Contraception & unplanned pregnancy Flashcards
How long does the COC take to work?
7 days
How does the COC work?
decreases LH & FSH release (HPO axis)
What are the advantages of the COC?
Regular, lighter,less painful periods
Decreased risk of endometrial,ovarian & rectal cancers
When stopped normal fertility
Which groups is the COC not suitable for?
Very overweight Age >35 + smoker Migraine with aura Past history of VTE Past history of breast or cervical cancer Cervical ectropion
How long does the progesterone-only pill take to work?
2 days
How does the progesterone-only pill take to work?
Thickens cervical mucous
Can suppress ovulation
What are the advantages of the progesterone-only pill?
Can be used if >35 + smoker
Can be used in breastfeeding
What are the disadvantages of the progesterone-only pill?
May cause ovarian (follicular) cysts
May cause migraine, breast tenderness
May cause weight gain & headaches
How does the implant work?
Inhibits ovulation
What are the side effects of the implant?
Irregular periods
Weight gain
Acne
Nerve damage/vascular injury
How does the deep injection (deprovera/savana press) work?
Inhibits ovulation
What are the advantages of the deep injection?
Lasts for 13 weeks
Can be used if breast feeding
What are the disadvantages of the deep injection?
Periods may stop, become irregular or last longer
Fertility may not return for 12 months
Weight gain
What is the main mechanism of action of an IUS (Mirena/Jaydress)?
Thins endometrium to preventimplantation
What are the advantages of an IUS?
Mirena = 5 yrs Jaydress = 3 years
Mirena - lighter less painful periods
When removed fertility returns to normal
What are the disadvanages of an IUS?
Irregular bleeding & spotting for 6 months Ammenorrhoea in 30% PID risk (first 30 days) Ovarian cysts
How does the copper IUD work?
Inflammatory endometrial response preventing implantation
Toxic to sperm
How long can a copper IUD last?
5-10 years
What is a contraindication for the copper IUD?
Endometrial cancer
If high STI risk
What is the legal limit for social termination of pregnancy?
23 weeks & 6 days
In Tayside, what is the limit for surgical terminations of pregnancy?
Up to 12 weeks
In Tayside, what is the limit for medical termination of pregnancy?
Up to 18 weeks & 6 dyas
How is a medical TOP performed?
Oral mifepristone 200mg (anti-progesterone)
24-48 hours later - vaginal (or oral) prostaglandin (e.g. misoprostol)
if < 9 weeks can be done at home
How is a pregnancy terminated surgically if it is 6-12 weeks?
Cervical priming (vaginal prostaglandin) Vacuum aspiration
How is a pregnancy terminated surgically if it is 13-24 weeks?
Dilation & evacuation(not avails in Scotland)
How is a termination of pregnancy followed up?
Urine pregnancy test at 2-3 weeks
When can you take the levonelle after UPSI?
Up to 72 hours
When can you take ellaOne post UPSI?
Up to 120 hours
What can levonelle not be given with?
Enzyme-inducers
What can ellaOne not be given with?
Antacids
How long after UPSI can a copper IUD be inserted?
Up to 120 hours
When should a pregnancy test be performed after emergency contraception?
3 weeks for all methods
In terms of women who havehad their last period when should contraception be stopped?
Postmenopausal = not had a period for 12 months
If <50 y/o still require contraception or to not have had a period for 2 years
Which form of contraception is absolutely contra-indicated in pregnancy?
Combined oral contraceptive pil
