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Year 3 Primary Care > Contraceptives > Flashcards

Contraceptives Flashcards

(107 cards)

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1
Q

What are some generalised categories of contraceptive?

A 
Barrier methods
Combined contraceptives
Progesterone only contraceptives
Long-Acting Reversible Contraceptives
Sterilisation
Natural family planning
Emergency contraception
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2
Q

Which factors can influence a patients’ choice of contraceptive?

A 
Most effective
Ease of use
Reversibility
Side effect profile
Effect on menstruation
Non-hormonal
Previous experience
Family/Friend experiences
Practicality
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3
Q

What does the UKMEC score for contraceptives indicate?

A

Risk profile and suitability of various contraceptives for different patients

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4
Q

What does a UKMEC score of 1 indicate for a contraceptive?

A

No restriction for use in a particular patient

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5
Q

What does a UKMEC score of 4 indicate for a contraceptive?

A

This particular contraceptive is contra-indicated for this patient

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6
Q

How do barrier methods of contraception work?

A

Act as a barrier to prevent the sperm and ovum meeting and fertilising

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7
Q

What are Male Condoms?

A

A barrier of latex that covers the penis preventing sperm from entering the vagina

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8
Q

What are some advantages to male condoms?

A

Only used during intercourse
Reduce STI transmission
Side effects are rare

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9
Q

What are some disadvantages to male condoms?

A

Can break, split or tear during use
Application can interrupt intercourse
Technique must be correct
Latex allergies are possible

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10
Q

With male condoms, what is the unintended pregnancy rate?

A

18%

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11
Q

What are female condoms?

A

A barrier of polyurethene that goes inside the vagina to prevent sperm from passing through the cervix

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12
Q

What are some advantages of female condoms?

A

Only used in intercourse
Reduce STI transmission
Side effects are rare

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13
Q

What are some disadvantages of female condoms?

A

Can break, split or tear
Application can interrupt intercourse
Technique must be correct
Less commonly available

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14
Q

With female condoms, what is the unintended pregnancy rate?

A

21%

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15
Q

What is a Diaphragm/Cervical cap?

A

Flat silicone cap which is placed over the Cervix as a barrier to sperm

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16
Q

What must be used with a Diaphragm/Cervical cap?

A

Spermicide

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17
Q

What are some advantages to Diaphragm/Cervical cap?

A

Only used during intercourse
Can be inserted prior to intercourse
Side effects are rare

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18
Q

What are some disadvantages to Diaphragm/Cervical cap?

A

Can break, split or tear
May interrupt intercourse
Must know technique
Offer no STI protection

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19
Q

With the Diaphragm/Cap, what is the unintended pregnancy rate?

A

12%

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20
Q

What do Combined contraceptives contain?

A

Synthetic versions of Oestrogen and Progesterone

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21
Q

How do Combined contraceptives work?

A

Mimick the Luteal phase of the menstrual cycle, preventing the release of FSH and LH required for ovulation.

Also thicken cervical mucus and thin the endometrium

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22
Q

What are some contraindications for the use of combined contraceptives?

A 
Migraine with aura
Current Breast Ca
Risk factors for VTE
CV Risk factors - Hypertension, IHD
Severe liver disease
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23
Q

What is a commonly used example of a COCP?

A

Microgynon 30

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24
Q

What do COCP contain?

A

Oestrogen and Progestogen that inhibit ovulation

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25
When should COCP be taken?
21 days on then 7 off 63 days on then 7 off Continuous use
26
What will a patient on COCP experience during their 7 days off?
Menstrual bleed
27
What are some benefits to the COCP?
No interruption to intercourse Can be abruptly stopped Less-strict missed pill rules Can make periods lighter/less painful Can reduce the risk of ovarian, endometrial and bowel Ca Can help with endometriosis and menorrhagia
28
What are some limitations of the COCP?
``` Less effective if a pill is missed Vomiting affects usefullness Anti-epileptic medications can interract Increased VTE/Stroke risk No STI protection ```
29
What are some common side effects of the COCP?
Headaches Nausea Breast tenderness Mood swings
30
What is the unintended pregnancy rate with COCP?
9%
31
How do contraceptive patches work?
Supply oestrogen and progesterone via the skin
32
How often should contraceptive patches be applied?
Once every 7 days. Have a break after 21 days for 7 days
33
What are some benefits to contraceptive patches?
``` Don't have to remember daily No interruption to intercourse Can be stopped at short notice Gives lighter, less painful periods Reduces risk of ovarian, endometrial and bowel Ca Not affected by vomiting and diarrhoea ```
34
What are some limitations to contraceptive patches?
Not protected if forget patch Increased risk of VTE/Stroke No STI protection Can "Fall off"
35
What is the unintended pregnancy rate with contraceptive patches?
9%
36
What is a commonly used brand of Vaginal ring?
Nuvaring
37
What is a Vaginal Ring?
Small plastic ring placed high in the vagina that secretes oestrogen and progestogen for 21 days
38
What are the possible regimes with a vaginal ring?
21-7 | 63-7
39
What are some benefits of vaginal rings?
``` Don't need the patient to remember them No interruption to intercourse Can be stopped at any time Lighter, less painful periods Reduces risk of ovarian, endometrial and bowel Ca Not affected by vomiting and diarrhoea ```
40
What are some limitations of vaginal rings?
Increase VTE/Stroke risk No STI protection Affected by anti-epileptics
41
What is the unintended pregnancy rate with vaginal rings?
9%
42
What are some commonly used Progesterone-Only Pills (POPs)?
Desogestrel | Levonorgestrel
43
How does Desogestrel work?
Inhibits ovulation Thickens cervical mucus Thins endometrium
44
When should Desogestrel be taken?
Within the same 12 hour window every day
45
How does Levonorgestrel work?
Thickens cervical mucus | Thins endometrium
46
When should Levonorgestrel be taken?
Within the same 3 hour window every day
47
What are some benefits of POPs?
Suitable for patients that are contraindicated with oestrogen No break in dosage means its easier to remember No interruption to intercourse Can be stopped at short notice
48
What are some disadvantages to POPs?
Reduced protection if a pill is missed More-strict missed pill rule than COCP Can cause irregular bleeding, amenorrhoea or more frequent bleeding Vomiting and diarrhoea reduce effectiveness No STI protection
49
What is the unintended pregnancy rate with POPs?
9%
50
What is the contraceptive injection?
A 12 weekly injection of progesterone
51
Where is the contraceptive injection administered?
IM, into buttocks
52
How does the contraceptive injection work?
Thickens cervical mucus Thins endometrium Inhibits ovulation
53
What is a commonly-used contraceptive injection?
Depo-Provera
54
What are some benefits to the contraceptive injection?
Suitable for patients contraindicated to oestrogen No need to remember daily pill No interruption to intercourse
55
What are some disadvantages of the contraceptive injection?
Can cause amenorrhoea, irregular bleeding or more frequent bleeding Patient must tolerate injection Can affect bone mineral density if used long term No STI protection Irreversible for 12/52 Fertility can take months to return afterwards
56
What is the unintended pregnancy rate with the contraceptive injection?
6%
57
What are Long Acting Reversible Contraceptives?
Contraceptives that are inserted into the patient and provide years of ongoing protection
58
What is Nexplanon a form of?
Contraceptive Implant
59
What is the contraceptive implant?
A small plastic rod inserted sub-dermally in the upper arm
60
How does the contraceptive implant work?
Slowly releases Progestogen to inhibit ovulation, thicken cervical mucus and thin the endometrium
61
What are some benefits of the contraceptive implant?
Lasts for 3y once inserted Suitable for those that cannot use oestrogen Most effective contraceptive available No interruption to intercourse
62
What are some limitations of the contraceptive implant?
Can cause irregular bleeding, amenorrhoea or increased frequency of bleeding Requires qualified practitioner to insert Can worsen acne No STI protection
63
What is the unintended pregnancy rate with the contraceptive implant?
0.05%
64
What is the Mirena a form of?
Hormonal Coil (Intra-Uterine system)
65
What is a hormonal coil?
A T-shaped rod inserted into the uterus that locally release progestogen giving thickened cervical mucus and a thinned endometrium
66
What are some benefits to the hormonal coil?
Last 3-5y Suitable for those that cannot take oestrogen Very effective More likely to help with heavy menstruation ?Less side effects than implant
67
What are some limitations of the hormonal coil?
Can make menstruation irregular Can cause acne, breast tenderness and headaches Needs qualified practitioner to insert Must be fitted with a speculum exam Carries a small risk of uterine perforation Risk of ectopic pregnancy No STI protection
68
What is the unintended pregnancy rate of the hormonal coil?
0.2%
69
What is the Copper Coil?
T Shaped plastic and copper rods inserted into the uterus
70
How do Copper Coils act as contraceptives?
Create an inhospitable environment for sperm and ovum to survive in the uterus
71
What are some benefits of the Copper Coil contraceptive?
``` Last 5-10y Suitable for women that cannot use hormonal contraceptive Very effective Unaffected by other medications Can be used as emergency contraceptive ```
72
What are some limitations of the Copper Coil contraceptive?
Can lead to heavier, longer, more painful periods Must be fitted by a qualified practitioner via a speculum exam Risk of perforation and infection with insertion If pregnancy occurs its more likely to be ectopic No STI protection
73
What is the unintended pregnancy rate with a Copper Coil?
0.8%
74
When/How is Female Sterilisation usually carried out?
Under General Anaesthetic | During a Cesarian Section
75
What are the primary methods of female sterilisation?
Tubal Occlusion with Surgical Clips Hysteroscopic sterilisation with fallopian implants Salpingectomy
76
What are some benefits to female sterilisation?
Permanent No interruption to intercourse No change in hormonal levels
77
What are some limitations of female sterilisation?
Risks of surgery including bleeding and infection Often have pain post-operatively Very difficult to reverse Pregnancy can still happen, and is more likely to be ectopic No STI protection
78
What is the unintended pregnancy rate with female sterilisation?
0.5%
79
What is Male Sterilisation otherwise known as?
Vasectomy
80
What happens in a Vasectomy?
Procedure under local anaesthetic to remove a section of the vas deferens, preventing sperm from entering semen
81
What are some benefits of male sterilisation?
Permanent contraception No interruption to intercourse Less invasive than female sterilisation
82
What are some limitations of male sterilisation?
Risks of surgery Some men can experience pain after surgery Very difficult to reverse Still need contraception untill semen has been confirmed to be sperm free No STI protection
83
What is the unintended pregnancy rate with male sterilisation?
0.15%
84
What is Natural Family Planning/Fertility Awareness?
Intercourse is timed to the part of the cycle when ovulation is least likely
85
What is monitored in Fertility Awareness?
Body Temperature | Cervical secretions
86
What are the benefits of Fertility Awareness?
No side effects | Accepted by most faiths and cultures
87
What are some limitations of Fertility Awareness as a form of contraception?
``` Much less effective Must avoid sex/use other contraception around ovulation Needs significant patient input Fertility signs can be unreliable No STI protection ```
88
What is the unintended pregnancy rate with Fertility Awareness?
24%
89
When may women use Emergency Contraception?
If they've had Unprotected Sexual Intercourse (UPSI) or contraceptive failure
90
What types of emergency contraception are there?
Morning After Pills | Copper Coil
91
Name two examples of morning after pills
Levonelle | ellaOne
92
What does Levnoelle contain and how does it work?
Contains a high dose of synthetic progestogen, thought to delay ovulation until the sperm are non-viable
93
When must Levonelle be taken?
Within 72h of UPSI
94
When is Levonelle uneffective as emergency contraception?
If the LH surge has already begun
95
What are some benefits of Levonelle emergency contraception?
``` Can be taken if patient recently had POP Can start hormonal contraception same day Can be used more than once per cycle No insertion procedure necessary Easily accessible Fewer contraindications than ellaOne ```
96
What are some limitations of Levonelle emergency contraception?
``` No benefit if ovulation has already occurred Less effective at the end of 72h window Efficacy is affected by patient weight Least effective emergency contraception Offers no on-going contraception ```
97
What is the unintended pregnancy rate with Levonelle?
1.7-2.2%
98
What is the active ingredient of ellaOne?
Ulipristal Acetate
99
How does ellaOne act as emergency contraception?
Delays/Stops ovulation
100
When must ellaOne be taken?
Within 120h of UPSI
101
What are some benefits of ellaOne emergency contraception?
More effective than Levonelle Easily accessible Effective for up to 120h Can be used more than once per cycle
102
What are some limitations of ellaOne emergency contraception?
Little-No benefit after ovulation Must wait 5 days before starting hormonal contraception Not recommended in severe asthma, hepatic dysfunction or PPIs/Antacids No ongoing protection
103
What is the unintended pregnancy rate with ellaOne?
1.3-1.6%
104
When must the Copper Coil be inserted as emergency contraception?
Within 5 days of UPSI or 5 days of ovulation
105
What are some benefits of the Copper Coil as emergency contraception?
Most effective Provides up to 10y of ongoing protection Only emergency contraception that is effective if fitted after ovulation Not affected by weight or other medications
106
What are some limitations of the Copper Coil as emergency contraception?
Needs a qualified practitioner to fit Risks of insertion Less convenient Absolutely contraindicated if more than 5 days after ovulation
107
What is the unintended pregnancy rate with the Copper Coil emergency contraception?
<0.1%

Year 3 Primary Care (4 decks)

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