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Year 3 Primary Care > Contraceptives > Flashcards

Contraceptives Flashcards

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
Q

When should COCP be taken?

A

21 days on then 7 off
63 days on then 7 off
Continuous use

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26
Q

What will a patient on COCP experience during their 7 days off?

A

Menstrual bleed

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27
Q

What are some benefits to the COCP?

A

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

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28
Q

What are some limitations of the COCP?

A 
Less effective if a pill is missed
Vomiting affects usefullness
Anti-epileptic medications can interract
Increased VTE/Stroke risk
No STI protection
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29
Q

What are some common side effects of the COCP?

A

Headaches
Nausea
Breast tenderness
Mood swings

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30
Q

What is the unintended pregnancy rate with COCP?

A

9%

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31
Q

How do contraceptive patches work?

A

Supply oestrogen and progesterone via the skin

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32
Q

How often should contraceptive patches be applied?

A

Once every 7 days. Have a break after 21 days for 7 days

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33
Q

What are some benefits to contraceptive patches?

A 
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
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34
Q

What are some limitations to contraceptive patches?

A

Not protected if forget patch
Increased risk of VTE/Stroke
No STI protection
Can “Fall off”

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35
Q

What is the unintended pregnancy rate with contraceptive patches?

A

9%

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36
Q

What is a commonly used brand of Vaginal ring?

A

Nuvaring

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37
Q

What is a Vaginal Ring?

A

Small plastic ring placed high in the vagina that secretes oestrogen and progestogen for 21 days

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38
Q

What are the possible regimes with a vaginal ring?

A

21-7

63-7

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39
Q

What are some benefits of vaginal rings?

A 
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
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40
Q

What are some limitations of vaginal rings?

A

Increase VTE/Stroke risk
No STI protection
Affected by anti-epileptics

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41
Q

What is the unintended pregnancy rate with vaginal rings?

A

9%

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42
Q

What are some commonly used Progesterone-Only Pills (POPs)?

A

Desogestrel

Levonorgestrel

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43
Q

How does Desogestrel work?

A

Inhibits ovulation
Thickens cervical mucus
Thins endometrium

44
Q

When should Desogestrel be taken?

A

Within the same 12 hour window every day

45
Q

How does Levonorgestrel work?

A

Thickens cervical mucus

Thins endometrium

46
Q

When should Levonorgestrel be taken?

A

Within the same 3 hour window every day

47
Q

What are some benefits of POPs?

A

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
Q

What are some disadvantages to POPs?

A

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
Q

What is the unintended pregnancy rate with POPs?

A

9%

50
Q

What is the contraceptive injection?

A

A 12 weekly injection of progesterone

51
Q

Where is the contraceptive injection administered?

A

IM, into buttocks

52
Q

How does the contraceptive injection work?

A

Thickens cervical mucus
Thins endometrium
Inhibits ovulation

53
Q

What is a commonly-used contraceptive injection?

A

Depo-Provera

54
Q

What are some benefits to the contraceptive injection?

A

Suitable for patients contraindicated to oestrogen
No need to remember daily pill
No interruption to intercourse

55
Q

What are some disadvantages of the contraceptive injection?

A

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
Q

What is the unintended pregnancy rate with the contraceptive injection?

A

6%

57
Q

What are Long Acting Reversible Contraceptives?

A

Contraceptives that are inserted into the patient and provide years of ongoing protection

58
Q

What is Nexplanon a form of?

A

Contraceptive Implant

59
Q

What is the contraceptive implant?

A

A small plastic rod inserted sub-dermally in the upper arm

60
Q

How does the contraceptive implant work?

A

Slowly releases Progestogen to inhibit ovulation, thicken cervical mucus and thin the endometrium

61
Q

What are some benefits of the contraceptive implant?

A

Lasts for 3y once inserted
Suitable for those that cannot use oestrogen
Most effective contraceptive available
No interruption to intercourse

62
Q

What are some limitations of the contraceptive implant?

A

Can cause irregular bleeding, amenorrhoea or increased frequency of bleeding
Requires qualified practitioner to insert
Can worsen acne
No STI protection

63
Q

What is the unintended pregnancy rate with the contraceptive implant?

A

0.05%

64
Q

What is the Mirena a form of?

A

Hormonal Coil (Intra-Uterine system)

65
Q

What is a hormonal coil?

A

A T-shaped rod inserted into the uterus that locally release progestogen giving thickened cervical mucus and a thinned endometrium

66
Q

What are some benefits to the hormonal coil?

A

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
Q

What are some limitations of the hormonal coil?

A

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
Q

What is the unintended pregnancy rate of the hormonal coil?

A

0.2%

69
Q

What is the Copper Coil?

A

T Shaped plastic and copper rods inserted into the uterus

70
Q

How do Copper Coils act as contraceptives?

A

Create an inhospitable environment for sperm and ovum to survive in the uterus

71
Q

What are some benefits of the Copper Coil contraceptive?

A 
Last 5-10y
Suitable for women that cannot use hormonal contraceptive
Very effective
Unaffected by other medications
Can be used as emergency contraceptive
72
Q

What are some limitations of the Copper Coil contraceptive?

A

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
Q

What is the unintended pregnancy rate with a Copper Coil?

A

0.8%

74
Q

When/How is Female Sterilisation usually carried out?

A

Under General Anaesthetic

During a Cesarian Section

75
Q

What are the primary methods of female sterilisation?

A

Tubal Occlusion with Surgical Clips
Hysteroscopic sterilisation with fallopian implants
Salpingectomy

76
Q

What are some benefits to female sterilisation?

A

Permanent
No interruption to intercourse
No change in hormonal levels

77
Q

What are some limitations of female sterilisation?

A

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
Q

What is the unintended pregnancy rate with female sterilisation?

A

0.5%

79
Q

What is Male Sterilisation otherwise known as?

A

Vasectomy

80
Q

What happens in a Vasectomy?

A

Procedure under local anaesthetic to remove a section of the vas deferens, preventing sperm from entering semen

81
Q

What are some benefits of male sterilisation?

A

Permanent contraception
No interruption to intercourse
Less invasive than female sterilisation

82
Q

What are some limitations of male sterilisation?

A

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
Q

What is the unintended pregnancy rate with male sterilisation?

A

0.15%

84
Q

What is Natural Family Planning/Fertility Awareness?

A

Intercourse is timed to the part of the cycle when ovulation is least likely

85
Q

What is monitored in Fertility Awareness?

A

Body Temperature

Cervical secretions

86
Q

What are the benefits of Fertility Awareness?

A

No side effects

Accepted by most faiths and cultures

87
Q

What are some limitations of Fertility Awareness as a form of contraception?

A 
Much less effective
Must avoid sex/use other contraception around ovulation
Needs significant patient input
Fertility signs can be unreliable
No STI protection
88
Q

What is the unintended pregnancy rate with Fertility Awareness?

A

24%

89
Q

When may women use Emergency Contraception?

A

If they’ve had Unprotected Sexual Intercourse (UPSI) or contraceptive failure

90
Q

What types of emergency contraception are there?

A

Morning After Pills

Copper Coil

91
Q

Name two examples of morning after pills

A

Levonelle

ellaOne

92
Q

What does Levnoelle contain and how does it work?

A

Contains a high dose of synthetic progestogen, thought to delay ovulation until the sperm are non-viable

93
Q

When must Levonelle be taken?

A

Within 72h of UPSI

94
Q

When is Levonelle uneffective as emergency contraception?

A

If the LH surge has already begun

95
Q

What are some benefits of Levonelle emergency contraception?

A 
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
Q

What are some limitations of Levonelle emergency contraception?

A 
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
Q

What is the unintended pregnancy rate with Levonelle?

A

1.7-2.2%

98
Q

What is the active ingredient of ellaOne?

A

Ulipristal Acetate

99
Q

How does ellaOne act as emergency contraception?

A

Delays/Stops ovulation

100
Q

When must ellaOne be taken?

A

Within 120h of UPSI

101
Q

What are some benefits of ellaOne emergency contraception?

A

More effective than Levonelle
Easily accessible
Effective for up to 120h
Can be used more than once per cycle

102
Q

What are some limitations of ellaOne emergency contraception?

A

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
Q

What is the unintended pregnancy rate with ellaOne?

A

1.3-1.6%

104
Q

When must the Copper Coil be inserted as emergency contraception?

A

Within 5 days of UPSI or 5 days of ovulation

105
Q

What are some benefits of the Copper Coil as emergency contraception?

A

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
Q

What are some limitations of the Copper Coil as emergency contraception?

A

Needs a qualified practitioner to fit
Risks of insertion
Less convenient
Absolutely contraindicated if more than 5 days after ovulation

107
Q

What is the unintended pregnancy rate with the Copper Coil emergency contraception?

A

<0.1%

Year 3 Primary Care (4 decks)

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