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Long Acting Reversible Contraception Flashcards

1
Q

What are the physical reasons people have sex?

A

Sexual pleasure, release of sexual tension, attraction to person, stress relief, mood booster, exercise

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2
Q

What are the emotional reasons for having sex?

A

Love, commitment, sexual curiosity and novelty, nurturance, gratitude, need for affection

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3
Q

What are some reasons motivated by insecurity that people have sex?

A

To boost self-esteem/social status, to keep partner, feeling sense of duty, wanting to fit in, external pressure

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4
Q

What are some goal-based reasons for people wanting to have sex?

A

To improve social status and reputation, to enhance power, to seek revenge or cause jealousy, for financial/material gain, to make a baby

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5
Q

How many women get pregnant in a year when not using contraception?

A

85% = around 40% of pregnancies in UK are unplanned

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6
Q

What are the mechanisms of action of contraceptives?

A

Prevent ovulation, fertilisation or implantation

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7
Q

How do contraceptives prevent ovulation?

A

Work by suppressing LH and FSH (e.g most hormonal methods)

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8
Q

How do contraceptives prevent fertilisation?

A

Work by creating a mechanical/surgical barrier or by direct toxicity = condoms, diaphragms + spermicide, sterilisation, IUD, hormonal methods

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9
Q

How do contraceptives prevent implantation?

A

Works by creating hostile endometrium or direct toxicity = intrauterine and hormonal methods

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10
Q

What are some contraceptive methods that cause ovulation suppression?

A

Combined hormonal contraception, medroxyprogesterone acetate, subdermal implant, lactational amenorrhoea method, desogestrel-containing progestogen only pill, IUS (coil)

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11
Q

What are some contraceptives that work by thickening the cervical mucous?

A

IUS, medroxyprogesterone acetate, progestogen only pill, subdermal implant

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12
Q

What contraceptives have direct toxic effect?

A

IUD and spermicides

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13
Q

What are some methods that create a mechanical barrier to prevent pregnancy?

A

Condoms, diaphragm, cervical caps

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14
Q

What are some contraceptive methods that cause endometrial changes?

A

IUS, IUD, subdermal implant, medroxyprogesterone acetate, progestogen only pill, combined hormonal contraception

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15
Q

What are the different classifications of contraception?

A

Hormonal methods = ring, patch, DMPA injection, pill
Barrier methods
Intrauterine methods = IUD, IUS
Permanent methods = sterilisation
Emergency methods = emergency IUD or pill
Fertility awareness methods

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16
Q

What are some factors that influence choice of contraception?

A

Personal preference, age, mental capacity, child protection/wellbeing concerns, lifestyle, allergies, weight, BMI, blood pressure

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17
Q

What sexual factors should be considered when choosing a contraceptive method?

A

Frequency and type of sex, relationship status, pregnancy risk and future pregnancy plans
Medical, surgical and obs & gynae history

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18
Q

What are some child welfare concerns that may arise when seeking contraception?

A

Intercourse or any other sexual activity < age 13
Partner = age gap >=2 years, power imbalance, coercion
Drug/alcohol use, especially during sex

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19
Q

What are some things that a patient will have to weigh up the acceptability of when choosing contraceptives?

A

Amenorrhoea, irregular bleeding, side effects or invasive procedure

20
Q

What are some non-contraceptive benefits of hormonal contraception?

A

Reduce period pain, heavy menstrual bleeding, irregular PV bleeding, ovulation pain, PMS, cyclical breast tenderness, ovarian cysts, endometriosis, ovarian cancer, acne/hirsutism (CHC)

21
Q

What are some highly effective methods of contraception?

A

Subdermal implants, vasectomy, IUS, female sterilisation, IUD

22
Q

How can user failure occur when using condoms?

A

Used too late, wrong lube, wrong technique, inconsistent use, wrong storage

23
Q

How can user failure occur when using a diaphragm?

A

Used too late, removed too early, wrong technique, inconsistent use, no damage checks, no replacement

24
Q

How can hormonal methods of contraception be used incorrectly?

A

Inconsistent use, late injection, wrong use or storage, late replacement when coming out, drug interactions

25
Q

What are some iatrogenic reasons for user failure when using contraception?

A

Poor or wrong instructions, no support, no extra precaution recommended when quickstarting, drug interaction, incorrect insertion

26
Q

What kind of failure rate do long acting reversible contraceptives have?

A

Equal user failure rate to method failure rate

27
Q

How long do intrauterine contraception last for?

A

Between 3-10 years depending on device = have less than 1% failure rate

28
Q

What are the types of intrauterine contraception?

A 
Intrauterine device (IUD) = copper coil
Intrauterine systems (IUS) = hormonal coil
29
Q

How does intrauterine contraception work?

A

Mainly prevent fertilisation but also prevent implantation

30
Q

What are the negatives of intrauterine contraceptives?

A

Invasive = quick but often painful insertion

Carry small risk of perforation, PID and malposition

31
Q

How painful can intrauterine contraceptives be?

A

Pin scale is 3/10 for parous women and 5/10 for nulliparous women

32
Q

How long do IUDs last for?

A

Up to 10 years = if inserted >= 40 years can be kept until menopause

33
Q

What are some features of IUDs?

A

Non-hormonal

Can be used as emergency contraception

34
Q

What is a possible side effect of IUDs?

A

Often make periods heavier, longer and more painful = especially in first 3 months, NSAIDs can help with pain

35
Q

What may be the only contraceptive method that will be suitable for women post-breast cancer?

A

IUD

36
Q

Are IUDs or IUSs more effective?

A

IUS

37
Q

What are the 4 main types of IUS?

A

Mirena, Levosert, Kyleena, Jaydess

38
Q

What are some features of the Mirena IUS?

A

Licensed to treat heavy periods, can be part of HRT and can be used for endometriosis or hyperplasia
50% amenorrhoea at 6 months

39
Q

What are some features of IUS?

A

Spotting common in weeks-months after insertion

Systemic hormone levels very low = hormonal side effects uncommon

40
Q

What does the UK MEC stand for?

A

UK Medical Eligibility Criteria for contraceptive use

41
Q

What are the categories in the UK MEC?

A 
1 = always useable 
2 = broadly useable
3 = caution
4 = do not use
42
Q

What are categories 1 and 2 described as in the UK MEC?

A 
1 = a condition for which there is no restriction for use of contraceptive method 
2 = a condition where the advantages of using the method generally outweigh the risks
43
Q

What are categories 3 and 4 described as under the UK MEC?

A 
3 = a condition where the risks generally outweigh the advantages of using the method (need expert opinion)
4 = a condition which represents unacceptable risk if the contraceptive method is used
44
Q

What are the main themes in the UK MEC?

A

VTE risk, CVD risk, liver problems, hormone dependent tumour

45
Q

What is the UK MEC to be used as?

A

Acts as guide = not a replacement for clinical judgement, less relevant for therapeutic use

46
Q

What are some contraceptive counselling tools?

A

Family planning association, websites (Brooks, Contraceptive choices), contraception bedsider

Reproduction (62 decks)

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