Family Planning Flashcards
List the 5 types of long-acting reversible contraceptives (LARC)
Progesterone-only implant (Nexplanon)
Levonorgestrel-releasing intrauterine system (hormone coil)
Copper intrauterine device (copper coil)
Progesterone-only injectables (Depo or Sayana Press)
What are some hormone-free methods of contraception?
Female sterilisation Vasectomy Copper intrauterine device (copper coil) Male and female condoms Diaphragm Fertility awareness methods
What are the two types of contraceptive pills?
Progesterone-only pills (mini pill)
Combined hormonal contraceptive pill (COCP)
Which contraception methods are progesterone-only?
Progesterone-only pills (mini pill)
Progesterone-only injectables (Depo or Sayana Press)
Progesterone-only implant (Nexplanon)
Levonorgestrel-releasing intrauterine system (hormone coil)
How long can sperm live in the female genital tract?
7 days
On what day (range of days) does ovulation occur in the menstrual cycle?
Day 10-16
How long does an egg survive after ovulation?
24-48 hours
When using fertility awareness methods as contraception, when should sex be restricted?
7 days before ovulation, and at least 2 days after ovulation.
What is the failure rate of fertility awareness methods with typical use?
24%
Which is the only method of contraception that protects against (most) STIs?
Male condom
What is the failure rate of the combined pill with typical use?
9%
What hormones does the combined pill contain?
Oestrogen and progesterone
If you want to be protected immediately from pregnancy, what days of the menstrual cycle does the combined pill have to be started on?
Days 1-5
If the combined pill is started after day 5 of the menstrual cycle, how long do you need extra protection (condoms or abstinence) for?
7 days
What is the definition of a missed pill (COCP)?
When it is more than 24 hours since you should have taken it.
What do you do if you miss one pill in your pack? (COCP)
Take the last pill (even if this means 2 in a row/in one day). No extra protection is needed.
What do you do if you miss two pills in a pack in week 1? (COCP)
Emergency contraception should be considered if unprotected sex occurred in the pill-free interval or week 1.
What do you do if you miss two pills in a pack in week 2? (COCP)
No emergency contraception is needed if the pill was taken for 7 consecutive days prior to the missed pill.
What do you do if you miss two pills in a pack in week 3? (COCP)
Finish the current pack, and then start a new packet the next day, omitting the pill free interval.
The combined hormonal contraceptive pill increases the risks of what types of cancer?
Cervical cancer and breast cancer.
The combined hormonal contraceptive pill decreases the risks of what types of cancer?
Endometrial, ovarian and colorectal cancer.
List 3 absolute contraindications (UKMEC4) to the combined hormonal contraceptive pill.
- More 35 years old and smoking more than 15 cigarettes/day
- Migraine with aura
- History of thromboembolic disease or thrombogenic mutation
- History of stroke or ischaemic heart disease
- Uncontrolled hypertension
- Current breast cancer
- Major surgery with prolonged immobilisation
List the contraception methods that use both oestrogen and progesterone.
Combined hormonal contraceptive pill (COCP)
Combined transdermal patch (CTP)
Combined vaginal ring (CVR)
Which progesterone-only injectable is subcutaneous?
Sayana Press
Which progesterone-only injectable is intramuscular?
Depoprovera
Which progesterone-only injectable can be self-administered?
Sayana Press
How long are progesterone-only injectables licensed for?
13 weeks
What is the rate of unintended pregnancy with typical use of progesterone-only injectables?
6%
List some disadvantages of progesterone-only injectables?
- Injection cannot be reversed once given
- Delayed return to fertility (up to 12 months)
- Irregular bleeding – usually first 3/12 use
- Potential for weight gain (especially in adolescents with baseline BMI >30)
- Can increase risk of osteoporosis (long-term use and those at increased risk)
- No protection against STIs
- Hormonal side effects
How does the progesterone-only pill work?
It thickens the cervical mucus and prevents ovulation.
What is the failure rate of the progesterone-only pill with typical use?
9%
In what time frame do progesterone-only pills have to be taken?
POPs should be taken at the same time every day.
Older, traditional POPs (that do not contain desogestrel) must be taken within a 3 hour window every day.
Desogestrel-containing POPs must be taken no later than 12 hours after the usual time.
What should you do if you miss a desogestrel-containing POP?
If it is less than 12 hours late, take the pill as normal.
If it is more than 12 hours late, take the missed pill as soon as you remember and continue with the rest of the pack. You must use condoms until the pill has been taken for 48 hours!
How long does the subdermal implant (nexplanon) last for?
3 years
How does the intrauterine system (IUS) work?
It keeps the endometrium thin, preventing implantation, and thickens the cervical mucus, making it harder for a sperm to reach an egg.
How long does an IUS have to be in situ until it is effective?
7 days
It is, however, immediately effective if inserted within days 1-5 of the menstrual cycle
If within days _______ of the menstrual cycle, an IUS is immediately effective from insertion.
1-5
What is the risk of IUS expulsion in the first 3 months after insertion?
1 in 20 (5%)
Name the 3 brands of IUS
Mirena (52mg levonorgestrel)
Kyleena (19.5mg levonorgestrel)
Jaydess (13.5mg levonorgestrel)
How long are the IUSs Mirena and Kyleena licenced for?
5 years
How long is the IUS Jaydess licenced for?
3 years
How long are copper IUDs effective for?
5-10 years depending on the device
Other than the morning after pill, name one other form of emergency contraception.
Copper IUD
A copper IUD can be inserted up to _____ days after an episode of unprotected sexual intercourse as emergency contraception.
5
What are some side effects of a copper IUD
- Heavier bleeding
- More painful periods
- Longer periods
- Spotting/bleeding between periods
What is the failure rate of male sterilisation?
1 in 2000
What structure is blocked in a vasectomy?
Vas deferens
What is the failure rate of female sterilisation?
1 in 200
What are some risks of female sterilisation?
- Ectopic pregnancy
- Procedural risks (bleeding, infection etc)
How many weeks after unprotected sexual intercourse should a pregnancy test be taken?
3 weeks
How does EllaOne work as an emergency contraceptive?
EllaOne is a progesterone receptor modulator that delays/inhibits ovulation.
EllaOne can be taken up to ____ hours after unprotected sex to prevent pregnancy.
120 (5 days)
Levonelle can be taken up to ____ hours after unprotected sex to prevent pregnancy.
72 (3 days)
How does levonelle work as an emergency contraceptive?
Levonelle contains levonorgestrel (a progesterone) that delays/inhibits ovulation and reduces the chance of a successful implantation.
How effective is Levonelle?
84% effective within 72 hours of unprotected sex.
Which emergency contraceptive reduces the effectiveness of hormonal contraception?
EllaOne - as it blocks progesterone. Hormonal contraception should be restarted 5 days after taking EllaOne.
If you vomit within ___ hours of taking Levonelle or EllaOne as an emergency contraceptive then you should take another dose.
3
What is the active ingredient in EllaOne?
Ulipristal Acetate
What is the most effective form of emergency contraception?
Copper IUD
What are the criteria for the lactational amenorrhoea method (LAM) to work as an effective form of contraception?
• Only effective up to 6 months postnatally
• Must be exclusively breastfeeding (at least every 4 hours during the day and at
least every 6 hours during the night)
• Fully amenorrhoeic
The hormonal IUC or copper IUD can be inserted up to ____ hours after a vaginal delivery as postnatal contraception.
48
How long should you wait after giving birth to start a combined hormonal contraceptive?
At least 3 weeks due to the risk of VTE.
Under what act is abortion legal in the UK?
1967 Abortion Act
