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AA Y4 Finals cards NE > Gynaecology- contraception > Flashcards

Gynaecology- contraception Flashcards

1
Q

which methods of contraception should always be avoided in patients with current or past breast cancer?

A

always avoid hormonal contraception

instead, give copper coil or barrier methods

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2
Q

what form of contraception must be avoided in women with cervical or endometrial cancer?

A

avoid the mirena coil (IUS)

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3
Q

what form of contraception must be avoided in a women with Wilson’s disease?

A

the copper coil

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4
Q

name specific risk factors that would make you avoid giving the COCP (UKMEC 4)?

A
  • current breast cancer
  • uncontrolled HT (>160/>100)
  • > 35y/o and smoking
  • prolonged immobility (wheelchair)
  • migrane with aura
  • history of VTE
  • SLE or antiphospholipid syndrome
  • IHD, AF, vascular disease, stroke or cardiomyopathy
  • liver cirrhosis or liver tumours
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5
Q

which form of contraception can be used up till age 50 and can be used to tx perimenopausal symptoms?

A

COCP

the progesterone injection should also be stopped at age 50 due to risk of osteoporosis

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6
Q

in women <20y/o, which 2 forms of contraception are favoured (UKMEC 1)?

A
  • COCP and POP

- progesterone-only implant is good LARC

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7
Q

why is the progesterone only injection and coil UKMEC 2 (and not UKMEC 1) in women <20y/o?

A

progesterone only injection: may reduce bone mineral density

coil: increased risk of expulsion

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8
Q

after how many days are women considered fertile post pregnancy?

A

21 days

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9
Q

how long is lactational amenorrhoea classed as effective contraception following childbirth?

A

6 months

providing that the woman is having no periods and is fully breastfeeding

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10
Q

compare how safe different contraceptives are during breastfeeding?

A

safe for breastfeeding: POP and implant

COCP: should not be started for the 1st 6 weeks postpartum

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11
Q

when can the IUS or copper coil be inserted following pregancy?

A

either within the 1st 48 hours of birth or more than 4 weeks after

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12
Q

which 2 forms of contraception can be started at any time following birth?

A

POP

implant

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13
Q

what is the primary method of action of the COCP?

A

prevents ovulation

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14
Q

what effect do the hormones in the COCP have on the body to prevent ovulation?

A

progesterone and oestrogen provide neg feedback to the hypothalamus and ant pit

there is no release of GnRH, FSH or LH = no ovulation

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15
Q

what can occur with extended use of the COCP without a pill-free period?

A

breakthrough bleeding

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16
Q

name the 2 1st line COCP pills? why are they 1st line?

A

microgynon (contains levonorgestrel)

leostrin (contains norethisterone)

both these pills have a lower risk of VTE

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17
Q

what are the 3 common options for taking the COCP?

A
  • 21 days on, 7 days off
  • 63 days on, 7 days off (tricycling)
  • continuous use without a pill free period
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18
Q

name some common side effects of the COCP?

A
  • unscheduled bleeding in the 1st 3 months of using (should settle with time)
  • mood changes
  • headaches
  • breast pain and tenderness
  • hypertension

rare s/e = VTE, small increased risk of breast and cervical cancer

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19
Q

which cancers does COCP increase risk of, and which does it reduce risk of?

A

increase risk: breast and cervical

reduce risk: endometrial, ovarian and colon

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20
Q

how does COCP affect menorrhagia and dysmenorrhoea

A

COCP improves both menorrhagia and dysmenorrhea

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21
Q

what BMI is considered UKMEC 3 for the COCP?

A

BMI >35

UKMEC 3= risks generally outweigh the benefits

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22
Q

compare when protection is offered by the COCP depending on which day of the menstrual cycle it is started on?

A

started before day 5 of menstrual cycle: effective immediately

started after day 5 of menstrual cycle: 7 days of condom use before they are fully protected

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23
Q

what is needed if a patient is switching between a POP and the COCP?

A

can switch at any point, but 7 days of condom use is required

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24
Q

in the case of a missed COCP pill, compare when additional barrier contraception is required and when it is not?

A

if only 1 missed pill: take missed pill ASAP, even if it means taking 2 in 1 day. No barrier contraception required

if missed 2 pills: take most recent pill ASAP, use condoms for the following 7 days while taking the pill

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25
Q

which medication can reduce the effectiveness of the COCP?

A

rifampicin

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26
Q

compare the frequency at which COCP and POP is taken?

A

COCP is usually taken cyclically, with a free pill period

POP is taken continuously

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27
Q

what is the only UKMEC 4 criteria for taking the POP?

A

active breast cancer

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28
Q

there are 2 types of POP: traditional POP and desogesteral-only pill. compare their mechanisms of action?

A

traditional POP: thickens cervical mucous, makes endometrium less hospitable and reduces colliery function

desogesteral pill: inhibits ovulation

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29
Q

if the POP is started within 1-5 days of the menstrual cycle, it is effective immediately. when is it effective if it is started outwith this period? why?

A

it takes 48 hours for POP to become effective

this is the length of time it takes to thicken the cervical mucous enough

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30
Q

why does the POP take 48 hours to be effective, while the COCP takes 7 days?

A

POP takes 48 hours to thicken cervical mucous

COCP takes 7 days to inhibit ovulation

31
Q

what is considered one of the primary adverse effects of the POP?

A

unscheduled bleeding/changes to the bleeding schedule

this should settle after the 1st 3 months

32
Q

other than unscheduled bleeding, what other side effects may be experienced by the POP?

A
  • headaches
  • acne
  • breast tenderness
33
Q

name rare but possible risk factors of the POP?

A
  • slightly increased risk of ectopic pregancy due to impaired cilliary function
  • ovarian cysts
  • small risk of breast cancer, returning to normal 10 years after stopping
34
Q

how can the possible bleeding pattern that may be experienced when on the POP be explained to patients?

A

the rule of 1/3s

1/3 will have lighter or no bleeding

1/3 have normal bleeding

1/3 have heavier, prolonged or unscheduled bleeding

35
Q

compare the timeframes that define a ‘missed pill’ in COCP and POP

A

COCP: when the pill is >24 hours late

POP: traditional: >3hours
desogestrel POP: >12 hours

36
Q

how long are condoms required for in the case of a POP missed pill?

A

48 hours

48 hours is how long it takes for the cervical mucous to thicken back up

37
Q

how frequently must the progesterone-only injection be given?

A

every 12-13 weeks

38
Q

how long does it take fertility to return after stopping the progesterone-only injections?

A

12 months

this may make it a less favourable form of contraception

39
Q

name the 2 forms of progesterone only infections?

compare their administration?

A
  • depo provera - IM injection

- sayana press: self administered by patient

40
Q

what is the only UKMEC 4 contraindication for the Prog injection?

A

active breast cancer

41
Q

name 4 UKMEC 3 contraindications for the prog injection?

A
  • IHD and stroke
  • unexplained PV bleeding
  • liver cancer
  • severe liver cirrhosis
42
Q

what should be considered in older women on steroids when thinking about the prog injection as a form of contraception?

A

it can cause osteoporosis

43
Q

what is the main mechanism of action of the progesterone injection? how does it do this?

A

inhibits ovulaiton

it suppresses FSH release from the ant pit –> prevents the development of follicles in the ovaries

44
Q

if the progesterone injection is started after day 5 of the menstrual cycle, how long are condoms required?

A

condoms required for 7 days

45
Q

how does the progesterone injection cause osteoporosis ?

A

bone density is maintained by oestrogen

the progesterone injection stops follicular development

the follicles are the main site of oestrogen production

46
Q

what are the 2 side effects unique to the progesterone injection?

A
  • weight gain
  • osteoporosis

these side effects are not experienced in any other forms of contraception

47
Q

which 2 cancers does the progesterone injection reduce risk of?

A
  • ovarian cancer

- endometrial cancer

48
Q

what is the only UKMEC 4 criteria for the implant?

A

active breast cancer

49
Q

what ages is the implant licensed for use?

A

18-40 y/o

50
Q

what is the mechanism of action of the implant?

A
  • inhibits ovulation
  • thickens cervical mucous
  • makes endometrium less hospitable
51
Q

according to the FSRH, how can problematic bleeding when on the implant be treated?

A

a 3 month course of COCP

52
Q

which forms of contraception can improve painful periods (dysmenorrhoea)?

A
  • implant
  • progesterone injection
  • IUS (mirena)
53
Q

when are either of the coils contraindicated?

A
  • pregancy
  • PID
  • unexplained PV bleeding
  • immunosuppression
  • pelvic cancer
  • fibroids causing uterine cavity distortion
54
Q

what needs to be done for 7 days before the coil is removed?

A

7 days of condom use or abstinence for 7 days

55
Q

what is the 1st line ix done to locate a coil?

A

U/S

56
Q

which is the only form of contraception which is effective immediately?

A

the copper coil

57
Q

what is the main mechanism of action of the IUS?

A

thickens cervical mucous

makes endometrium less hospitable

58
Q

what is the most effective form of emergency contraception?

A

the copper coil

59
Q

compare the timeframe from UPSI that ulipristal, levonorgestrel and copper coil need to be taken?

A

levonorgesterel: take within 3 days (72 hours) of UPSI
ulipristal: take within 5 days (120 hours) of UPSI

copper coil: 5 days of UPSI

60
Q

name one risk factor for the IUD?

A

pelvic inflammatory disease

especially in women who are at risk of STIs

61
Q

in terms of starting LARC following emergency contraception, what benefit does Levonorgestrel have over ulipristal?

A

the POP or COCP can be started immediately after taking levonorgestrel

with ulipristal, COCP and POP can only be taken 5 days later

62
Q

compare ulipristal and levonorgestrel when breastfeeding?

A

levonorgestrel is safe when breastfeeding

ulipristal is not safe when breastfeeding

63
Q

which emergency contraception is contraindicated in patients with severe asthma?

A

ulipristal

it is contraindicated in cases where asthma is controlled by oral steroids

64
Q

how long after taking ulipristal should breastfeeding be avoided for?

A

1 week

milk should be expressed and discarded

65
Q

how many days post UPSI must levonorgestrel and ulipristal be taken?

A

levonorgestrel: 3 days
ulipristal: 5 days

66
Q

under what age are children always considered to be unable to consent for sexual intercourse?

A

under 13y/o

all consultations with people under 13 should trigger child protection measures

67
Q

in a women with heavy menstrual bleeding, which is more appropriate? the IUS or IUD?

A

IUS

The IUD (copper coil) tends to make periods heavier

68
Q

what period of amenorrhoea in a women of what age allows her to be classed as menopausal?

A

> 50y/o with amenorrhoea for 12 months

<50y/o with amenorrhoea for 24 months

69
Q

why is the progesterone injectable not recommended in women over 50 y/o?

A

due to its effect on reducing bone mineral density

70
Q

which form of emergency contraception is not recommended in a women with a suspected STI?

A

the copper coil

71
Q

what interactions may occur between the POP and antibiotics?

A

none - there are no interactions

the only interactions would be between POP and enzyme inducing antibiotics (rifampicin)

72
Q

which is the only form of contraception that can be started at any point post partum, regardless if they are breastfeeding or not?

A

POP

73
Q

following delivery, when can a women restart the COCP if she a) isn’t breastfeeding and b) is breastfeeding with VTE risk factors?

A

3 weeks post partum if she is not breastfeeding and has no VTE risk factors

6 weeks post partum if she is breastfeeding or has VTE risk factors

AA Y4 Finals cards NE (40 decks)

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