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Reproduction and Sexual Health > Long-acting Contraceptives > Flashcards

Long-acting Contraceptives Flashcards

1
Q

What is measured for the natural family planning method of contraception?

A 
Basal body temp
Cervical mucus
Cervical position
Standard (fertile) days
Breast feeding
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2
Q

What is cervical mucus like:
post-ovulation
ovulation and 3 days after?

A

Post-ovulation - thick and sticky

Ovulation and 3 days after - thin, watery, stretchy

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3
Q

What position is the cervix when the woman is:
fertile
less fertile?

A

Fertile - cervix is high in vagina, soft and open

Less fertile - cervix is low in vagina, firm and closed

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4
Q

On what days of menstrual cycle is the woman most fertile?

A

Days 8 - 18

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5
Q

What are the 3 criteria for using breast feeding for natural family planning?

A

Exclusively breast feeding
Less than 6 months post-natal
Amenorrhoeic

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6
Q

What is the pearl index for contraception?

A

Failure rate

i.e. the number of contraceptive failures per 100 women users per year

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7
Q

How is the pearl index worked out?

A

Number of estimated accidental pregnancies x 1200/ total number of months of exposure

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8
Q

What are the main types of long acting reversible contraception? and it’s pearl index?

A

Injectable contraceptive -
Depo provera IM
Sayana press (sub cut)
Pearl index - 0.2%

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9
Q

What is the mode of action of depo provera?

A

Inhibit ovulation
(also thickens cervical mucus
and makes endometrium thin)

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10
Q

How often is depo provera given?

A

Every 13 weeks (will last 14)

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11
Q

What are prior examinations that need to be done before giving depo inj?

A

BP
Smear status
Risk factors for osteoporosis

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12
Q

What are the modifiable risk factors for osteoporosis?

A 
Underweight
Prolonged steroid use
Excess alcohol intake
Immobility
Smoking
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13
Q

What are the unmodifiable risk factors for osteoporosis?

A 
Hypothyroidsm
Coeliac disease
Rheumatoid arthritis
Hyperparathyroidism
IBD
Chronic renal disease
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14
Q

How long does it take to inhibit ovulation?

A

7 days

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15
Q

On what day of menstrual cycle should depo be started to avoid need for additional contraception?

A

Day 5

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16
Q

On what day of menstrual cycle are women most fertile?

A

Day 14 (ovulation) - therefore give depo on day 5 (takes 7 days to inhibit ovulation) = day 12 i.e. before the woman is most fertile/ ovulates

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17
Q

How long can sperm live once past the vagina?

A

7 days

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18
Q

What are the criteria to say you are ‘reasonably certain’ a woman is not pregnant?

A

No sex since last period
Consistently using reliable contraception
<7 days since last normal period
<4 weeks post-partum and not breastfeeding
Fully breastfeeding, amenorrhoeic and <6 months post-partum
Negative pregnancy test and >3 weeks since unprotected sexual intercourse (UPSI)

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19
Q

Side effects of depo?

A

Weight gain due to appetite stimulation
Delay in return of fertility
Irregular bleeding
Risk of oestoporosis

20
Q

How long can it take for fertility to return after stopping depo injections?

A

18 months

21
Q

What are the types of very long acting reversible contraception?

A

Intrauterine device
Intrauterine system
Implant (progesterone)

22
Q

How does the intra-uterine device work?

A

Prevents fertilisation

Copper is toxic to ovum and sperm joining

23
Q

How can the IUD be used as emergency contraception?

A

It products an inflammatory response in endometrium which is toxic for the fertilised ovum

24
Q

How long can the IUD be used for?

A

5-10 years

25
Q

What is the pearl index of IUD?

A

0.6-0.8% (i.e. 1/200 women will accidentally become pregnant)

26
Q

When can the IUD be fitted?

A

Within the first 7 days of period (stopping implantation, not trying to stop ovulation)
Any time as long as reasonably certain not pregnant
Within 48hours or > 4 weeks post partum
Immediately post TOP

27
Q

When can the IUD be fitted for emergency contraception?

A

Up to 5 days after unprotected sex

28
Q

What are the SE of IUD?

A 
Heavy, prolonged menses
Pain, infection and PID risk in first 20 days
Perforation
Expulsion
Ectopic risk
29
Q

What are the contraindications for IUD?

A

Current pelvic infection
Abnormal uterine anatomy
Pregnancy
Sensitive to the materials - Wilson’s disease
Gestational trophoblastic disease when the bHCG levels are abnormal or persistantly elevated
Endometrial cancer
Cervical cancer awaiting treatment

30
Q

What are the types of intra-uterine system?

A 
52mg progesterone (mirena)
13.5mg (jaydess)
31
Q

What is the form of progesterone used in IUS?

A

Levonorgestrel (LNG)

32
Q

What is the Mirena IUS used for?

A

Contraception
Heavy periods
HRT

33
Q

Why is Jaydess IUS not licensed for heavy periods or HRT?

A

Because it contains less hormone than mirena

34
Q

What is the mode of action for IUS?

A

Makes endometrium unfavorable for implantation

Also thicken cervical mucus

35
Q

What is the pearl index of IUS?

A

0.2% (1/500)

36
Q

When can the IUS be fitted?

A

Within first 7 days of a period
Anytime if reasonably certain not pregnant
Within 48hrs or >4 weeks postpartum
Immediately post TOP

37
Q

Why can’t the IUS be used for emergency contraception?

A

Takes 7 days to have effect

38
Q

What are the SE of IUS?

A 
Lighter, less frequent bleeding
Pain, infection and PID increase in first 20 days
Perforation
Expulsion
Possible ectopic risk
Failure
39
Q

What are contra-indications for IUS?

A 
Current pelvic infection
Abnormal uterine abnormality
Pregnancy
Gestational trophoblastic disease when bHCG levels are abnormal / persistantly elevated
Endometrial cancer
Cervical cancer awaiting treatment
40
Q

How long is the implant licensed for?

A

3 years

41
Q

What form of oestrogen does the implant contain?

A

Etonogestrel (ENG) - 68 microgram

42
Q

What is the mode of action of implant?

A

Inhibit ovulation

43
Q

What is the pearl index of implant?

A

0-0.1%

44
Q

When can the 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 post-partum

45
Q

Side effects of implant?

A

Irregular bleeding
Weight gain
Acne
Nerve damage or vascular damage

Reproduction and Sexual Health (18 decks)

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