What are the 3 methods of EC?
Copper IUD LNG-EC (72 hours post UPSI) UPA-EC (120 hrs post UPSI)
58
What is the mode of action of the copper IUD?
Should be offered to all eligible women requesting EC Pre and post fertilisation effects Toxic to sperm/ ovum Anti-implantation
59
When can Cu IUD be inserted?
Up to 120 hours post -UPSI Up to 5 days after earlisest expected date of ovulation Can be retained for ongoing contraception
60
When will a pregnancy implant?
84% implant at 8-10 days post fertilisation | Hence Cu IUD can be fitted up to 5 days post UPSI
61
Mode of action of UPA-EC?
Anti-progesterone - delays ovulation | Works until after start of LH surge but not after peak
62
Mode of action of LNG-EC?
High dose progesterone - delays ovulation | Works before LH surge
63
Do either of the oral ECs work after ovulation?
No
64
When is UPA avoided?
If wishin to quick start hormonal contraception as must delay ongoing contraception for 5 days If hormonal contraception has been used in past 7 days If patient has acute severe asthma uncontrolled by oral steroids
65
What is the life span of a sperm and ovum?
Sperm; 6 days | Ovum; 2 days
66
Risks assoc with copper IUD?
5% are expelled by a uterus Assoc with PID up to 21 days following insertion Can cause dysmenorrhoea and menorrhagia Risk of ectopic pregnancy is 1:20 if pregnancy occurs
67
CI to Cu IUD insertion?
``` Pregnancy Current PID. STI Allergy to copper Wilson's disease Heavy/painful periods Trophoblastic disease or gynaecological malignancy Undiagnosed abnormal uterine bleeding ```
68
When can Cu IUD be inserted after ToP/miscarriage and birth?
ToP/miscarriage: immediate | Birth; 4 wks
69
When should women check for the threads of Cu IUD?
After each period
70
In what high risk groups can mirena be used?
Obese Breastfeeding CV disease Women taking hepatic-enzyme inducing drugs
71
What side effects commonly occur in the first few weeks post IUS insertion?
Spotting +/- heavy bleeding
72
What is a CI to UPA EC?
If vomiting occurs less than 3 hours; need another dose Within 28 days of taking enzyme inducer Antacids or drugs that increase gastric pH Severe asthma uncontrolled by oral corticosteroids Liver dysfunction
73
Can you breastfeed post UPA EC?
Wait 36 hours
74
Oestrogenic side effects of COC?
``` Breast tenderness Nausea Cyclical weight gain Bloating Vaginal discharge ```
75
Progestogenic SE of COC
``` Mood swings PMT Vaginal dryness Sustained weight gain Decreased libido Acne ```
76
When should emergency contraception be used in terms of missed pills?
If 3 or more 30-35mcg pills or 2 or more 20mcg pills forgotten in 1st 7 days of pack and UPSI occured If 1 or more POP missed or taken >3hrs late
77
What contraceptive methods act to prevent fertilization?
``` Condoms Diaphragm + spermicide Female and male sterilisation IUD Hormonal methods ```
78
What contraceptive methods act to prevent implantation?
IUD (copper coil) | Hormonal methods
79
What contraceptive methods have a direct toxic effect?
Cu IUD | Spermicides
80
Which contraceptive methods result in ovulation suppression?
``` CHC Injection Subdermal implant Lactational amenorrhoea POP IUS ```
81
What should raise child protection or wellbeing concerns?
Coitarche or any other sexual activities under 13 Partner (s) age difference of > 2 years Drug/alcohol use Other vulnerability factors; in care, out of school/ education, mental health
82
What is the window period for CT/GC, HIV/sphyilis and Hep B/C?
Chlamydia/gonorrhoea: NAAT 2 weeks HIV/syphilis: 4 weeks Hep B/c: 12 weeks
83
What are the non-contraceptive benefits of hormonal contraception?
``` Period pain Heavy menstrual bleeding Irregular PV bleeding Mittelschmerz PMS Cyclical breast tenderness Ovarian cysts Endometriosis Ovarian cancer Acne or hirsutism (CHC only) ```
84
How long do copper coils last?
10 years depending on device Non-hormonal Can be used as emergency contraception
85
SE of copper coil
Can make periods heavier, longer and more painful esp during first 3/12 post insertion
86
What is mirena licensed for?
Heavy periods HRT Endometriosis Hyperplasia
87
What is the percentage of amenorrhoea at 6/12 on mirena?
50%
88
What is the most effective of all contraceptive methods?
Subdermal contraceptive implant
89
What is the main se of subdermal implant?
Prolonged PV bleeding

Repro and Sexual Health (77 decks)

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