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Reproductive System > Fertility Control > Flashcards

Fertility Control Flashcards

1
Q

What is the most used contraceptive in the UK?

A

Combined hormonal contraception 25%

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2
Q

What is the pearl index?

A

Number of pregnancies per 100 women - years
Total months or cycles of exposure from initiation of the product to the end of the study

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3
Q

What is LARC?

A

Long acting reversible contraception

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4
Q

When can sex cause pregnancy?

A

If 26-32 day of cycle and not on hormonal contraception
Ovulate 12-18 day and egg survives 24 hrs and sperm survive less than 4 days
So highest chance on day 8-19

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5
Q

Describe the combined hormonal contraception

A

Pill, patch and vaginal ring
Combination of 2 hormones - ethinyl estradiol and synthetic progesterone
Stops ovulation and affects cervical mucus and endometrium

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6
Q

What is the regime of the combined hormonal contraception?

A

Standard regime - 21 days with a hormone free week
Tailored - tricycling or continuous use
Pill taken daily, Patch (EVRA) is changed weekly and ring is changed every 3 weeks

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7
Q

What are the non-contraceptive benefits of combined hormonal methods?

A

Regulates and reduces bleeding
Stops ovulation
Reduces functional ovarian cysts
Reduction in ovarian and endometrial cancer
Improves acne/ hirsutism
Reduction in benign breast disease, RA, colon cancer and osteoporosis

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8
Q

What are some side effects of combined hormonal methods?

A

Breast tenderness, nausea, headache and irregular bleeding in first 3 months
Mood and weight gain

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9
Q

What are the serious risks of the combined hormonal methods?

A

Increased risk of DVT or PE, arterial thrombosis - MI/ ischaemic stroke, cervical cancer and breast cancer

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10
Q

When should combined hormonal methods be avoided in risk if venous thrombosis?

A

If BMI > 34, previous VTE, 1st degree relative VTE under 45, reduced mobility and thrombophilia

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11
Q

When should combined hormonal methods be avoided in risk of arterial thrombosis?

A

Smokers >35, personal history, focal migraine, age > 50 and hypertension of 140/90

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12
Q

When should combined hormonal methods be avoided?

A

If active gall bladder disease or previous liver tumour
Avoid if previous breast cancer - BRCA

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13
Q

What is the increase risk of VTE on combined hormonal methods?

A

Increases three-fold

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14
Q

Describe the progesterone only pill (POP or mini pill)

A

Take it same time every day without pill free interval
Not good if have GI upset
Desogestrel pill
LNG NET pills
Oestrogen free

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15
Q

Describe the desogestrel pill

A

12 hour window period
Nearly all cycles anovulant and also affects mucus
Most users are bleed free after4-6 months

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16
Q

Describe LNG NET pills

A

3 hour window period
1/3 anovulant 2/3 rely on cervical mucus effect
1/3 are bleed free, 1/3 irregular and 1/3 regular periods

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17
Q

What are the progestogenic side effects?

A

Appetite increase, hair loss/ gain, mood change, bloating or fluid retention, headache and acne

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18
Q

When should progesterone only pill be avoided?

A

If current breast cancer or liver tumour past/ present

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19
Q

Describe the injectable progesterone ‘the jag’

A

Solution of medroxyprogesterone acetate dose every 3 weeks
1ml deep IM injection into upper quadrant of buttock - Depoprovera
0.6 SC injection in abdomen or thigh - Sayana press

20
Q

How does the injectable progesterone work?

A

Prevents ovulation
Alters cervical mucus making it hostile to sperm
Makes endometrium unsuitable for implantation

21
Q

What are the positives of injectable progestogen?

A

Only need to remember every 12-14 weeks
70% of women amenorrhoeic after 3 doses
Oestrogen free so few contraindications

22
Q

What are the negatives of injectable progestogen?

A

Delay in return to fertility - average 9 months
Reversible reduction in bone density
Problematic bleeding esp first 2 doses
Weight gain 2/3 of women (2-3kg)

23
Q

What is ‘the rod’?

A

Subdermal progestogen implant Nexplanon

24
Q

Describe the progestogen implant

A

Inhibition of ovulation and effect on cervical mucus
Can last 3 years and no user input needed
No effect on weight

25
Q

What are the negatives of the progestogen implant?

A

60% are almost bleed free but 30% have prolonged/ frequent bleeding
Can cause mood change more often than the other progestogen only methods

26
Q

What are the positives of intrauterine contraception?

A

Little user input after fitting - neither woman or partner are aware of device
Can be fitted at any age and parity
Side effects immediately reversible once removed

27
Q

What are the risks of the intrauterine contraception?

A

Small risk of infection in first 3 weeks
1:1000 risk perforation
5:100 risk expulsion
If conceives then may be ectopic
Not suitable if pelvic infection or distorted endometrial cavity

28
Q

What is the mode of action of the copper IUD?

A

Toxic to sperm - stops sperm reaching egg and may sometimes work by preventing implantation of fertilised egg

29
Q

What are some features of the copper IUD?

A

Hormone free
May make periods heavier/ crampier
Can last 5-10 years on type
Not a contraindication to MRI

30
Q

Describe the levonorgestrel IUS

A

Affects cervical mucus and endometrium - stops fertilisation of egg and some women may still ovulate
Slow release progestogen on stem
Reduces menstrual bleeding after 4 months of irregular bleeding
Low circulating progestogen

31
Q

What are types of Levonorgestrel IUS?

A

Mirena
Kyleena and Jaydess

32
Q

Describe the Mirena IUS

A

5 year contraception
Most women bleed free after 12 months
Equivalent systemic dose to 3 POP/ week
Licensed to treat heavy menstrual bleeding and can act as progestogenic part of HRT

33
Q

Describe the Kyleena and Jaydees IUS

A

Less progestogen so even less chance of side effects but less likely to be bleed free
Smaller frame and insertion tube
3 year contraception only

34
Q

What is the most effective option of emergency contraception?

A

Copper IUD - fit before implantation - within 120 hrs UPSI ant time cycle or by day 19 of 28 day cycle

35
Q

What are other options of emergency contraception?

A

Levonorgestrel pill - take within 72 hrs
Ulipristal pill - take within 120 hrs (has more contraindications like breast feeding and enzyme inducing drugs)

36
Q

When should contraception be started?

A

In first 5 days of cycle - immediate cover
Can start at other time of cycle if no risk of pregnancy (need condoms for 7 days)

37
Q

When can women get pregnant after delivery and breast feeding?

A

21 days after delivery and 5 days after miscarriage or abortion
Breast feeding is contraception only in first 6 months + feeding evert 4 hrs + amenorrhoeic
Breast feeding women can use any type of contraception

38
Q

What are drug interaction of contraception?

A

Enzyme inducing drugs like carbamazepine, topiramate, rifampicin
Incresae metabolism of progestogen and oestrogen and reduce effectiveness of combined pill/ patch/ ring, implant and POP
Not injection, copper IUD and levonorgestrel IUS

39
Q

What are the negatives of female sterilisation?

A

Risks of GA and laparoscopy
Irreversible
Failure rate is 1 in 200 lifetime risk - ectopic
No effect on periods/ hormones

40
Q

Describe female sterilisation

A

Laparoscopic sterilisation - Filshie clips applied across tube to block lumen
Okay for MRI
May do salpingectomy at planned caesarean section

41
Q

Describe a vasectomy

A

Vas deferens divided and ends cauterised small incision midline scrotum
Local anaesthetic
Takes 4-5 months to be effective - 2 sperm samples sent

42
Q

What are the positives and risks of vasectomy?

A

Failure rate is 1 in 2000
Irreversibility
Less than 1 in 100 risk of long term testicular pain
No effects on testosterone and sexual function

43
Q

What contraception was most used before need of abortion?

A

Condoms mainly then UPSI, pills and LARC

44
Q

What is involved in the clinic consultation before abortion?

A

Medical history, circumstances and scan needed
Discuss methods of abortion and contraception for after
STI bloods are offered
Vaginal swab

45
Q

What are the long term effects of abortion?

A

Safer than a full term delivery
No effect on future fertility unless infection or on cancer risks
Emotional effects

46
Q

Describe cervical priming in termination of pregnancy

A

Misoprostol 3 hrs preop helps dilation and reduces risk of perforation/ haemorrhage
GA or LA cervical block
Transcervical - 6-0mm suction catheter
Risks of GA and perforation

47
Q

Describe Mifepristone oral antiprogestogen tablet

A

36-48hrs later Misoprostol initiates uterine contraction which opens cervix and expels pregnancy
Average 4-6 hrs to pass pregnancy
Some may need surgery for incomplete abortion

Reproductive System (33 decks)

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