Fertility control Flashcards
COCP that does not follow the 7d additional precautions rule?
Qlaira® requires 9 days of additional contraceptive precautions
COCP that does not follow the d1-5 with no additional precautions rule?
Estradiol-containing combined oral contraceptives (Qlaira and Zoley) require additional precautions if started after Day 1
Problematic bleeding on hormonal contraception: investigations
STI test
Cervical screening
UPT
Problematic bleeding on hormonal contraception: when not to examine
no risk factors for STIs,
no concurrent symptoms suggestive of underlying causes,
they are participating in an NHSCSP,
and have had no more than 3 months of problematic bleeding.
Problematic bleeding on hormonal contraception: when to endometrial biopsy
in women aged ≥45 years or in women aged <45 years with risk factors for endometrial cancer who have persistent problematic bleeding after the first 3 months of use of a method or who present with a
change in bleeding pattern
Bleeding on COC
For women using a COC the lowest dose of ethinylestradiol (EE) to provide good cycle
control should be used. However, the dose of EE can be increased to a maximum of 35 µg to provide good cycle control.
Although DONT change within the first 3 months.
Bleeding on POP
There is no evidence that changing the type and dose of POP will improve problematic bleeding; bleeding patterns may vary with different POP
preparations and this may help some individuals.
PO-injectable: mefenamic acid 500 mg twice daily (or as licensed up to three times daily) for 5 days.
PO-injectable, implant or
IUS: COC may be tried for 3 months (this can be used in the usual cyclic manner
or continuously without a pill-free interval and is outside the product licence).
Upper arm anatomy
Separated into anterior (flexor) and posterior (extensor) compartments by fascia, bones and ligaments.
Arm: Anterior compartment
contains 3 muscles:
(1) Biceps brachii:
*Flexor of the forearm at the elbow joint
*Supinator of the forearm
*Accessory flexor of arm at glenohumeral joint
*Biceps tendon reflex tests C6
(2) Brachialis:
*Flexor of the forearm at the elbow joint
(3) Coracobrachialis:
*Flexor of arm at glenohumeral joint
All predominantly innervated by musculocutaneous nerve
Brachialis has small component laterally which is innervated by the radial nerve
Posterior compartment
contains only the triceps brachii
Innervated by the radial nerve
Extensor action on the forearm at the elbow
Triceps tendon reflex tests C7
Arteries in the arm
Aortic arch -> gives rise to Brachiocephalic trunk on the right -> right subclavian and common carotid
On the left, the subclavian and common carotid arise directly from the aortic arch
**Remember ABCs – Aorta: Brachiocephalic, Common carotid, Subclavian **
The subclavian artery -> (gives rise to ) axillary artery -> (becomes the) brachial artery when passes beyond the lower border of teres major -> (becomes the) radial and ulnar arteries distal to the elbow
Brachial artery gives off profunda brachii, which passes into and supplies the posterior compartment of the arm (which it enters alongside the radial nerve)
(Profunda brachii passes along the radial groove and anastomoses with the posterior circumflex humeral artery)
Veins in the arm
Includes the superficial veins (cephalic and basilic) and deep veins (brachial and axillary)
Veins of the arm -> (become the) subclavian vein -> (joins with the jugular veins) brachiocephalic vein -> (right and left brachiocephalic veins merge) superior vena cava -> (empties into) right atria
The basilic vein passes vertically in the medial distal half of the arm
*Penetrates the deep fascia
*Becomes the axillary vein at the border of the teres major
The cephalic vein passes on the anterolateral aspect of the arm
*Proximally, it joins with the axillary vein
The paired brachial veins pass along the medial and lateral sides of the brachial artery
Nerves of the arm
Musculocutaneous (C5 - C7)
Axillary (C5, C6)
Median (C5-T1)
Radial (C6-T1)
Ulnar (C8, T1)
Nerve injury from Implant INSERTION
Ulnar nerve damage: If damaged proximally (as we would from implants) - when try to make a fist hand resembles an ‘OK sign’ as cannot bend the medial 2 digits
Nerve injury from Implant removal
median, cutaneous and ulnar nerves
Ulnar nerve damage: If damaged proximally (as we would from implants) - when try to make a fist hand resembles an ‘OK sign’ as cannot bend the medial 2 digits
Median nerve: If damaged proximally (as could occur with implant removal) when asked to make a fist - hand of benediction (unable to bend lateral 3 digits)
