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Year 3 - primary care + medicine > Contraceptives > Flashcards

Contraceptives Flashcards

1
Q

Name all the different types of contraceptives available in the UK

A

Natural - abstinence, fertility awareness
Barrier - condoms, diaphragm
Combined hormonal contraceptives - COCP , patch, vaginal ring
Progesterone only contraceptives - POP , implant, injections
Intrauterine - IUS (hormonal - mirena coil) or IUD (copper)
Sterilisation - vasectomy , tubal occlusion
Emergency contraception - EllaOne, Plan B, IUD

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2
Q

How effective are condoms?

A

98% with perfect use but 82% with typical use

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3
Q

How effective are diaphragms or cervical cap?

A

If used properly with spermicide then approx 95%

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4
Q

What are the three options for emergency contraception?

A

Copper coil - IUD - within 5 days
Levonorgestrel pill - PlanB - within 72 hours - 1.5mg single dose
Ulipristal acetate - EllaOne - within 120 hours - 30mg single dose

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5
Q

When is emergency contraception used?

A

After unprotected sexual intercourse (UPSI)

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6
Q

How does the copper coil work?

A

It is toxic to sperm.

It also inhibits implantation.

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7
Q

What is the most effective method of emergency contraception?

A

IUD - copper coil

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8
Q

How does levonorgestrel (PlanB) work?

A

a type of progesterone that works by preventing or delaying ovulation.

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9
Q

What are some side effects of oral levonorgestrel?

A

Nausea and vomiting - if sick within 3 hours of taking then the dose should be repeated.
Spotting or changes to next menstrual cycle
Diarrhoea
Dizziness
Breast tenderness

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10
Q

How does ulipristal acetate (EllaOne) work?

A

It is a selective progesterone receptor modulation that works by delaying ovulation.

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11
Q

What are some side effects of ulipristal acetate?

A

Nausea and vomiting - if sick within 3 hours of taking then the dose should be repeated.
Spotting or changes to next menstrual cycle
Abdo / pelvic / back pain
Headache
Mood changes
Dizziness
Breast tenderness

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12
Q

Who should not take ulipristal acetate?

A

Breastfeeding women - must avoid breastfeeding for 1 week after taking
Severe asthmatics

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13
Q

When may oral emergency contraceptives not be effective?

A

After ovulation has occurred - normally 14 days before the end of the cycle (so estimate using shortest cycle length)

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14
Q

What advise may you give to a patient who is wanting emergency contraception?

A

STI screening
Advise about long term contraceptive options
Ensure there are no safeguarding concerns
If next menstrual period is late do a pregnancy test as not 100% effective.

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15
Q

What are the two types of contraceptive coils?

A

Copper coil - Cu-IUD

Levonorgestrel intrauterine system - IUS - Mirena coil

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16
Q

What are contraceptive coils?

A

T shaped devices that are inserted up into the uterus to act as long acting reversible contraception.

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17
Q

How effective are contraceptive coils?

A

Greater than 99% when properly inserted

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18
Q

What are some contraindications for the coil?

A 
PID / infection.
Immunosuppression.
Pregnancy.
Unexplained bleeding.
Pelvic cancer.
Uterine cavity disorders such as fibroids.
Wilsons diseases for the IUD
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19
Q

What is done before insertion of the coil?

A

sTI screening for chlamydia and gonorrhoea

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20
Q

What are the risks related to insertion of the coil?

A 
Bleeding.
Pain on insertion.
Vasovagal reactions - dizziness, bradycardia and arrhythmias.
Uterine perforation
PID
Expulsion
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21
Q

What is done when the coil thread are non visible?

A

Use extra contraception such as condoms
Exclude expulsion, pregnancy and uterine perforation.
Ultrasound and abdo X-ray may be required

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22
Q

How long can the IUD last?

A

Between 5 and 10 years

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23
Q

What are the benefits of the IUD?

A
  • Reliable
  • Can be inserted at any point of the menstrual cycle and is effective immediately
  • Contains no hormones so safe in those with increased VTE risk or FH of hormone related cancer
  • May reduce the risk of endometrial and cervical cancers
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24
Q

What are the disadvantages to the IUD?

A
  • Insertion and removal risks
  • Can cause heavy or intermenstrual bleeding
  • may cause pelvic pain
  • no protection from STIs
  • increased risk of ectopic pregnancies
  • risk of displacement / falling out
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25
Q

What is the most common IUS called?

A

The Mirena coil

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26
Q

How long does the Mirena coil work for?

A

5 years

27
Q

What is the Mirena coil licensed/used for?

A

Contraception
Menorrhagia
Endometrial protection for women on HRT (for 4 years)

28
Q

How does the levonorgestrel IUS work?

A

Local release of progesterone causes

  • thickened cervical mucus
  • decreased implantation
  • in some it may inhibit ovulation
29
Q

What are the benefits of the IUS?

A
  • can make periods lighter / stop altogether
  • may improve dysmenorrhoea or pelvic pain related to endometriosis
  • no increased risk of thrombosis
  • can be used in obese patients
30
Q

What are the disadvantages of the IUS?

A
  • risks of insertion and removal
  • can cause spotting and irregular bleeding
  • pelvic pain
  • no protection against STIs
  • increased risk of ectopic pregnancies
  • increased incidence of ovarian cysts
  • systemic absorption can lead to acne, headaches or breast tenderness
  • displacement / falling out
31
Q

What hormone does the implant release?

A

Progesterone

32
Q

What is the contraceptive implant?

A

a small, plastic flexible rod that is placed in the upper arm, beneath the skin. It slowly releases progesterone into the systemic circulation.

33
Q

How long does the contraceptive implant last?

A

3 years

34
Q

What is the name of the implant used in the UK?

A

Nexplanon

35
Q

What is the mechanism behind the progesterone-only implant?

A

the progesterone released

  • inhibits ovulation (as is systemic rather than local)
  • thickens cervical mucus
  • alters endometrium to make it harder for implantation to occur
36
Q

What are the benefits of the progesterone only implant?

A
  • effective (99%) and reliable
  • can improve dysmenorrhoea
  • can make periods lighter / stop altogether
  • doesn’t cause weight gain (unlike injection)
  • doesn’t increase risk of thrombosis (unlike COCP)
  • can use in obese patients (unlike COCP)
37
Q

What are the disadvantages of the progesterone only implant?

A
  • requires a minor op with local anaesthetic (lidocaine) for insertion and removal
  • can worse acne
  • doesn’t protect against STIs
  • can cause problematic bleeding
  • can become bent or fractures
  • rarely can become impalpable / deeply implanted
38
Q

How often is the depot injection given?

A

every 12-13 weeks

39
Q

What does the depot injection contain?

A

Medroxyprogesterone acetate (a type of progestin)

40
Q

Is the depot injection reversible?

A

yes but it takes 12 months for fertility to return to normal

41
Q

What are contraindications for the depot injections?

A 
Active breast cancer
Ischaemic heart disease and stroke
Unexplained vaginal bleeding
Severe liver cirrhosis
Liver cancer
42
Q

What is a complication of the depot injections?

A

Osteoporosis - think about this in older women

Small risk of breast and cervical cancer

43
Q

How does the depot injection work?

A
  • Inhibits ovulation by inhibiting FSH secretion by the pituitary gland which prevents developments of follicles in the ovaries.
  • Thickened cervical mucus
  • Decreases implantation in endometrium
44
Q

What are some of the side effects of the depot injections?

A
  • changes to bleeding schedule - irregular, heavier, longer
  • weight gain
  • acne
  • mood changes
  • reduced libido
  • alopecia
  • osteoporosis
45
Q

How does the depot injection lead to osteoporosis?

A

Suppressing follicular development means less oestrogen is produced which leads to decreased mineral density

46
Q

What are the benefits of the depot injections?

A
  • improves dysmenorrhoea
  • improves endometriosis symptoms
  • reduces risk of endometrial and ovarian cancers
47
Q

How is the POP taken?

A

Daily, continuously.
Traditional must be taken within a 3 hour window.
Desogestrel can be taken up to 12 hours late and still be effective

48
Q

How does the POP work?

A

Inhibits ovulation
Thickens the cervical mucus
Altering the endometrium
Reduced ciliary action in the fallopian tubes

49
Q

What are some of the disadvantages of the POP?

A
  • unscheduled irregular bleeding (some will get amenorrhoea)
  • breast tenderness
  • headaches
  • acne
  • increased risk of ovarian cysts
  • increased risk of ectopic pregnancy
50
Q

What is the COCP?

A

A combined contraceptive pill of oestrogen and progesterone

51
Q

How does the COCP work?

A

Prevents ovulation
Progesterone thickens the cervical mucus
Progesterone inhibits proliferation of endometrium making implantation less likely

52
Q

How does the COCP prevent ovulation?

A

Oestrogen and progesterone have a negative feedback effects on the hypothalamus and anterior pituitary. This suppresses the release of GnRH, LH and FSH which means ovulation doesn’t occur.

53
Q

Name some of the different COCPs

A

Yasmin
Levest
Microgynon

54
Q

What are the disadvantages of the COCP?

A
  • unscheduled bleeding
  • breast pain and tenderness
  • mood changes and depression
  • headaches
  • hypertension
  • venous thromboembolisms
  • increased risk of breast and cervical cancer
  • increased risk of MI and stroke
55
Q

What are the benefits of the COCP?

A
  • effective contraception
  • rapid return of fertility
  • improves PMS, menorrhagia and dysmenorrhoea
  • reduced risk of endometrial, ovarian and colon cancer
  • reduced risk of benign ovarian cysts
56
Q

When is the COCP contraindications?

A
  • uncontrolled hypertension
  • migraine with aura
  • history of VTE
  • aged over 35 and smoker
  • vascular disease or stroke
  • ischaemic heart disease or a fib.
  • liver cirrhosis or tumours
  • SLE
  • obesity (BMI >35)
57
Q

What is tubal occlusion and how does it work?

A

Female sterilisation technique where the fallopian tubes are clipes or cut. This prevents the ovum from travelling from the ovary to the uterus meaning fertilisation cannot occur.

58
Q

What is a vasectomy and how does it work?

A

Male sterilisation where the vas deferens is cut to prevent sperm from travelling from the testes into the semen, hence stopping pregnancy.

59
Q

What follow up is needed post vasectomy?

A

Testing of the semen 2-3 months after to test for sperm to confirmed that it has worked

60
Q

What are the advantages of vasectomy over tubal occlusion?

A

Vasectomy is a quick surgery that is less invasive

Both performed under local anaesthetic

Tubal occlusion has a higher failure rate

61
Q

What are the Frazer guidlines?

A

Guidance for providing contraception to under 16s without parental consent

  • they are mature and intelligent enough to understand the treatment
  • they can’t be persuaded to discuss with parents
  • they are likely to have intercourse regardless of treatment
  • their physical or mental health is likely to suffer without treatment
  • treatment is within their best interest

Ensure no safeguarding concerns!

62
Q

What can be used to assess whether girls under 16 should be given contraceptives?

A

Gillick competence

Frazer guidlines

63
Q

At what age can children not give consent for sexual activity?

A

Children under 13 - always raise as safeguarding concerns

Year 3 - primary care + medicine (20 decks)

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