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Year 3 Repro (JK) > Fertility control > Flashcards

Fertility control Flashcards

1
Q

What is the most common method of contraception in the UK for women aged 16-49?

A

sterilisation

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2
Q

What percentage of women in the UK do not use contraception despite being sexually active and no wish to get pregnant?

A

12%

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3
Q

examples of combined contraception

A

pills, patch and vaginal ring

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4
Q

examples of progesterone only methods of contraception

A

pills, injectable and implant

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5
Q

Give some aims of an ideal contraceptive

A

100% effective
does not relate to intercourse and is convenient
100% reliable, free of adverse side effects and protection against STIs
non-contraceptive benefits
low maintenance and no ongoing medical input

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6
Q

What type of contraceptives have the most adverse effects?

A

containing oestrogen

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7
Q

Closest contraception regime to 100% effective?

A

vasectomy then implant

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8
Q

What is the only contraceptive method which is not reversible?

A

sterilisation

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9
Q

Only contraceptive which is related to intercourse

A

condoms

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10
Q

2 methods of tracking the failure rates

A

pearl index and life table analysis

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11
Q

pearl index

A

number of contraceptive failures per 100 women - years of exposure
total months or cycles of exposure from initiation of product to end of cycle

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12
Q

life table analysis

A

contraceptive failure rate over specified time frame

cumulative failure rate for any specific length of exposure

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13
Q

pearl index of COC

A

0.3-4 per HWY

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14
Q

2 ingredients of COC

A

ethinyl estradiol

synthetic progesterone - progestogen

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15
Q

dose of EE in the COC

A

20-35 mcg –> 50 if on liver enzyme inducers

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16
Q

2nd gen COC

A

levonorgestrel and norethisterone

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17
Q

3rd gen COC

A

gestodene and desogestrel

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18
Q

How is the COC taken?

A

21 days with a 7 day free period

some new evidence for tricycling/continual use

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19
Q

3 modes of action of COC

A

prevents ovulation
prevents implantation by providing inadequate (thin) endometrium
progesterone alters cervical mucus to inhibit sperm penetration

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20
Q

How long does COC take to work?

A

7 days —> USE CONDOMS

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21
Q

Non contraceptive benefits of COC

A
  1. regular, less painful, less heavy bleeding
  2. help with anaemia
  3. reduced functional ovarian cysts, benign breast disease, osteoporosis, RA, colon cancer
  4. decreased endometrial and ovarian cancer
  5. improve acne
22
Q

Risks of COC

A

VTE
focal migraine –> ischaemic stroke
breast cancer - small and returns to normal in 10 yrs
cervical cancer? doubles with 10 year use

23
Q

Increased risk factors for VTE

A 
postnatally in 21 days 
major surgery and immobility 
thrombophilias 
FH in under 45's
BMI>30
underlying vascular disease
24
Q

Progesterone only pill - name and method of taking

A

desogestrel
12 hour window but usually taken in 3 hours
no pill free interval

25
pearl index of progesterone only pill
0.3-3.1
26
Why might there be a lower failure rate of POP in older women?
less fertile? | less sexually active?
27
methods of action of POP
cervical mucus max effect after 48 hours of ingestion effect lost if > 3 hours late ovulation
28
What is DepoProvera?
aqueous solution of progesterone crystals
29
How is DepoProvera given?
im injection in upper outer quadrant of buttock every 12 weeks --> new subcut can be done at home
30
3 modes of action of DepoProvera
prevents ovulation alters cervical mucus prevents implantation - inadequate endometrium
31
positives of DepoProvera
good for forgetful pill takers oestrogen free 70% amenorrhoeic
32
4 negatives of DepoProvera
delay in return to fertility reversible reduction in bone density weight gain problematic bleeding
33
Describe the subdermal implant
4cm x 2mm --> 68mg of progestogen in EVA | lasts 3 years
34
Primary action of subdermal implant
inhibit ovulation
35
secondary action of subdermal implant
effect on cervical mucus - inhibit sperm entering upper reproductive tract
36
LARC
long acting reversible contraception: 5-10 years
37
copper coil
toxic to sperm so can be used as emergency contraception | lasts 5-10 years
38
Emergency contraception - 2 pills and one other option **
copper IUD is best - within 120 hours levonelle: 1500 micrograms levonorgestrel within 72 hours Ella one - ulipristal acetate 30mg within 120 hours
39
Method of female sterilisation
laparascopic - tube ligation using flishie clips | 1 in 500 lifetime risk of failure
40
What is a vasectomy?
permanent division of vas deferens under LA
41
Describe the vasectomy
1 in 2000 failure - irreversible pain due to sperm granuloma no change in testosterone and semen of same colour and volume no evidence of prostate and testicular cancer
42
Target for terminations
70% under 9 weeks
43
Is medical or surgical abortions more common in Grampian?
medical
44
After what gestation must a woman be referred to England for abortion?
20 weeks
45
Reasons for abortion
less than 24 weeks pregnancy will cause greater harm to physical or mental health of the women and/or other children social medical eg anomaly, maternal health
46
Home abortion - what is taken home?
misoprostol
47
Clinic consultation for home abortion
methods of termination prolonged bleeding after TOP and counselling contraception FBC/group&screen/rubella/scan/chlamydia and gonorrhoea self obtained swab/STI bloods certificate A signed
48
2 medications in medical abortion
mifepristone | misoprostol
49
mifepristone mode of action
switches off pregnancy hormones keeping uterus from contracting and allowing pregnancy to grow
50
misoprostol mode of action
initiates uterine contractions | opens cervix and expels pregnancy
51
complications of abortion
``` failure haemorrhage infection prolonged bleeding psychological uterine perforation cervical trauma ```
52
Conscientous objection
medical staff allowed to object being part of abortion but must ensure woman can still access and receive the correct care

Year 3 Repro (JK) (33 decks)

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