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Repro > Contraception non-LARC > Flashcards

Contraception non-LARC Flashcards

1
Q

Failure rates for CHC are perfect use 0.3% and typical use 8%. What are three available choices for Combined Hormonal Contraception and what is their method of contraception? (CHC)

A

ring, patch and pill - STOP ovulation

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2
Q

When can you start the COC?

A

Start in first 5 days of period OR at any time during cycle when reasonably sure you’re not pregnant BUT use condoms for first 7 days!

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3
Q

How do you take the COC? (licenced and off licence)

A

Take it for 21 days followed by 7 day break (licensed) OR (off licence) tricycling - take 3 packets straight through then stop for 7 days OR (off licence) continuous use and if you bleed for 4 days or more stop for 4 days then start again

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4
Q

What are 3 factors that may affect effectiveness of CHC?

A

impaired absorption (COC), increased metabolism (e.g. liver enzyme induction, drug interaction), forgetting

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5
Q

What are 3 risks of CHC?

A

venous thrombosis, arterial thrombosis and slight increased risk of breast and cervical cancer (reduces 10yrs after stopping pill)

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6
Q

There is a small additional risk of VTE in COC users that varies according to oestrogen dose and progesterone type. Risk in population is 2/10,000, risk on levonorgestrel is 5-7/10,000. and risk on drospirenone is 9-12/10,000. True/false?

A

True

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7
Q

COC may increase blood pressure in some individuals. Under what BP is ok to start COC and when should it be checked?

A

Under 140/90. Should be checked initially, at 3 months, then annually

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8
Q

Why must you be cautious when prescribing COC to smokers, people over age 35 and people with hypertension?

A

It can increase risk of MI due to arterial disease

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9
Q

Why must you be cautious when prescribing COC to smokers, people over age 35 and people with hypertension?

A

It can increase risk of MI due to arterial disease

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10
Q

Why can’t you prescribe COC to patients who experience migraine with aura?

A

Increases risk of ischaemic stroke

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11
Q

What is a migraine with aura?

A

Migraine that is preceded by an aura which is a change occurring 5-20 minutes before headache onset. Visual: often scotoma, altered sensation, smell or taste, hemiparesis

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12
Q

What exams are carried out before prescribing CHC?

A

BP, BMI, cervical smear if appropriate & UKMEC

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13
Q

Up to what age can CHC be used?

A

up to 50yrs if no risk factors

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14
Q

All CHC can show a beneficial effect on acne. Which pills in particular show this?

A

Oestrogen/cyproterone acetate (dianette) because is antiandrogen

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15
Q

What are 6 non-contraceptive benefits of CHC?

A 
protection against ovarian and endometrial cancer, 
improves acne, 
less bleeding, 
fewer functional ovarian cysts, 
helps with PMS
helps PCOS
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16
Q

What are 4 side effects of CHC?

A

nausea,
break-through bleeding,
worsening spots,
breast tenderness

17
Q

Desogestrel (brand cerelle) is main progesterone pill prescribed. The perfect failure rate is <1% and typical failure rate is 9%. What is the mode of action?

A

inhibits ovulation

18
Q

How to start progestogen only methods? POP, subdermal implant and DMPA

A

Day 1-5 of period
OR
anytime if reasonably sure not pregnant with condoms for 7 days.
Only need condom for 2 days with POP

19
Q

Subdermal implants and POP are safe to use in most circumstances and have little effect on metabolism. However they are UKMEC 4 for what condition?

A

Current breast cancer

20
Q

List 4 potential side effects of POP

A

nausea,
bleeding,
spots
headaches

21
Q

List 4 potential side effects of POP

A

nausea, irregular bleeding (common), spots and headaches

22
Q

How do you take POP?

A

Take at same time every day and if more than 12 hours late it won’t work for 2 days

23
Q

What is the difference between Depo provera and Sayana Press?

A

Depo provera is administered by doctor/nurse whereas sayana press is self administered

24
Q

Typical use failure rate DMPA is 3% and perfect use is 0.3%. How does DMPA work?

A

lowers oestrogen and suppresses FSH so wipes out menstrual cycle

25
Q

DMPA cannot be used in those on enzyme inducing drugs, especially epileptics. True/false?

A

False - opposite! Particularly useful in those

26
Q

List 5 side effects of DMPA?

A 
nausea, 
spots, 
headaches, 
weight gain (quite common),
irregular bleeding for first few months
27
Q

What can DMPA have a negative effect on?

A

Bone health because suppressing oestrogen so cautious about using it in teenagers as may lower peak bone mass or people with risk factors for osteoporosis e.g. poor calcium absorption or FH

28
Q

At what age is DMPA recommended stopping?

A

close to menopause, around late 40s

29
Q

How effective is the diaphragm with typical use?

A

71-88%

30
Q

How does diaphragm work?

A

Put in vagina before sex and leave in vagina for 6hrs after to allow spermicide to work

31
Q

Vasectomy can be done under local or general anaesthetic. Vasectomy failure rate?

A

0.1%

32
Q

Vasectomy can be done under local or general anaesthetic. Vasectomy failure rate?

A

0.1%

33
Q

List 4 potential side effects of vasectomy?

A

anaesthetic,
pain,
infection,
bleeding/haematoma

34
Q

What is usual reason for failure of vasectomy?

A

early non-compliance - don’t come get semen analysis

35
Q

Female sterilisation has failure rate of 2-3/1000. This makes it not actually that effective compared to other LARCs and depo. True/false

A

True

36
Q

What is effective rate of natural family planning?

A

76%

37
Q

Transgender men assigned female at birth need contraception if sexually active. Which methods are unsuitable and why?

A

Combined hormonal methods (CHCs) are unsuitable as can counteract masculinising effect of testosterone

38
Q

Transgender men receiving testosterone do not need contraception as it acts as one. True/false?

A

False - testosterone is NOT a contraceptive method and is teratogenic

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