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Obs&Gynae > contraceptives > Flashcards

contraceptives Flashcards

1
Q

how do you do natural family planning?

A

: using calendar apps
- Using body temp
- Cervical mucous

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2
Q

what is the aim if natural family planning?

A

: prevent pregnancy by reducing risk of sperm being present during ovulation

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3
Q

what are the advantages of natural family planning?

A

No side effects
Acceptable in most faiths/ cultures

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4
Q

what are disadvantages of natural family planning?

A

Less effective form of contraception
Avoiding sex
Need other forms during ovulation
Need pt commitment during ovulation to monitor signs
Fertility signs are unreliable when breastfeeding
Fertility signs can be affected by illness and stress
Does not protect STI

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5
Q

what is the pregnancy risk of natural family planning?

A

24%

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6
Q

how does barrier methods work?

A

act as barrier to stop sperm from entering cervix and stopping sperm from fertilising
- Only methods that protect against STI

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7
Q

what are male condoms made from?

A

barriers of latex, polyisoprene or polyurethane to cover penis

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8
Q

what are advantages of male condoms?

A

Reduces STI transmission
Side effects are rare
Non- hormonal

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9
Q

what are disadvantages of male condoms?

A

Can break, split or tear
Can interrupt sex to put on condom
Should not be used with oil-lubricants  risk of bleeding
Need correct technique
Latex allergies

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10
Q

what is the pregnancy risk of condoms?

A

18% of using just this within a yr of regular sex

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11
Q

what are female condoms made from?

A

polurethane

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12
Q

what are advantages of female condoms?

A

Reduces STI transmission
Side effects are rare
Non- hormonal

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13
Q

what are disadvantages of female condoms?

A

Can break, split or tear
Can interrupt sex to put on condom
Should not be used with oil-lubricants  risk of bleeding
Need correct technique
Latex allergies
Not used as widely as male
Pregnancy risk = 21%

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14
Q

what is the diaphragm/ cervical cap?

A

: silicone cup that is placed over cervix as barrier
- Placed in like moon cup

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15
Q

what must be used with diaphragm/ cervical cup?

A

spermicide

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16
Q

what are the advantages of diaphragm/ cervical cap?

A

Only used during intercourse
Can be put in advance
Side effects are rare
Non-hormonal

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17
Q

what are disadvantages of diaphragm/ cervical cap?

A

Can break, split, tear
May interrupt sex
Pts must be comfortable self examining and taught correct technique
Must be left in place for 6hrs following intercourse – if more sex need more spermicide
Does not protect against STI
Pregnancy risk = 12%

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18
Q

what is within COCP?

A

synthetic versions of oestrogen and progesterone

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19
Q

what is the moa of COCP?

A

mimics luteal phase leading to inhibition of hypothalamic-pituitary- gonadal axis
- Prevents LH/ FSH needed for ovulation
- Reduce risk of pregnancy by thickening cervical mucus and prevent sperm passage and thickening endometrium to reduce chance of implantation

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20
Q

what are contra-indications for COCP?

A

Migraine with aura
Current breast cancer
Significant VTE eg previous VTE, thrombogenic mutations, previous stroke, SLE, AF, age >35, smoking >15
CVS Risks: HTN, history of IHD

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21
Q

what are advantages to COCP?

A

No interruption to intercourse
Can be stopped at short notice
Less strict ‘missed pill rule’ than POP
Make peroids regular, lighter and less painful
May reduce risk of ovarian, endometrial, bowel cancer
May have therapeutic benefits in gynaecological disorders including endometriosis and menorrhagia

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22
Q

what are disadvantages to COCP?

A

Less effective if poor compliance
Side effects: N+V, headaches, breast tenderness, mood swings
V+D may affect effectiveness
Certain drugs (anti-epileptics) affect effectiveness
Increases risk of VTE and stroke
Potentially increases risk of breast/ cervical cancer while on COCP
Do not protect against STIs
Pregnancy risk = 9%

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23
Q

how do you take COCP?

A

How to take: take 21days and 7days break for a withdrawal bleed
- Can use 21days and then use 4day break
- Can use up to three packs then have a break

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24
Q

why should you have a bleed every three months?

A

risk of endometrium building up and then hyperplasia - endometrial cancer

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25
Q

name some cocp?

A

microgynon 30 or rigevidon

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26
Q

what does the patch do?

A

deliver oestrogen and progestogen through skin

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27
Q

where can the patch be applied to?

A
  • Can be applied to any patch of skin except breast where tissue is oestrogen sensitive (back, abdo, bum)
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28
Q

how do you use the patch?

A

How to take: apply for 7days and then immediately change for anew one, wear for 21days then 7day patch free  would get withdrawal bleed

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29
Q

what are the advantages of the patch?

A

Do not need to remember daily pill
No interruption to intercourse
Can be stopped at short notice
Make periods more regular, lighter and less painful
Good if forgetful with pill

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30
Q

what are the disadvantages with the pill?

A

Protection may be compromised if forget to take switch
Side effects: headaches, N+V, breast tenderness, mod swings
Interact with anti-epileptics
Potentially increase risk of breast and cervical cancer while using patch
No protection from STI
Pregnancy rate = 9%

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31
Q

what is the vaginal ring?

A

: NuvaRing is a small plastic ring self inserted high into vagina and secretes oestrogen and progesterone

32
Q

what is the direction of use for vaginal ring?

A

inserted into vagina for 21dayd and then removed for 7day break before new one put in
can put 3 rings in a row then break

33
Q

what are the advantages of the ring?

A

Do not need to remember daily pill
No interruption to intercourse
Can be stopped at short notice
Make peroids more regular, lighter and less painful

34
Q

what are the disadvantages of the vaginal ring?

A

Side effects: headaches, N+V, headaches, breast tenderness, mood swings
Certain drugs may affect protection including anti-epileptics
Does not protect against STI
Can become dislodged
Unintended pregnancy rate = 9%

35
Q

what is the POP?

A

Progestogen – only pill: taken daily without breaks, contain no oestrogen

36
Q

what are the three types of POP?

A

desogestrel pop
norethisterone and levonorgestrol
dropirenon pop

37
Q

how does desogestrol pop work?

A

inhibits ovulation and thickens mucus and thinning endometrium, should be taken at same time – 12hr window

38
Q

how does - Norethisterone and levonorgestrel POP work?

A

work mainly thickening cervical mucus and thinning endometrium – 3hr window

39
Q

how does - Drospirenon POP work?

A

inhibits ovulation and taken daily, however 4 pills out of 28days are hormone free  have placebos

40
Q

what are pop advantages?

A

Good if oestrogen is contraindicated or those intolerant to oestrogen
Daily pill – do not need to start and stop
No interruption to intercourse
Can be stopped at short notice if not tolerated
POP safe post-partum and when breastfeeding

41
Q

what are pop disadvantages?

A

Not effective if pill is forgotten
More strict – missed pill than COCP
May cause irregular bleeding/ amenorrhoea
V+D may affect protection
Certain drugs including enzyme inducers affect effectiveness
No STI protection
Pregnancy rate – 9%

42
Q

what is depo injection?

A

Contraceptive injection: contains progesterone only and given every 12weeks

43
Q

where is depo injection given?

A

either side - alternate each time
upper 1/4 of bum

44
Q

what is moa of depo injection?

A

systemic progesterone inhibits ovulation, thickens cervical mucus and thins endometrium

45
Q

what are advantages of depo injection?

A

Good if oestrogen is contra-indicated
Do not need to remember daily pill
No interruption to intercourse

46
Q

what are disadvantages to depo injection?

A

May cause irregular bleeding, amenorrhoea/ more frequent bleeding
Can affect bone mineral density if long term
No STI protection
Fertility can take up to a year to return
Pregnancy rate = 6%

47
Q

what is the implant?

A

Contraceptive implant: small plastic rod approx. 4cm in length inserted sub dermally in upper arm

48
Q

what is moa of implant?

A

slowly releases progesterone (levonorgestrel) to prevent pregnancy

49
Q

what is the name of implant?

A

nexplanon

50
Q

what are advantages of implant?

A

Lasts 3yrs
Suitable if not allowed oestrogen
Most effective form of contraception
No interruption to intercourse

51
Q

what are disadvantages to implant?

A

May cause irregular bleeding, amenorrhoea or more frequent bleeding
Need qualified required to insert implant
Can cause/ worsen acne
Need procedure to insert/ remove it  risk of bruising and infection
Does not protect from STIs
Can be affected enzyme inducers eg carbamazepine
Pregnancy rate = 0.05%

52
Q

what is the hormonal coil?

A

hormonal coil containing levonorgestrel
- T shape plastic rod with threads inserted into uterus and releases progesterone locally
- Threads remain in vagina to allow for removal of coil

53
Q

what is the moa of hormonal coil?

A

prevents pregnancy by thinning endometrium to prevent implantation and thickens cervical mucus to prevent sperm passage

54
Q

what brands of hormonal coil are there and how long can they last?

A
  • Mirena: used for 6yrs for contraception and 5yrs for endometrial protection
  • Kyleena: slightly smaller hormonal coil containing less progestogen and licensed 5yrs
  • Jaydess: similar size to Kyleena and licensed for 3yrs
55
Q

what are the advantages of the hormonal coil?

A

Lasts 3 or 5yrs
Suitable if can not take oestrogen
No interruption to sex
More likely to reduce heavy menstruation esp mirena
Some individual report fewer side effects – local

56
Q

what are disadvantages of hormonal coil?

A

Can make menstruation irregular esp in first 6mths – can cause amenorrhea
Can cause acne, headache and breast tenderness
Need qualified practioner to insert coil
Needs speculum to fit and remove
Small risk of perforation and infection with infection
If pregnant – more likely to be ectopic
Does not protect STI
Pregnancy risk = 0.2%

57
Q

what is the copper coil?

A

Copper coil: IUD – does not contain hormones, rod is coated in copper and creates inhospitable environment for sperm

58
Q

what are advantages of copper coil?

A

Lasts 5-10yrs
Non- hormonal method
Very effective in preventing pregnancy
No interruption to intercourse
Does not interact with medications
Can be emergency

59
Q

what are disadvantages of copper coil?

A

Can cause heavier, longer and more painful menstruation
Need qualified practitioner to insert
Involves speculum to insert and remove
Small risk of uterine perforation and infection if pregnant, likely to be ectopic
Does not protect against from STI
Pregnancy risk= 0.8%

60
Q

how do you perform female sterilisation?

A
  • Tubal occlusion with surgical clips
  • Salpingectomy
61
Q

what are benefits to female sterilisation?

A

Permanent contraception
No interruption to sex
Does not affect hormonal levels
Does not interact

62
Q

what are disadvantages to female sterilisation?

A

Carriers risk of surgery including bleeding, infection and pain
Very difficult to reverse
In very rare cases can become pregnant
No STI protection

63
Q

how can male sterilisation be performed?

A

Male sterilisation: vasectomy is done under LA

64
Q

how does male sterilisation work?

A

a: prevents pregnancy by preventing sperm from entering semen  irreversible

65
Q

what are the advantages of male sterilisation?

A

Permanent contraception
Does not interrupt intercourse
Less invasive and lower-risk than female sterilisation

66
Q

what are disadvantages of male sterilisation?

A

Carries surgical risk -bleeding and infection and infection
Some men experience post-vasectomy pain
Very difficult to reverse
Contraception should be used until semen is confirmed to be sperm-free
Does not protect from STIs
Pregnancy rate= 0.15%

67
Q

how does levonelle - emergency contraception work?

A

high dose of synthetic progestogen  delays ovulation so sperm would not be viable

68
Q

when does levonelle must be taken in order for it to work?

A

Direction: must be taken within 72hrs of UPSI occurred – any later would not be effective

69
Q

what are the advantages of levonelle - emergency?

A

Can be taken if already on POP
Can start hormonal contraception on same day
Can be taken more than once in cycle
Can be bought OTC
Fewer conta-indications than ellaONe

70
Q

what are disadvantages of levonelle emergency?

A

Least effective form on emergency contraception
Gets less effective as 72hrs go on
Does not provide ongoing contraception
Delays menstruation
Pregnancy rate 1-7-2.2% even when taken right

71
Q

what is ellaONe?

A

ellaOne: contains ulipristal acetate, prevents pregnancy by delaying or stopping ovulation

72
Q

when must ellaOne be taken?

A

within 120hrs

73
Q

what are advantages of ellaOne?

A

More effective than levonelle
Can be bought OTC
Can be effective for up to 120hrs after UPSI
Can be used more more than once in same cycle

74
Q

what are disadvantages of ellaONe?

A

Affected by pt weight and enzyme inducing medications
Must wait 5days from taking ellaOne before hormonal contraception
Not recommended in those with severe asthma
Delays menstruation
Pregnancy rate: 1.3-1.6% even when taken correctly

75
Q
A

Obs&Gynae (17 decks)

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