NICE; contraception Flashcards
How should a woman be assessed for barrier methods and spermicides?
Vaginal exam at initial fitting of cap or diaphragm to ensure correct fit
Who is the diaphragm/ cap not suitable for?
Those on teratogenic drugs Before 6 weeks PP Before 6 weeks following 2nd trim ToP Poor vaginal tone Shallow pubic ledge Abnormal cervical positioning
When should you take special care when counselling someone for sterilisation?
Younger than 30 Without children Taking decisions during pregnancy Taking decisions at end of relationship If at risk of coercion
What examinations should be performed on men and women requesting sterilisation?
Assess suitability for GA
Scrotal exam on man
Bimanual pelvic exam for females
What is the only UKMEC 4 condition for POP and implant?
Breast cancer
Should only be used after consultation with an expert in a women with a history of breast cancer, liver tumours and unexplained vaginal bleeding
Ensure woman is up to date with cervical smears
What considerations need to be taken into account with the progesterone injection?
No breast cancer
RF for arterial CV disease
Vascular disease
Risk for osteoporosis
What are the UKMEC 4 conditions for prescription of CHC?
Current breast ca
Breastfeeding and less than 6 weeks PP
Aged over 35 and smoking >15 a day
What should you enquire specifically about when prescribing CHC?
Migraine
CV risk factors; smoking, obesity, hypertx, hyperlipidaemia
Previous VTE
Family history
What should be ensured before a LGN-IUS or Ci-IUD is fitted?
Exclude pregnancy
STI risk
What conditions are UKMEC 3 and 4 to insertion of IUC?
4; current breast ca (LGN-IUS only), PID or unexplained vaginal bleeding
3; uterine fibroids, history of breast ca
What are the side effects assoc with the POP?
Weight gain Bloating Breast tenderness HEadaches Acne Depression
What side effects are assoc with the progesterone implant or injections?
Weight gain Irregular bleeding Amenorrhoea PMS; bloating, fluid retention, breast tenderness Loss of bone mineral density
What side effects are assoc with COC?
Mood changes Headaches Nausea Fluid retention Breast tenderness DVT Stroke Heart attacks
How is the vaginal ring used?
Week 1-3; ring inside vagina
Remove ring for 1 week
Start a new ring on 8th day
Do you require additional contraception if the vaginal ring has been out for more than hours in the first or second week of use?
Yes; must use additional contraception or avoid sex until the ring has been in place for 7 continuous days
What are the options if the vaginal ring is out for more than 3 hours in the third week of use?
Insert a new ring immediately and start a new ring cycle
Start 7 day ring free interval ; this can only be used if the ring was used continuously for previous 7 days
Which classes of drug can affect effectivity of CHC?
AEDs
HAART
TB drugs
St John’s wort
What are the advantages of the Cu-IUD for emergency contraception?
Most effective method
Work after ovulation as it prevents fertilization and implantation
Can be used after multiple UPSI and/or previous EHC in same cycle
Can be kept as LARC
Can be used weeks after UPSI (up to 5 days after predicted date of ovulation)
No drug interactions
No effect on breastfeeding
What are the disadvantages of the Cu-IUD for emergency contraception?
Not easily accessible
Can be painful
Complications; PID, uterine perforation or expulsion
Periods often heavier +/- more painful with Cu-IUD
What are the advantages to LGN-EC?
Cheap
No need to delay quick-starting new hormonal contraceptive methods
No reduced effectiveness in women on gastric pH lowering meds
Not contraindicated when breastfeeding
Not contraindicated for women on liver enzyme inducers; give double dose
What are the disadvantages of LNG-EC?
Least effective of all EC methods
Only works 72 hours post UPSI
Becomes less effective over time since unprotected intercourse
Only inhibits/ delays ovulation; no effect on fertilization or implantation
Not effective after start of LH surge
Less effective in women with a weight >70 kg and/or BMI >26; double dose should be given