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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
Q

pearl index of progesterone only pill

A

0.3-3.1

26
Q

Why might there be a lower failure rate of POP in older women?

A

less fertile?

less sexually active?

27
Q

methods of action of POP

A

cervical mucus
max effect after 48 hours of ingestion
effect lost if > 3 hours late
ovulation

28
Q

What is DepoProvera?

A

aqueous solution of progesterone crystals

29
Q

How is DepoProvera given?

A

im injection in upper outer quadrant of buttock every 12 weeks
–> new subcut can be done at home

30
Q

3 modes of action of DepoProvera

A

prevents ovulation
alters cervical mucus
prevents implantation - inadequate endometrium

31
Q

positives of DepoProvera

A

good for forgetful pill takers
oestrogen free
70% amenorrhoeic

32
Q

4 negatives of DepoProvera

A

delay in return to fertility
reversible reduction in bone density
weight gain
problematic bleeding

33
Q

Describe the subdermal implant

A

4cm x 2mm –> 68mg of progestogen in EVA

lasts 3 years

34
Q

Primary action of subdermal implant

A

inhibit ovulation

35
Q

secondary action of subdermal implant

A

effect on cervical mucus - inhibit sperm entering upper reproductive tract

36
Q

LARC

A

long acting reversible contraception: 5-10 years

37
Q

copper coil

A

toxic to sperm so can be used as emergency contraception

lasts 5-10 years

38
Q

Emergency contraception - 2 pills and one other option **

A

copper IUD is best - within 120 hours
levonelle: 1500 micrograms levonorgestrel within 72 hours
Ella one - ulipristal acetate 30mg within 120 hours

39
Q

Method of female sterilisation

A

laparascopic - tube ligation using flishie clips

1 in 500 lifetime risk of failure

40
Q

What is a vasectomy?

A

permanent division of vas deferens under LA

41
Q

Describe the vasectomy

A

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
Q

Target for terminations

A

70% under 9 weeks

43
Q

Is medical or surgical abortions more common in Grampian?

A

medical

44
Q

After what gestation must a woman be referred to England for abortion?

A

20 weeks

45
Q

Reasons for abortion

A

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
Q

Home abortion - what is taken home?

A

misoprostol

47
Q

Clinic consultation for home abortion

A

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
Q

2 medications in medical abortion

A

mifepristone

misoprostol

49
Q

mifepristone mode of action

A

switches off pregnancy hormones keeping uterus from contracting and allowing pregnancy to grow

50
Q

misoprostol mode of action

A

initiates uterine contractions

opens cervix and expels pregnancy

51
Q

complications of abortion

A 
failure 
haemorrhage 
infection 
prolonged bleeding 
psychological 
uterine perforation 
cervical trauma
52
Q

Conscientous objection

A

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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