Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Midwifery > Contraceptives > Flashcards

Contraceptives Flashcards

1
Q

What is meant by the lactational amenorrhoea method (LAM) of contraception? How does it work?

A
  • breastfeeding reduces the possibility of pregnancy by temporarily suppressing fertility
  • infant sucking inhibits ovulation by disrupting the release of GnRH, FSH, LH and oestrogen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How effective is LAM in preventing pregnancy?

A
  • less than 2% chance of pregnancy in first 6 months if:
  • fully breastfeeding (no supplementary feeds or solids)
  • amenorrhoea
  • less than 6 months post birth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are other names for the progesterone only pill?

A
  • the mini pill
  • levonorgestrel (Microlut)
  • norethisterone (Locilan 28, Micronor, Noriday 28)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the benefits of the progesterone only pill?

A
  • suitable for breastfeeding women

- may be commenced any time after birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the disadvantages of the progesterone only pill?

A
  • should be taken at the same time each day (within 3 hours)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What may interfere with the efficacy of the progesterone only pill?

A
  • if taken late: an alternative method should be used if sex within 3 pills/48 hours
  • vomiting within 2 hours of taking pill
  • severe diarrhoea
  • some medications - particularly antibiotics, anti-retroviral and anti-epileptic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Does the progesterone only pill have any inactive pill days?

A

No, it contains 28 pills of the same dose taken every day without any break

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the mode of action of the progesterone only pill?

A
  • thickens cervical mucosa making it impenitrable to sperm
  • alters the endometrium to inhibit implantation
  • may prevent ovulation in some women
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How effective is the progesterone only pill in preventing pregnancy?

A

96-97% effective depending on compliance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the contraindications to using the progesterone only pill?

A
  • breast cancer
  • altered liver function
  • taking some medications
  • CVD and hypertension
  • abnormal lipids
  • undiagnosed bleeding
  • generally thought to have fewer side effects than combined oral contraceptive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the most common side effects of the progesterone only pill?

A
  • irregular bleeding
  • amenorrhoea
  • headaches
  • weight changes
  • mood changes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the recommendations around commencing the progesterone only pill after birth?

A
  • may be commenced at any time, but no contraception required for 21 days postpartum
  • effective immediately if breastfeeding and within 21 days of birth or or day 1-5 of cycle if menstruation has returned
  • otherwise exclude pregnancy if necessary, effective after 48 hours/3 pills
  • recommend annual followup with GP or family planning service
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the active ingredients in the combined oral contraceptive pill?

A

synthetic estrogens and progestegens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the mode of action of the combined oral contraceptive pill?

A
  • inhibits FSH, LH release preventing follicle maturation and ovulation
  • thickens cervical mucous and reduces fallopian tube motility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When is the combined oral contraceptive pill not recommended?

A
  • while breastfeeding and within the first 6 months after birth (may alter milk composition, suppress prolactin and reduce supply)
  • within 21 days of birth due to risk of thrombosis
  • for women with increased risk of thrombosis (smoker, obesity, advanced age, diabetes, hypertension, reduced mobility)
  • History of heart disease, stroke, VTE, DVT, pulmonary emobolism
  • migraines with aura
  • current breast cancer
  • advanced diabetes
  • efficacy reduced by some medications (antibiotics, liver enzyme altering drugs, antiepileptic drugs and st johns wort)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Does the combined oral contraceptive pill have any inactive pill days?

A

Yes, they generally contain 21 days of hormones and 7 days of placebo tablets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What different combined oral contraceptive pill types are available?

A
  • may be monophasic (active pills all contain same formulation), biphasic (two-phases), tri-phasic (three-phases)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How effective is the combined oral contraceptive pill?

A

91-99.7% effective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the most common side effects of the combined oral contraceptive pill?

A
  • breakthrough bleeding
  • breast tenderness
  • lowered libido
  • mood changes
  • headache
  • nausea
  • weight gain
  • bloating
20
Q

What risks may be associated with taking the combined oral contraceptive pill?

A
  • increased risk of gallbladder disease
  • VTE
  • stroke
  • heart attack
  • cervical cancer
21
Q

What are the recommendations around commencing the combined oral contraceptive pill after birth?

A
  • not recommended if breastfeeding prior to 6 months postpartum
  • not recommended before 21 days postpartum
  • if menstruation has returned effective immediately if commenced day 1-5
  • otherwise exclude pregnancy if required
  • effective in 7 days
22
Q

What contraceptive methods can be considered postpartum?

A
  • Lactational amenorrhoea method
  • condoms
  • diaphragms and cervical caps
  • progesterone only pill
  • combined oral contraceptive pill
  • implanon
  • Depo-provera
  • copper or hormonal IUD
23
Q

When can condom use be commenced postnatally?

A
  • can be used immediately with no impact on breastfeeding
24
Q

When can use of diaphragms and cervical caps be commenced postnatally?

A
  • > 6 weeks after birth when vaginal tone returns

- now less common, very little consistancy in terms of products

25
Q

What to do if a combined oral contraceptive pill is late or missed?

A
  • within 24 hours, take pill ASAP, then continue as usual
  • after 24 hours late, take most recent pill and use another form of contraception until 7 days/pills
  • missing more than 4 pills is considered stopping the pill
26
Q

What is the trade name of Depot medroxy-progesterone acetate (DMPA) or the progestogen only injection?

A

Depo-Provera

27
Q

What is Depo-provera?

A
  • an injectable contraceptive

- progestagen is injected deep IM every 12 weeks

28
Q

What is the mode of action for Depo-provera in preventing pregnancy?

A
  • inhibits GnRH secretion
  • prevents follicle maturation and ovulation
  • increases thickness of cervical mucous
  • changes lining of the uterus
29
Q

What recommendation would you give a woman about Depo-provera?

A
  • 99.8% effective when given every 12 weeks
  • need to see a doctor every 3 months for an injection (cost?)
  • important not to massage injection site as this can decrease duration
  • not usually commenced before 6 weeks postpartum due to risk of increased vaginal bleeding
  • ensure not pregnant before commencing
  • suitable for breastfeeding
30
Q

What are common side effects associated with Depo-provera?

A
  • lighter or heavier than usual periods
  • some women don’t get periods at all
  • weight changes
  • headaches
  • abdominal discomfort
  • mood changes
  • reduced libido
  • fluid retention
  • breast tenderness
  • acne
  • may increase long term risk of osteoporosis
  • potential for anaphylaxis
31
Q

What advice would you give a woman about the return of her fertility after using Depo-provera?

A
  • once injection is given, hormone cannot be removed for 3 months
  • periods may take 6-12 months to return after ceasing injections
  • 50% of women fall pregnant within 12 months and >90% within 2 years
32
Q

What are some advantages of Depo-provera?

A
  • highly effective
  • don’t need to remember to take a pill every day (but need to see doctor for injection)
  • may get lighter or no periods
  • may reduce risk of ovarian cancer, endometrial cancer, endometriosis and pelvic infection
  • is not affected by stomach upsets
  • appropriate for breastfeeding women (may actually increase prolactin and milk supply in some women, but may also decrease, safe for baby)
33
Q

When is Depo-provera not recommmended?

A
  • women with coagulation disorders or on anticoagulants
  • undiagnosed bleeding
  • already pregnant
  • wanting to become pregnant within 12 months
  • certain other medical conditions
34
Q

What is the trade name of the etonogestrel (progestogen) implant? What is it? how long does it last?

A
  • Implanon
  • 4cm long, 2mm diameter polymer rod impregnated with synthetic estrogen
  • implanted just under skin of arm
  • lasts for 3 years
35
Q

What are some advantages of implanon?

A
  • highly effective (failure rate of 0-0.7 per 100 women)
  • low cost (about $38) with medicare
  • suitable for breastfeeding women
  • can be implanted any time after birth
  • lasts 3 years, don’t have to remember to take pill
  • may cause lighter than usual or absent periods
  • rapid return to fertility
  • can be removed at any time
36
Q

What is the mode of action for the progestogen implant (implanon)?

A
  • inhibits ovulation
  • changes thickening of the endometrium to make less hospitable to implantation
  • increases viscosity of cervical mucous
37
Q

What are some disadvantages/side effects of the progestegen implant (implanon)?

A
  • irregular or frequent bleeding
  • some women have no periods
  • weight changes
  • mood changes
  • acne
  • abdominal pain
  • painful periods
38
Q

When will Implanon not be recommended?

A
  • if woman may be pregnant
  • recent breast cancer
  • undiagnosed vaginal bleeding
  • unable to take progestogens
  • recent thrombosis or DVT
39
Q

What recommendations would you give a woman about when Implanon can be commenced?

A
  • any time after birth
  • effective immediately if inserted from day 1-5 of menstrual cycle
  • if after day 5 effective after 7 days
  • exclude pregnancy if appropriate
40
Q

What kinds of intrauterine devices are available?

A
  • copper

- Mirena

41
Q

What is Mirena?

A
  • an intrauterine system (IUS)
  • a T shaped device containing levonorgestrel (progestogen)
  • at implantation releases around 20mcg per day, reduced to 10mcg/day at 5 years, mean 14mcg/day
42
Q

What is the mode of action of Mirena?

A
  • changes to the endometrium - less hospitable to implantation
  • decreased GnRH and estrogen
  • thickening of cervical mucous
  • inhibits ovulation in some women
43
Q

What are the advantages of Mirena?

A
  • highly effective (0.7% failure rate at 5 years)
  • very low daily dosage due to localised effect
  • lasts for 5 years
  • often very light or absent periods, unlike copper IUDs that often cause heavy bleeding (particularly good for women with heavy periods)
  • appropriate for breastfeeding women
  • quick return to fertility after removal
44
Q

What is the only contraceptive that prevents STIs?

A

CONDOMS

45
Q

When can mirena be used after birth?

A
  • it is recommended that it should be implanted after 6 weeks after birth, particularly when breastfeeding due to slightly increased risk of perforation and spontaneous expulsion
  • exclude pregnancy
  • effective within 7 days
46
Q

What are the side effects/risks of Mirena?

A
  • changes in bleeding patterns (may cause spotting, shorter, longer or absent periods particularly in first 6 months)
  • headache
  • abdominal/pelvic/back pain
  • vulvovaginitis
  • mood changes
  • decreased libido
  • nausea
  • acne
  • breast tenderness
  • weight changes
  • may increase susceptibility to infections
  • possible expulsion
  • very rarely perforation (breastfeeding and insertion up to 36 weeks post birth are risk factors)
  • lost threads
  • ectopic pregnancy
  • ovarian cysts (usually asymptomatic)
  • removal threads may be felt by partner during intercourse
47
Q

What are contraindications to using mirena?

A
  • pregnancy
  • pelvic inflammatory disease
  • vaginal, cervical or uterine infection
  • postpartum endometritis
  • cervical dysplasia
  • some cancers (particularly uterine, cervical or some breast)
  • undiagnosed bleeding
  • uterine anomolies such as fibroids in some cases
  • increased susceptibility to infection
  • liver disease
  • inability to take progestogens
  • not the first choice for young nulligravid women or postmenopausal women due to difficulty of insertion

Midwifery (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions