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JUST4MED clinical cases > O+G- Contraception > Flashcards

O+G- Contraception Flashcards

1
Q

What are the only two methods of contraception that protect against STIs?

a) The combined oral pill and male condoms
b) The implant and the vaginal ring
c) Male condoms and Femidom
d) Merina and copper coil

A

c) Male condoms and Femidom

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2
Q

Which method of contraception can last 5-10 years?

a) The implant
b) Sterilisation
c) The copper coil
d) The Mirena coil

A

c) The copper coil

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3
Q

Which methods should not be recommended as an effective method of contraception?

a) Combined oral contraceptive pill
b) The withdrawal method
c) The rhythm method and fertility tracking
d) Male condom

A

b) The withdrawal method
c) The rhythm method and fertility tracking

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4
Q

What is contraception?

A

It is a means of preventing pregnancy and/or STIs using different methods. For some parts of the world where maternal mortality is still high, lack of access to contraception is a matter of life and death

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5
Q

Contraception can also be used for?

A

Contraception can also be used for other things such as to improve acne or to lighten, regulate or make periods less painful

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6
Q

What is a female condom?

A

A barrier that is similar to male condom. It has two rings either end. The end with the small ring should be inserted into the vagina before sexual intercourse. The large ring at the other end should cover the area around the vagina and the penis should be inserted into it. Femidoms also protect both partners against STIs. Not as popular as male condoms.

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7
Q

What are the advanatges for barrier methods: condoms?

A
  • Both can be used by everyone! If a partner has a latex allergy, polyurethane condoms can be used instead
  • Both provide STI protection for both partners
  • Widely available (femidoms are less available than male condoms)
  • Both involve no serious side effect
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8
Q

What are the disadvanatges for barrier methods: condoms?

A

• Both can be seen as an interruption to sex

Sperm can still enter the vagina even with the use of either condom in situations such as:

  • The condom splits
  • The wrong size is used
  • Too much or too little lubricant is used
  • If the penis touches the vagina before a condom is used (pre-ejaculation fluid can contain sperm)
  • Femidom can be pushed too far into vagina and the penis can accidentally enter the sides of the vagina rather than the condom itself
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9
Q

Contraception

diaphram and caps

WHat are they?

A

These are another barrier method. These must be inserted into the vagina before sexual intercourse and must remain in situ for at least 6 hours afterwards (no longer than 24 hours).

The cervical cap fits over the cervix and the latex dome of the diaphragm holds it between the pubic bone and the sacral curve, covering the cervix. Often told to be used with spermicide containing nonoxynol-9 which attacks the acrosomal membranes of the sperm, immobilising them, but it is now not recommended as nonoxynol can damage the vaginal epithelium

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10
Q

Advanatages of diaphragm and caps

A
  • 92-96% effective with perfect use
  • Only has to be used during sex
  • No serious health risks
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11
Q

Disadvanatages of diaphragm and caps

A
  • Using spermicide can be messy and some people are sensitive to it
  • Takes time to learn how to use them
  • Avoid using during a period – risk of toxic shock syndrome!
  • Very limited STI protection – better to use condom!
  • Can be uncomfortable to insert and interrupts sex
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12
Q

What does combines oral contraceptive pill (COCP) contain?

A

Contains ethinyloestradiol (an oestrogen) and progestogen

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13
Q

What is combined oral contraceptive pill (COCP) contain?

A

The combined pill exerts a negative feedback effect on gonadotropin (FSH/LH) release via hypothalamopituitary axis, preventing ovulation. The combined pill also thins the endometrium and thickens cervical mucus, thus impeding sperm and preventing implantation

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14
Q

What to expect with combines oral contraceptive pill (COCP)

A

One pill is to be taken for 21 days at the same time everyday to be most effective. After 21 days, there is a 7 day break, a withdrawal bleed is expected during this break. Pill packets can be taken ‘back to back’ if it is more convenient but break through bleeds can happen.

It is best to start taking the pill on the 1st day of a period as it will protect against pregnancy immediately. If the patient decides to start taking the pill at any other point during the menstrual cycle another method of contraception should be used (such as a condom) for the first 7 days.

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15
Q

What are the different types of COCP

A

Monophasic 21 day pills

  • Phasic 21 day pills
  • Everyday pills (ED)
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16
Q

Which COCP is the most common?

A

Monophasic 21 day pills

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17
Q

Examples of Monophasic 21 day pills

A

Microgynon, Yasmin and Marvelon

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18
Q

What are phasic 21 day pills

give an example

A

– contains different coloured sections within the pack. Each coloured section contains pills with a different amount of hormones. It is vital these are taken in the right order.

An example is Logynon

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19
Q

What is an everyday pill (ED)

give an example

A

– within the pack there are 21 active pills and 7 inactive “dummy” pills. With this pack, a pill is taken everyday for 28 days, no break!!! Some women may prefer to use this to get into the habit of taking a pill everyday.

An example is Microgynon ED

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20
Q

Containdications for COCP?

A
  • If he patient might be pregnant
  • If they are over 35 and smoke or over 35 and stopped smoking less than a year ago
  • Past history of thrombosis, heart disease, stroke, hypertension, migraines with aura, breast cancer or BRCA positive, liver or gallbladder disease
  • Not to be used in first 6 weeks of breastfeeding as it can suppress lactation
  • BMI over 40
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21
Q

Advantages of COCP

A
  • >99% effective with perfect use
  • Usually makes periods lighter, less painful and more regular (improving dysmenorrhea and menorrhagia)
  • Can help with PMS
  • Can improve acne
  • Protective - proven to reduce the risk of ovarian, endometrial and colon cancer
  • Can reduce the risk of fibroids, ovarian cysts and endometriosis
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22
Q

Disadvantages of COCP?

A
  • Side effects: can increase blood pressure, risk of venous thrombosis, arterial thrombosis, MI and stroke (risk greatest during 1st year taking it), depression. Major complications are very rare! Benefits outweigh risks!
  • Research suggests there is a small increased risk of being diagnosed with breast cancer or cervical cancer due to the long term use of oestrogen and progestogen
  • Does NOT protect against STIs
  • Breakthrough bleeds and spotting are common in the first few months of use
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23
Q

Is there a link between weight gain and CoCP

A

There is no link between the COCP and gaining weight! Weight can change throughout menstrual cycle due to fluid retention

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24
Q

Progestogen only pill is also known as?

A

mini pill

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25
Q

What is a progestogen only pill

A

only contains progestogen. >99% effective if taken same time everyday.

  • Makes cervical mucous hostile to sperm and prevents ovulation in 50% of women. Can also reduce cilia activity in the fallopian tubes
  • Patient takes a pill everyday with no break in between packs. 28 pills per pack. Starting it is the same as COCP.
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26
Q

Contraindications fro progesterone only pill? POP

A

Still contraindicated if past history of thrombosis, liver disease or breast cancer

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27
Q

What is the different tyoes of POP:

A
  1. Traditional POP – e.g. Micronor
  2. Desogestrel POP – a higher dose of 3rd generation progesterone which inhibits ovulation in 95% of cycles, more effective and has a 12hour window instead of 3hours (traditional) for missed pills e.g. Cerazette and Cerelle
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28
Q

Advantages od POP

A
  • It is suitable for older women ‘
  • Suitable for the majority of those who are contraindicated for COCP such as lactating mothers or those who cannot have oestrogen
  • There is no risk of increased thrombosi
29
Q

Disadvanges of POP

A
  • It is less effective than the combined pill if not taken properly – timing must be meticulous! If a pill is missed by more than 3 or 12 hours (depending on type of POP) another should be taken ASAP and condoms should be used for the next 2 days. Should not be given to women who are not compliant with medication e.g. if they are forgetful.
  • No protection against STIs!
  • Period pattern can change – could become lighter, more frequent, stop altogether or have some spotting.
  • Initial side effects in first few months such as breast tenderness, mood changes, headache and migraine, vomiting and diarrhoea and ovarian cysts (not harmful and usually disappear without treatment).
30
Q

What is Transdermal combined patch (Evra)?

A

Thin and beige coloured adhesive patch that releases ethinyloestradiol and the progestogen, norelgestromin. New patch applied weekly for 3 weeks, followed by a patch free week. Side effects and contraindications similar to the COCP. Advantages similar to COCP. The hormones do not need to be absorbed by the stomach so no need to worry about efficacy if vomiting or diarrhoea.

31
Q

Does the transdermal combined patch (Evra) protect against STIs?

A

No

32
Q

What is Combined vaginal ring (Nuvaring)?

A

• A flexible and transparent plastic ring. Releases a constant dose of micrograms of ethinyloestradiol and 120micrograms of the progestogen, etonogestrel to inhibit ovulation. Inserted into the vagina and worn for 3 weeks, the removed for a week free break with a withdrawal bleed. A new ring is then inserted. Same side effects and contraindications to COCP and the patch

33
Q

Does the Combined vaginal ring (Nuvaring) protect against STIs?

A

No

34
Q

What are contracetpive injections?

A

Progestogen is slowly released, bypassing the portal circulation. Ovulation is usually prevented and they protect against ovarian cysts and ectopic pregnancy. 99% effective at perfect use. Most often it causes amenorrhoea but can also cause irregular periods or spotting. Some injection users will have longer and heavier periods as a result of use. Every woman is different!

35
Q

What are the three different types of contraceptive injections?

A
  1. DepoProvera
  2. Sayana Press
  3. Noristerat
36
Q

When and how do uoi take DepoProvers?

A

– medroxyprogesterone acetate 150mg IM every 13 weeks. Irregular bleeding in 1st week then followed by amenorrhoea. Bone density decreases with 1st two years of using it then stabilises and is regained after stopping. Other contraceptives are therefore preferable in younger patients as peak bone mass may not yet be achieved

37
Q

Which women should not use DepoProvers?

A

women at risk of osteoporosis

38
Q

DepoProvers are useful during…

A

lactation and when compliance is a problem.

39
Q

How are Sayan Press taken?

A

subcutaneous preparation of medroxyprogesterone acetate – it is licensed for self administration and lasts for 13 weeks.

40
Q

How are Noristerat taken?

A

IM containing norethisterone enantate given every 8 weeks. Often used as a short term contraceptive such as when waiting for partners vasectomy to become a effective

41
Q

Contraceptive injections advantages?

A
  • All three can be used in breast feeding women but Depo and Savana should be given no sooner than 6 weeks after birth
  • Basically the ideal contraception because there is no need to remember to take it or worry about patient compliance!
  • Not affected by other medicines
  • Good for those who cannot have oestrogens
42
Q

Contraceptive Injections disadvantages?

A
  • No protection from STIs
  • If patient wants to get pregnant with in next year, not to be used as it can delay a return to fertility
  • Do not give to patients with breast cancer, liver disease, heart disease or stroke, risk factors for osteoporosis
  • Involves an injection! Not suitab
43
Q
A
44
Q

What is the implant? (nexplanon)

A

A LARC ( a long acting reversible contraceptive). A single flexible 40mm rod only containing progestogen (68mg etonogestrel). It looks like a matchstick. It is inserted into the upper arm subdermally with local anaesthetic. Can prevent ovulation, thicken cervical mucus and thin endometrial lining.

45
Q

Key points to know about implants?

A

>99% effective, one of the most effective methods.

  • Lasts for 3 years!!!!
  • Periods can be irregular, last longer or stop completely
  • Not suitable for the same women as the injections
46
Q

Advantages of the implant?

A
  • Lasts 3 years
  • Fertility returns to normal as soon as it is taken out
  • Suitable for women who cannot have oestrogens
  • Can be put in anytime after giving birth
47
Q

Disadvantages of the implant

A
  • Period pattern can change
  • Can make acne worse
  • Not suitable if patient is on enzyme reducing drugs
  • Requires a small procedure to implant and take out
  • Does not protect against STIs!
  • Rare risk of getting infection from where implant was put in
48
Q

What is the coil?

A

Another LARC! Coils are inserted into the uterine cavity. Thin plastic string bear down from the coil through the cervix, these are pulled to remove the device. The coil is T shaped and quite small.

49
Q

What are the two main types of coils?

A

The Progesterone, levonorgestrel intrauterine system (IUS)

Copper coil Intrauterine device (IUD)

50
Q

The Progesterone, levonorgestrel intrauterine system (IUS) –

How do they work?

A

slowly released locally over several years. Jaydess and Levosert last for 3 years and the Mirena lasts for 5 years! Mirena can also be used in HRT to protect endometrium. The IUS changes cervical mucus and uterotubal fluid to impair sperm motility and also thins endometrium to impede implantation. Progestogen levels are much lower than the mini pill and so systemic side effects are low.

51
Q

Copper coil Intrauterine device (IUD)

How do they work?

A

acts to prevent fertilisation as the copper ion is toxic to sperm. It can also prevent implantation and alter cervical mucus. The copper is wrapped around the coil. Lasts for 5-10 years

52
Q

Advantages of the coil

A
  • Fertility returns to normal as soon as it is taken out
  • Levonorgesterel/IUS can help with dysmenorrhoea and menorrhagia
  • Once it is in do not have to worry for up for at least 3 years or up to 10 years depending on IUS or IUD. Do not have to think about taking a pill everyday and no interruption to sex.
53
Q

Disadvantages of the coil?

A
  • Copper/IUD - Can make periods heavier, longer or more painful – do not recommend for patients with dysmenorrhoea or menorrhagia
  • Does not provide STI protection
  • Internal/bimanual exam required for fitting
54
Q

The risks of the coil?

A
  1. Expulsion
  2. Infection
  3. Perforation
  4. Ectopic pregnanc
55
Q

What are the sterilisation types male and female?

A

Vasectomy

Tubal occlusion

56
Q

What is vasectomy?

A

More effective than female sterilisation. Involves ligation and removal of vas deferens from the scrotum, thus preventing release of sperm. Sterility cannot be confirmed until azoospermia is confirmed by two separate semen analyses, this can take up to six months. Reversal is difficult and not guaranteed. Patient should be able to have an erection and ejaculate, this ejaculate will just have no sperm in it

57
Q

What is tubal occlusion?

A

Clips can be applied, sealing, tying, cutting or removing part of the fallopian tubes is carried out to completely occlude the lumen. Most commonly done laparoscopically. Patient will still ovulate but the egg released will be absorbed naturally by the body. 1/200 lifetime risk of failure. Risk of ectopics. Reversal difficult and not available on NHS

58
Q

What are the emergency contraception options?

A

Morning after pill”- levonelle

Morning after pill- ellaOne/Ullpristal

IUS/Copper Coil

59
Q

“Morning after pill” Levonelle

WHat does it contain?

How is it most effective?

Side effects?

A

e contains a single 1.5mg dose of progestoge, levonorgestrel.

l. Most effective (95%) if taken within 24 hours of unprotected sex and should be taken no longer than 72 hours after ( at 72 hours 58% effective)

Side effects: vomiting and disturbances to next menstrual cycle

60
Q

“Morning after pill” ellaOne/Ulipristal

what is it?

A

al is a selective progesterone receptor modulator (SPRM). It prevents or delays ovulation and can reduce the risk implantation. Can be used up to 120 hours after unprotected sex . Since it blocks progesterone binding, it will reduce the effectiveness of other contraception and so condoms should be used until the next period.

61
Q

IUD/Copper coil

What are they?

A

is also used as a method of emergency contraception! Can be inserted up to 5 days after unprotected sex. This can then be used as an ongoing method of contraception!

62
Q

What is the rhythm method?

A

• The Rhythm method involves avoiding sex on the days when the woman is most fertile. Tracking the menstrual cycle using a calendar or an app and monitoring fertility signs such as cervical secretions and body temperature is especially risky with women who have irregular menstrual cycles. These fertility signs can also be unreliable when breastfeeding, when ill or stressed.

It also involves avoiding sexual intercourse altogether when ovulating. Sperm can live inside a woman’s body for up to 7 days, if a woman has had sex up to 7 days before ovulation, she could become pregnant. A woman can technically become pregnant at any point during her cycle, even during or just after her period. Some women may choose to opt for this method as there are no hormones involved and it is acceptable to all faiths and cultures

63
Q

What is the withdrawl method?

A

The withdrawal method involves removing the penis before ejaculation. This is not an effective method of contraception as pre-ejaculate can still contain sperm!

64
Q

Lactation and breast feeding can delay the return of periods after giving birth. This is called __________ __________

A

lactation amenorrhoea (LAM)

65
Q

d lactation amenorrhoea (LAM) can be used as a contraceptive method for up to __ months if the woman is fully breastfeeding and her periods have not started again.

A

6

66
Q

Whihc methods of contraception can be used after 21 days of birth?

A

condoms, the implant, POP, injection, fertility awareness. For other methods you must wait 3 weeks or longer.

67
Q

What is the criteria for prescribing or giving advice about sexual health or contraception without parental knowledge

A

Fraser guidelines –

68
Q

What is the fraser guidelines?

A
  • Young person should understand the advice and be mature enough to understand what is involved
  • Doctor should encourage the young person to inform their parents. If they refuse, it must be in their best interest to give such advice or treatment without parental consent.
  • Whether the young person is very likely to begin or continue having sexual intercourse with or without contraception
  • Without contraception advice or treatment, the young person’s physical or mental health could suffer.
69
Q
A

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