Brainscape's Knowledge GenomeTM

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


See full index

m4 obgyn > Family planning: Contraception > Flashcards

Family planning: Contraception Flashcards

1
Q

Importance of family planning

A

For reproductive health, physical, mental and social well-being
Satisfying and safe sex life
Freedom to decide - when and how often to reproduce

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

Factors to be considered in contraceptives

A

Age
Parity 
Future reproductive intention
Socioeconomic factors/ Education/ Sociocultural/ Peer influence
Sexual Hx
Motivation/ Compliance
Medical Hx
Method available
Government policies

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

2 statistical method to assess contraceptive efficacy

A

1: Pearl index
- Number of failures per 100 women-years of exposure
- Rate per HWY = (total no. of accidental pregnancies x 12 x 100) / total months of use
- disadvantage: assumes rate remains constant over period of time

2: Life table analysis
- calculates failure rate for a specified period

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

Types of family planning methods

A
  1. Coitus interruptus or withdrawal method
  2. Natural FP methods
  3. Hormonal methods
  4. Intrauterine devices
  5. Barrier methods
  6. Permanent methods
  7. Emergency Contraception
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Oral contraceptive pills are divided into 3 types

A
  1. Combined pills (contains oestrogens & progestin)
  2. Mini pills (contains only progestin)
  3. Morning after pills (contain both hormones or each one alone in a higher dosage)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do oral contraceptives work?

A

Oral contraceptives contain synthetic versions of 2 hormones produced naturally by the body: oestrogen and progestogen
- Steady levels of the 2 hormones will trick the pit gland that the woman is already pregnant, inhibiting the release of pituitary FSH and LH, thus inhibiting ovulation
- Progestogens thicken cervical mucus which blocks sperm penetration to uterus
- Progestogens induce endometrial thinning and atrophy to prevent egg from attaching

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Types of OCPs

A
  1. Monophasic
    - same oestrogen and progestogen composition for all 21 days
  2. Biphasic
    - 1st 10 days: 1 dose
    - next 11 days: another dose
  3. Triphasic
    - dosage changes every 7 days for 21 days and repeats in next cycle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Non-contraceptive benefits of COC

A
  • Lighter menstruation (more regular, less flow, less dysmenorrhea and anemia)
  • Treats certain gynae conditions
  • Reduce endometrial, ovarian CA
  • Reduce ovarian cysts, uterine fibroids, endometriosis
  • Reduce benign breast disease
  • Increase BMD (Protects against osteoporosis)
  • Improve CVS (Protects against atherosclerosis)
  • Fewer ectopic pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Side effects of COCs

A

Estrogen excess
- N/V
- Headache**
- Edema
- Leg cramps
- Increase in breast size
- Chloasma (mask of pregnancy)
- Visual changes
- HTN
- Vascular headache

Estrogen deficiency
- Early spotting
- Hypomenorrhea
- Nervous
- Atrophic vaginitis -> painful intercourse

Progestogen
- Acne, facial pigmentation
- Weight gain

Others
- No protection against STIs

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

Major S/E of COCs

A
  1. CVS disease
    - MI
    - Ischaemic/haemorrhagic stroke
    - Venous thromboembolism
    -> Must stop COC 4 weeks before major Sx
    -> Limited to current users presently, unrelated to duration of use
  2. HTN
  3. Cacinogenecity
    - Breast cancer
    -> Risk up to 10 years before stopping
    -> Risk stops 10 years after stopping
    -> Increased risk if started COC before 20yo
    - Cervical cancer
  4. Liver disease
    - benign hepatocellular adenoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Absolute C/I to COC

A

(think of the major S/E)
- Smokers > 35 yo
- Thrombotic disorders
- CVA
- CAD
- Impaired liver function
- Hepatic adenoma
- Estrogen dependent malignancy: Breast, endometrium Ca
- Pregnancy, breastfeeding (due to increase risk of thromboembolism)
- Undiagnosed irregular genital tract bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Combined patches: Ortho Evra

A
  • Applied once weekly for 3 weeks
  • Start D1 or within 1st week of menses
  • S/E profile similar to OCPs
  • 99% effective
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Vaginal ring: Nuvaring

A
  • Contains E + P
  • Flexible, soft transparent ring
  • 1 cycle use for 3 weeks
  • Inserted into vagina, outside cervix
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Progestogen only pill (POP)

A
  • Estrogen free oral contraceptives containing low dose progesterone
  • For women with S/E to oestrogen containing pills
  • For women C/I to COC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Composition, administration and efficacy of POP

A

Levonorgestrel
- Taken daily, non-stop
- Less effective than COC
??If missed pills, shld start as soon as rmb
??If >3h delay, requires alternative contraceptive method for 48h or abstinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Mode of action of POP

A
  • Progestogens thicken cervical mucus which blocks sperm penetration to uterus
  • Progestogens induce endometrial thinning and atrophy to prevent egg from attaching
  • Inhibits ovulation in 50% of cycles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Advantages of POP

A
  • Does not suppress lactation -> suitable for breastfeeding women***
  • Suitable for those with medical C/I to estrogen containing pills
  • Reversible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Disadvantages of POP

A
  • Requires user motivation -> can lead to poor compliance
  • Increased menstrual irregularity or stops completely
  • Progestogenic side effects: mastalgia, bloatedness, headache, nausea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Progestogen-only Injectables: Depo Provera

A
  • 150mg IM every 13 weeks (or 3 months) OR
  • 300mg IM every 6 months
  • Can be up to 2 weeks early or 4 weeks late
  • Injected into buttock/ deltoid
  • If there is abnormal PV bleed, exclude endometrial CA first
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Advantages of progestogen-only injectables

A
  • Convenient
  • Highly effective
  • Breastfeeding
  • Shortens and lightens menstruation: good for menorrhagia, dysmenorrhea, Fe deficiency anemia and endometriosis
  • Protection against ovarian/ endometrial CA
  • Reduce risk of PID
  • Used for those C/I to estrogen
  • Decrease sickle cell crises
  • No increase in VTE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Disadvantages of progesterone-only injectables

A
  • Irregular bleeding pattern/ menstruation can stop completely
  • Weight gain
  • Short term can cause reversible loss in BMD (Osteopenia) but is regained after stopping injections
  • No protection against STIs
  • Delayed return to fertility: takes up to ~9 months to return to fertility after stopping injections, even longer in obese women
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Contraindications of progesterone-only injectables

A

Absolute C/I
- Current breast cancer
- Pregnancy

Relative C/I
- Vascular Disease
- IHD/ Stroke
- Past breast CA
- Liver disease
- Undiagnosed vaginal bleeding
- SLE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Subdermal implants

A

Silicone rubber capsule filled with etonorgestrel inserted under the skin
- Nexplanon: 1 rod (non-biodegradable)
- High efficacy, better than female sterilisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Mode of action + Frequency of Administration of subdermal implant

A

Sustained slow and steady release of progesterone
Prevents ovulation
Thickens cervical mucus -> hence poor sperm penetration
Thins endometrium

  • Frequency of administration: once every 3 years
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Advantages of subdermal implants

A
  • High efficacy
  • Long acting reversible contraception
  • Breastfeeding
  • Reduces dysmenorrhea/ovulation pain
  • No risk of VTE/stroke/MI
  • No effect on BMD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Disadvantages of subdermal implant

A
  1. Menstrual irregularities
    - 1/3 infrequent bleeding
    - 1/4 prolonged/frequent bleeding
    - 1/5 amenorrhea
  2. Acne
  3. Insertion/Removal (refer to next card)
  4. Reduced efficacy in obese (high BMI) patients
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Contraindications of subdermal implant

A

Absolute C/I
- Current breast cancer
- Pregnancy

Relative C/I
- Vascular Disease
- IHD/ Stroke
- Past breast CA
- Liver disease
- Undiagnosed vaginal bleeding
- SLE

28
Q

Side effects of SDI insertion & removal

A
  • Non-insertion/pregnancy
  • Skin incision -> skin atrophy
  • Deep insertion -> difficulty to remove
  • Nerve and vascular injury
  • Bleeding
  • Bruising
  • Scar
  • Infection
  • Fibrosis
  • Breakages
29
Q

Mirena (levonorgestrel-releasing intrauterine system)

A
  • Long acting reversible contraception
  • Stem has a silastic rod impregnated with levonorgestrel
  • Slow release over 5 years
  • High efficacy
30
Q

Mode of action + Frequency of administration of mirena

A
  • Thickens cervical mucus
  • Endometrial atrophy
  • Does NOT affect ovulation
  • Freq: inserted every 5 years
31
Q

Contraindications of Mirena

A
  • Pregnancy, puerperal sepsis, septic abortion
  • Unexplained vaginal bleeding
  • Current cervical or endometrial cancer
  • Current breast cancer
  • Current PID, chlamydia/gonorrhea
  • Persistently high hCG suggestive of gestational trophoblastic neoplasia
  • Known pelvic tuberculosis
  • Severe liver disease
32
Q

Advantages of Mirena

A
  • High efficacy
  • LARC
  • Breastfeeding
  • Lowest plasma concentration of all hormonal methods
  • No delay in return of fertility
33
Q

Disadvantages of Mirena

A
  1. Menstruation irregularities up to 6 months
    - Usually starts with spotting/ HMB for the 1st 6 months
    - Usually amenorrhea after that

2 .Risks: Perforation, expulsion, PID, ovarian cysts (1st 20 days after insertion)

  1. Temporary hormonal S/Es
    - Breast tenderness
    - Acne
    - Mood swings
    - Headache
    - Bloatedness
34
Q

Non-contraceptive benefits of Mirena

A
  • Treats HMB*
  • Improve Hb levels and iron stores
  • Relief of dysmenorrhea in adenomyosis
  • Reduce incidence and growth of fibroids
  • Treatment of endometrial hyperplasia
35
Q

Non-hormonal contraceptives

A
  • Intrauterine contraceptive devices
  • Barriers and spermicides
  • Natural family planning
  • Sterilisation
36
Q

Intrauterine contraceptive device

A

Copper device inserted into womb

37
Q

MOA of IUCD

A

Prevents fertilisation

38
Q

When can IUCD be started?

A

Anytime when sure that patient is not pregnant
- Works immediately

39
Q

Contraindications of IUCD

A

=similar to mirena=

  • Pregnancy, puerperal sepsis, septic abortion
  • Unexplained vaginal bleeding
  • Current cervical or endometrial cancer
  • Current breast cancer
  • Current PID, chlamydia/gonorrhea
  • Persistently high hCG suggestive of gestational trophoblastic neoplasia
  • Known pelvic tuberculosis
  • Severe liver disease
40
Q

Advantages of IUCD

A
  • High efficacy
  • LARC
  • Breastfeeding
  • NO hormones
  • No delay in return of fertility
  • Few S/E
  • Cheap
  • Can last up to 10 years and can be removed anytime
  • Works immediately (Post-sex)
  • Only one can be used for breast CA
41
Q

Disadvantages of IUCD

A
  1. Menstruation irregularities up to 6 months
    - Usually starts with spotting/ HMB for the 1st 6 months
    - Usually amenorrhea after that

2 .Risks: Perforation, expulsion, PID, ovarian cysts (1st 20 days after insertion)

  1. Training required for insertion and removal
  2. Ectopic pregnancy
42
Q

Post IUCD insertion plans

A

Check using U/S that IUD is in the uterus
F/u after first menses comes or 3-6 weeks after insertion:  
- Ensure no infection  
- Ensure no perforation/ expulsion (Check thread)

43
Q

Types of barrier contraception

A

Condoms
Diaphragm
Cervical caps

44
Q

MOA of barrier contraception

A

Prevent sperm from reaching upper genital tract

45
Q

When should barrier contraception be used?

A

Inserted into vagina before intercourse occurs

46
Q

Advantages of barrier contraceptions

A
  • Immediately effective
  • No effect of breastfeeding
  • ‘Double dutch’: both partners use
  • No systemic S/E
  • Easily available
  • Protects against STD
47
Q

Disadvantages of barrier contraception

A
  • Interferes with coital act -> affects sexual pleasure -> affects motivation and compliance
  • Allergy
48
Q

Diaphragms and cervical caps

A
  • Dome-shaped appliance made of rubber rim that fix overs the cervix
  • Used with spermicidal jelly
  • Needs to be assessed for size especially after birth or weight gain/ loss
  • Less effective, needs to be fitted
  • Leave for 6 hours after sexual intercourse
49
Q

Spermicides

A

Causes sperm cell membranes to break
Types: tablets, cream, aerosols

50
Q

Advantage and disadvantages of spermicides

A

Advantages
- Immediate, no systemic S/E, backup method, some protection against STDs

Disadvantages
- Allergy, less effective, require consistency, inconvenient

51
Q

Natural family planning methods

A
  1. Basal body temperature charting
    - identifies luteal phase of menstrual cycle by postovulatory increase in basal body temp (all other days -> fertile)
  2. Calendar calculation
  3. Cervical mucus monitoring
  4. Lactational amenorrhea
    - maximises suppression of ovulation during breastfeeding (6 months postpartum)
  5. Symptothermal method
52
Q

Calendar calculation

A
  • Dependent on regular cycles
  • Monitor for at least 6 cycles
  • Longest cycle subtract 11 = Y
  • Shortest cycle subtract 18 = X
  • Fertile period is from day X to day Y
53
Q

Methods for sterilisation

A
  1. Minilaratomy for puerperal sterilisation
  2. Laparoscopic filshie clip application
  3. Laparotomy - either filshie clip application or modified Pomeroy’s method (ligation and division)

MOA: PERMANENTLY prevent sperm from reaching oocyte

54
Q

When to perform sterilisation?

A

Completed family and SURE does not want a pregnancy
During follicular phase, postpartum or postabortion

55
Q

Counselling for sterilisation

A

Permanent
Irreversible
Surgical procedure (pain, anaesthesia, trained doctor)
Small risk of failure (1-4 in 1000)
May regret later

56
Q

Advantages of sterilisation

A

Highly effective
Immediate
Permanent
No affect to breast feeding
No affect to coital act
No long term S/E

57
Q

Indications for use of emergency contraception

A

No contraception used
Contraceptive accident (ie. break in condom)
Victim of SA

58
Q

What factor determines which contraception to use in emergency contraception?

A

Window of opportunity

59
Q

Emergency contraception options

A
  1. Copper IUCD
    - inserted within 5 days of intercourse or 5 days of expected ovulation
  2. Progestogen only EC
    - Levonorgestrel within 72 hours
    - Failure increases with time
  3. Ulipristal acetate (ELLA)
    - best administered immediately after
    - can be within 120h
60
Q

MOA of ulipristal acetate

A

When taken immediately before ovulation occurs, ELLA postpones follicular rupture
-> inhibits or delay ovulation

Note: alterations to endometrium may affect implantation -> affect efficacy

61
Q

Contraindications for ulipristal acetate

A

Hepatic impairment
Poorly controlled asthma
Anti-epileptic medication

62
Q

When should post-natal contraception be initiated?

A

21 days after childbirth

63
Q

Post-natal contraception options

A

Lactational amenorrhea (postpartum infertility)
~ within 6 hours, fully breastfeeding and amenorrheic
Progestin-only pills
Subdermal Implanon
Progestogen-only Injectables
Barriers
Intra-uterine device: wait at least 4 weeks post NVD

64
Q

What post-natal contraceptions can be initiated immediately?

A

Progestin-only pills
Subdermal Implanon
Progestogen-only Injectables
Barriers

65
Q

Which type of contraception should not be initiated postpartum?

A

Combined oral contraceptive (pill, patch, ring)
- should not be initiated within 3 weeks of childbirth
- increased risk of thromboembolism

m4 obgyn (37 decks)

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