Contraceptive method and issues around the menopause TOG 2017 Flashcards
How does the perimenopause effect peroids?
Prolonged or shorter cycles
Can be HMB
What proportion of pregnancies are age > 40 yrs?
1/5
What proportion of pregnancies > 40 yrs are unplanned?
28%
For women > 50 yrs and < 50 non hormonal when can contraception be stopped?
> 50 1 year ammenorhhoea
<50 2 years
For which women using hormonal contraception can you use FSH to determine menopausal status?
POP
Subnormal implant
IUS
Dx menopause based on FSH
2 x FSH > 30 6 weeks apart
If going to test FSH in those on COCP, how long should stop before?
2 weeks before
If going to test FSH in those on DEPO, how long should stop before?
1 year
If not testing FSH when can stop contraception?
Age 55 years
If using HRT in perimenopause, what contraception can be advised?
POP methods and intrauterine contraception
Which contraception can provide endometrial protection for HRT users
Mirena levonorgestrel 52mg IUS, liscensed for 4 years but can use up to 5
If on COCP how to minimise menopausal Sx
Short pill free intervals
Advantages/disadvatnages COCP in perimenopausal, failure rate 1st year non perfect use
COCP
Regular bleeding pattern, reduction in menstrual bleeding and flushed
Increased risk thrombosis, breast/cervical cancer
9%
Advantages/disadvatnages in perimenopausal, failure rate 1st year non perfect use
POP
Very few medical contraindications
Dailing dosing required
Irregular bleeding
9%
Advantages/disadvatnages in perimenopausal, failure rate 1st year non perfect use
Depo
Long acting
Often induces amenorrhoea
Masks menopause
Bone mineral density concerns
Unable to remove after injection
6%
Advantages/disadvatnages in perimenopausal, failure rate 1st year non perfect use
POP implant
Few CI
Easily removed
Irregular bleeding
Reguires trained operatior
0.05%
Advantages/disadvatnages COCP in perimenopausal, failure rate 1st year non perfect use
Cu-IUD
Hormone free
Does not mask menopause
Long acting
Heavy bleeding,c rmaps
unsuitable if women has distorted cavity
0.8%
Advantages/disadvatnages in perimenopausal, failure rate 1st year non perfect use
LG-IUD
Long actin
tx heavy bleeding
endometrial protection
Irregular bleeding
Unstable distorted cavity
0.2
Most popular contraception in >40yrs
Vasectomy 28%
Criteria to exclude pregnancy
No signs or symptoms of pregnancy
No intercourse since last census
Reliable contraception
Miscarriage/terminaton within 7 days of the onset of menstruation
Neg preg test only accurate if > 3 weeks since last SI
When should COCP be stopped based on age if no other CI
50 years
If smoker stop at 35
CHC increase risk of VTE by how much
6 fold, highest in first few months of stateing
What % of women with implant have ammnorhoea
20%
What proportion of implant will have it removed in 1st year due to irregular PV bleeding
1/5
How often does DEPO provera need to be administered
Liscenced 12 weeks, but effective 14
With DEPO provera what proportion amennhorea after 1 and 2 years
1yr: 50%
2yrs: 70%
What % of bone lost within 2 years of DEPO
5%, unknown if bones make full recovery
How much of which hormone in Mirena and levosert?
52mg levonorgestrel
What dose of levonorgestrel is in Jaydess?
13.5mg levonorgestrel
How much does the IUS reduce bleeding within 3 months for women with HMB
80%
If on tamoxifen what can be offered for endometrial protection
52mg IUS
Which bacteria is associated with IUD and IUS
Actinomycetes
Effectiveness if condoms and women barrier methods (perfect use)?
99%
95%
What should not be used with condoms
Oil based lubricants
Oestrogen containing vaginal creams
Weaken latex
What proportion of women >40yrs use sterilisation?
18%
Can be before open, lap, hysteroscpically
Contraception should still be used for 3 months until occlusion is confirmed
Failure rate of vasectomy vs female sterilisation
vasectomy 1/2000
female 1/200
