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Obs & Gynae > LARC > Flashcards

LARC Flashcards

1
Q

Describe the UK MEC categories.

A
  1. No restriction for the use of the contraceptive method
  2. Where the advantages of using the method generally outweigh the theoretical or proven risks
  3. A condition where the theoretical or proven risks generally outweigh the advantages of using the method.
  4. A condition which represents an unacceptable risk if the contraceptive method is used
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2
Q

What is the primary action of Depo Provera?

A

Inhibits ovulation, but also has effects on cervical mucus and endometrium

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3
Q

What condition does depo provera have increased risk of?

A

Osteoporosis

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4
Q

What other risk factors must be taken into consideration before prescribing depo provera?

A

Osteoporotic risk factors i.e.:

  • underweight/anorexia
  • hypothyroidism
  • coeliac disease
  • RA
  • prologned steroid use
  • immobility
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5
Q

When should depo provera be started, and is additional coverage needed?

A

—Depo can be started up to and including Day 5 of the cycle without the need for any additional contraception

—Beyond Day 5 a woman can start the depo at any other time provided she is ‘reasonably certain’ she is not pregnant and use condoms/abstinence for 7 days

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6
Q

When can a doctor be ‘reasonably certain’ a woman is not currently pregnant?

A

—No sex since last period

—Reliable and consistant with last contraception

—< 7 days of normal period

—< 4 wks post partum (not breast feeding)

—Fully breastfeeding, amenorrhoeic and < 6m post partum

—Negative preg test > 3 wks since UPSI

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7
Q

What are the side effects of Depo provera?

A

—Weight gain

—Delay in return of fertility

—Irregular bleeding

—Possible risk of osteoporosis

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8
Q

What type of contraception is Depo Provera?

A

Progesterone only

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9
Q

What is the intrauterine device (IUD)?

A

A non-hormonal device containing copper and plastic

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10
Q

What is the primary mode of action of the IUD?

A

Prevents fertilisation

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11
Q

How long can an IUD be left inserted?

A

5 years

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12
Q

What kind of contraception is the IUS?

A

Progesterone only

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13
Q

What is the primary mode of action of the IUS?

A

Affects implantation: endometrium rendered unfavourable for implantation

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14
Q

What are the contraindications to inserting an IUD or an IUS?

A

—Current pelvic infection

—Abnormal uterine anatomy

—Pregnancy

—Sensitivity to any of the constituents

—Gestational trophoblastic disease when BHCG levels are abnormal

—Endometrial ca

—Cervical ca awaiting treatment

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15
Q

When can an IUD be fitted?

A

Within the first 7 days of a period

For emergency contraception, up to 5 days after UPSI

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16
Q

When can an IUD or IUS be inserted post TOP?

A

Immediately

17
Q

When can an IUD or IUS be insterted post partum?

A

<48 hours or >4 weeks

18
Q

When can an IUS be inserted and is any additional contraception needed?

A

Within first 7 days of a period/any time provided reasonably certain not pregnant

Use condoms for first 7 days

19
Q

What are the side effects of the IUD?

A

—Heavy, prolonged menses

—Pain, infection PID increased in first 20 days

—Perforation 1-2/1000

—Expulsion 1/20, most in first 3/12

—Higher post 2nd trim abortion

—Ectopic risk

20
Q

What are the two types of IUS and how long are each licensed for?

A

—52 mg levonorgestrel (5yr license)

—

—13.5 mg levornorgestrel (3 yr license)

21
Q

What are the side effects of the IUS?

A

—Lighter, less frequent bleeding

—Pain, infection PID increased in first 20 days

—Perforation 1-2/1000

—Expulsion, more frequent in first 3 months

Ectopic risk

22
Q

How long is the contraceptive implant licensced for?

A

3 years

23
Q

What is the primary mode of action of the contraceptive implant?

A

Inhibition of ovulation

24
Q

When can the contraceptive implant be fitted without any need for additional contraception?

A

—Within first 5 days of cycle

—Up to day 5 post first/second trimester abortion

—On or before day 21 postpartum

25
Q

When can contraceptive method be switched to the implant such that it is immediately effective?

A

—After last active pill in pack taken

Depo still within 14 weeks

—If week 2-3 of COC, patch or vaginal ring

26
Q

What are some of the side effects of the contraceptive implant?

A

—Irregular bleeding

—Weight gain

—Acne

27
Q

In what scenarios would additonal precautions need to be taken when first inserting the contraceptive implant?

A

—If it is reasonably certain she is not pregnant

—As a “quick start” after emergency contraception

28
Q

When would additional precautions need to be taken when switching contraceptive method to the implant?

A

Switching from progesterone only pill or IUS, or from a non-hormonal method

29
Q

Which of the contraceptives confer the best efficacy in an otherwise fit and healthy 24-year-old woman?

A

Subdermal implant

Obs & Gynae (20 decks)

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