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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
Q

What other non-contraceptive benefits can be seen from CHC aside from acne?

A

Less bleeding
Fewer functional ovarian cysts
Premenstrual syndrome
PCOS

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26
Q

Common side effects of CHC?

A

Nausea
Spots
Breast tenderness
Bleeding

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27
Q

What is the difference between COC and POP?

A

POP you take EVERY DAY with no break, even if you start to bleed you continue to take

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28
Q

How can progesterone only methods be administered?

A

POP
Subdermal implant
DMPA

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29
Q

When should you start progesterone only methods?

A

Day 1-5 of period

Anytime if reasonably certain not pregnant plus condoms for 7 (2 for POP) days

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30
Q

What are the risks assoc with POP and subdermal implant?

A

Little effect on metabolism
Can be given in most circumstances
Safer than pregnancy
UKMEC4 in current breast ca

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31
Q

How frequently is depot progesterone given?

A

Every 3 months

High change of amenorrhoea

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32
Q

What are the downsides to depo provera?

A

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

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33
Q

Are condoms a good method for contraception?

A

No; high failure rate

Use for STI prevention

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34
Q

What is the effectivity rate for the diaphragm?

A

71-88% with typical use

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35
Q

How is a diaphragm used?

A

Spermicide on rim and entered into vagina

Dome sits underneath the pubic bone

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36
Q

What are the 2 rules assoc with the diaphragm?

A

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
Q

What counselling should be offered before sterilisation?

A

Risks vs benefits

Regret - reversal

38
Q

How can a vasectomy be performed?

A

Local or GA

No scalpel technique

39
Q

Complications post vasectomy?

A 
Anaesthetic risk
Pain
Injection 
Bleeding/ haematoma
Failure 
Post vasectomy seminal analysis will show motile sperm at 7 months
40
Q

What is the failure rate post female sterilisation?

A

2-3/1000

Many LARCs will have a better contraceptive profile

41
Q

What are the different methods for female sterilisation?

A

Removal
Band
Clip
Essure

42
Q

What is the effectiveness of natural family planning?

A

76%

43
Q

Who is family planning good for?

A

People who want to get pregnant at some point - spacing in family
Therefore don’t really care if they get pregnancy

44
Q

What does natural family planning encompass?

A 
Basal body temp
Cervical mucous
Cervical position 
"Standard days" 
Breast feeding
45
Q

What is the cervical mucous like post ovulation?

A

Thick and sticky

46
Q

In a standard 28 day cycle, what days are most fertile?

A

8 to 18

47
Q

What is the criteria for lactational amenorrhoea?

A

Exclusively breast feeding
Less than 6/12 post natal
Amenorrhoeic

48
Q

What is the mode of action of CHC?

A

Primarily inhibits ovulation
Effect on cervical mucous
Effect on endometrium

49
Q

What is the mode of action of POP?

A

Inhibits ovulation
Effects on cervical mucous
Effects on fallopian tube transport
Effects on endometrium

50
Q

How long will the contraceptive implant last?

A

3 years

51
Q

What is the mode of action of the IUS?

A

Effect on implantation

Will also effect cervical mucus and pre-fertilization effects

52
Q

What is the mode of action of IUD?

A

Prevention of fertilization

Inflammatory response in endometrium

53
Q

What can indicate you to being reasonably certain a woman is not currently pregnant?

A

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
Q

What is quick-starting contraception?

A

Starting contraception when patient presents i.e. not waiting until next period

55
Q

What can you not quick start with?

A

IUD

Pills containing cyproterone acetate

56
Q

When is emergency contraception required in terms of contraception failure?

A

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
Q

What are the 3 methods of EC?

A

Copper IUD
LNG-EC (72 hours post UPSI)
UPA-EC (120 hrs post UPSI)

58
Q

What is the mode of action of the copper IUD?

A

Should be offered to all eligible women requesting EC
Pre and post fertilisation effects
Toxic to sperm/ ovum
Anti-implantation

59
Q

When can Cu IUD be inserted?

A

Up to 120 hours post -UPSI
Up to 5 days after earlisest expected date of ovulation
Can be retained for ongoing contraception

60
Q

When will a pregnancy implant?

A

84% implant at 8-10 days post fertilisation

Hence Cu IUD can be fitted up to 5 days post UPSI

61
Q

Mode of action of UPA-EC?

A

Anti-progesterone - delays ovulation

Works until after start of LH surge but not after peak

62
Q

Mode of action of LNG-EC?

A

High dose progesterone - delays ovulation

Works before LH surge

63
Q

Do either of the oral ECs work after ovulation?

A

No

64
Q

When is UPA avoided?

A

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
Q

What is the life span of a sperm and ovum?

A

Sperm; 6 days

Ovum; 2 days

66
Q

Risks assoc with copper IUD?

A

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
Q

CI to Cu IUD insertion?

A 
Pregnancy 
Current PID. STI 
Allergy to copper
Wilson's disease 
Heavy/painful periods 
Trophoblastic disease or gynaecological malignancy 
Undiagnosed abnormal uterine bleeding
68
Q

When can Cu IUD be inserted after ToP/miscarriage and birth?

A

ToP/miscarriage: immediate

Birth; 4 wks

69
Q

When should women check for the threads of Cu IUD?

A

After each period

70
Q

In what high risk groups can mirena be used?

A

Obese
Breastfeeding
CV disease
Women taking hepatic-enzyme inducing drugs

71
Q

What side effects commonly occur in the first few weeks post IUS insertion?

A

Spotting +/- heavy bleeding

72
Q

What is a CI to UPA EC?

A

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
Q

Can you breastfeed post UPA EC?

A

Wait 36 hours

74
Q

Oestrogenic side effects of COC?

A 
Breast tenderness
Nausea
Cyclical weight gain 
Bloating 
Vaginal discharge
75
Q

Progestogenic SE of COC

A 
Mood swings
PMT 
Vaginal dryness
Sustained weight gain 
Decreased libido 
Acne
76
Q

When should emergency contraception be used in terms of missed pills?

A

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
Q

What contraceptive methods act to prevent fertilization?

A 
Condoms
Diaphragm + spermicide 
Female and male sterilisation 
IUD 
Hormonal methods
78
Q

What contraceptive methods act to prevent implantation?

A

IUD (copper coil)

Hormonal methods

79
Q

What contraceptive methods have a direct toxic effect?

A

Cu IUD

Spermicides

80
Q

Which contraceptive methods result in ovulation suppression?

A 
CHC 
Injection 
Subdermal implant 
Lactational amenorrhoea 
POP
IUS
81
Q

What should raise child protection or wellbeing concerns?

A

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
Q

What is the window period for CT/GC, HIV/sphyilis and Hep B/C?

A

Chlamydia/gonorrhoea: NAAT 2 weeks
HIV/syphilis: 4 weeks
Hep B/c: 12 weeks

83
Q

What are the non-contraceptive benefits of hormonal contraception?

A 
Period pain
Heavy menstrual bleeding
Irregular PV bleeding
Mittelschmerz 
PMS 
Cyclical breast tenderness
Ovarian cysts 
Endometriosis 
Ovarian cancer 
Acne or hirsutism (CHC only)
84
Q

How long do copper coils last?

A

10 years depending on device
Non-hormonal
Can be used as emergency contraception

85
Q

SE of copper coil

A

Can make periods heavier, longer and more painful esp during first 3/12 post insertion

86
Q

What is mirena licensed for?

A

Heavy periods
HRT
Endometriosis
Hyperplasia

87
Q

What is the percentage of amenorrhoea at 6/12 on mirena?

A

50%

88
Q

What is the most effective of all contraceptive methods?

A

Subdermal contraceptive implant

89
Q

What is the main se of subdermal implant?

A

Prolonged PV bleeding

Repro and Sexual Health (77 decks)

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