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PRE-REG own > Genitourinary contraception > Flashcards

Genitourinary contraception Flashcards

1
Q

When can combined contraception be started in the cycle?

A

Up to and including day 5 of cycle without additional precautions, anytime after day 5 can be started but with additional precautions

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2
Q

which progesterone only pills have been approved by MHRA for OTC use?

A

Desogestrel 75mg - Hana,Lovima

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3
Q

What is an alternative contraceptive if patient takes enzyme inducing drugs? and for how long to use?

A

Progesterone only injectable e.g. medroxypogesterone acetate
OR Copper IUD

Until 4 weeks after stopping enzyme inducer

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4
Q

When can progesterone only pill be started?

A

up to day 5 of cycle without additional precautions

after this - ned 48hrs of additional contraception

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5
Q

Which contraceptive would be used if a patient experiences headaches?

A 
Containing 
Gestodene
dosperinone
norgestimate
desogestrel
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6
Q

How long supply can you give contraceptives prescriptions

A

12months

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7
Q

What is the age cut off for combined contraception

A

50 (not in >50)

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8
Q

What cancers do combined contraceptives reduce the risk of?

A

Ovarian
Endometrial
colorectal

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9
Q

Which contraception should be stopped prior to surgery and when?

A

Combined due to risk of VTE - discontinue at least 4 weeks before and use alternative e.g. progesterone and re-start 2 weeks after full mobilisation

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10
Q

When would you avoid oestrogens in contraception?

A

If risk factors for VTE e.g. obesity, smoking, immobilisation long term, >35, primary relative with VTE,
use of desogestrel, gestodene, drosperinone

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11
Q

There are concerns regarding bone loss due to progesterone only pills, so what are the restrictions on their use because of this?

A

<18 (only depot can be used if all other options unsuitable)
>50
Significant risk factors for osteoporosis
R/V every 2 years (no specific time limit)

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12
Q

How long can etonogestrel implant be used for?

A

3 years

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13
Q

How long can the intrauterine system releasing levonorgestel be used for?

A

3-10 years

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14
Q

What cancers do combined contraceptives increase the risk of?

A

Breast and cervical

progesterone is just breast

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15
Q

What is considered a missed pill for combined oral contraception? when is the critical time?

A

> 24hs
Critical when pill missed at start or end of cycle

(Zoely/qlaria is >12hrs)

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16
Q

If one contraceptive pill is missed then what should be done?

A

Take one pill ASAP and next one at normal time even if that means taking two.
No need for extra precuations

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17
Q

If 2 or more combined contraceptive pills are missed what is done?

A

Take one pill ASAP and use a condom for 7 days (9 days if zoely/qlaria)

If missed in the last 7 days: Omit pill free interval
If missed in first 7 days and unprotected sex: EHC needed

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18
Q

If a patient is vomiting or has diarrhoea for >24hrs (severe) then how is combined contraception advised?

A

Would need extra protection until 7 days after recovery and pill is resumed
(9 days of qlaria)

If it happens in last 7 days= omit pill free interval

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19
Q

If a patient is vomiting within 2 hours of taking then how is combined contraception advised?

A

Take another ASAP

20
Q

What is a missed progesterone only pill considered as?

A

> 3 hours

or desogesterl is 12hrs

21
Q

What to do if miss a progesterone only pill?

A

Take ASAP and use condoms for 2 days

If unprotected sex occurs before 2 pills are taken correctly - EHC

22
Q

If vomiting/diarrhoea is severe what is advised for progesterone only pill?

A

Additional Protection until 2 days after recovery and pill resumed

23
Q

What is considered a missed patch?

A

detached for >24hrs or delayed application at beginning of cycle
or delayed application in middle of cycle (day 8 or 15)

24
Q 
If a patch has a delayed application in middle of cycle (day 8 or 15) 
and its 
<48 hours OR
>48 hours 
what is advised
A

<48hrs - apply new patch and continue as normal

>48hrs- start a new day 1 cycle and condom for 7 days

25
Q

What is the most effective form of emergency contraception and when can it be used?

A

Copper IUD- up to 5 days after unprotected sex

26
Q

When would copper IUD as EHC be less suitable?

A

<25years due to risk of PID (But is used)

27
Q

What EHC is used if BMI >26kg/m2 or >70kg?

A

Ulipristal acetate

Or doubled dose of levonorgestrel (unlicensed)

28
Q

What are cautions of levonorgestrel

A

Crohns /malabsorption syndromes
past ectopic pregnancies
concomittant ciclosporin (toxicity)

29
Q

What is a contraindication of Ellaone

A

Repeat use in the same menstrual cycle - cannot do

30
Q

What are cautions of EllaOne

A

Sever asthma treated by oral corticosteroids

Severe liver impairment

31
Q

What is some counselling for Ulipristal acetate?

A

It reduces effectiveness of the regular contraceptives so use barrier protection for 14 days (combined) or 9 days (progesterone)

Wait 5 days until start taking regular contraception again

Use barrier protection until next period

If get any irregular periods/unusual - take a pregnancy test 3 weeks after

Lower abdominal pain - see GP - ectopic pregnancy rule out

32
Q

How long can you use the mirena coil for?

A

5 years

33
Q

What are 3 side effects of intrauterine devices?

A

Pain on insertion/bleeding

Uterine perforation - severe pelvic pain/changes in periods/bleeding

Infection risk

34
Q

What is the MHRA warning regarding IUD contraception?

A

Risk of uterine perforation - Report any severe pelvic pain after insertion or sudden changes in periods, pain in sex, bleeding >few weeks

35
Q

What pre treatment screening is done for IUD?

A

Chlamydia screening due to risk of PID / infection / carriage of existing STIs - in high risk groups e.g. <25, new partner, multiple partners, history of STI

BUT if its emergency contraception then abx prophylaxis given as screening wont occur - treat as emergency if sustained pain in the next 20 days

36
Q

What pre treatment screening is done for IUD?

A

Chlamydia screening due to risk of PID / infection / carriage of existing STIs - in high risk groups e.g. <25, new partner, multiple partners, history of STI

BUT if its emergency contraception then abx prophylaxis given as screening wont occur - treat as emergency if sustained pain in the next 20 days

37
Q

What situations would you refer requests for EHC OTC?

A

> 5 days since unprotected sex as need IUD fitting
Changes to periods
Liver dysfunction
Taking enzyme inducers

38
Q

What circumstance would you refuse EHC?

A

If only missed one pill of their regular combined oral contraceptive - no need

39
Q

What are the age limits for Levonelle and Ellaone OTC

A

Levonelle: 16+
Ellaone: all childbearing age incl <16

40
Q

Can women still breastfeed if taking EllaONe or levonelle?

A

Levonelle yes

Ellaone No - not recommended for 1 week - express/discard

41
Q

What is a significant interaction of levonelle?

A

Ciclosporin

42
Q

Can a menopausal woman be given EHC?

A

Yes because they can remain fertile up to 2 years after their last period

43
Q

How long does the medroxyprogesterone injection last? what is the risk of this?

A

2 years

Osteoporosis risk

44
Q

What contraceptive injection would be beneficial for short term use whilst awaiting for a male vasectomy to become effective?

A

Norethisterone injection - lasts 8 weeks

45
Q

What is the MHRA alert for etonogestrel implant?

A

Nexplanon - reports of device in the vasculature and lungs

  • may reach the lung via the pulmonary artery
  • needs to be palpable otherwise locate and remove
46
Q

How long does etonorgestrel implant last for

A

3 years

PRE-REG own (35 decks)

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