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AKT > O&G contraception > Flashcards

O&G contraception Flashcards

1
Q

MIrena IUS license time

A

5 years

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1
Q

copper IUD license time

A

5-10 years

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2
Q

Kyleena IUS license time

A

5 years

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3
Q

Jaydess IUS license time

A

3 years

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4
Q

IUD mode of action

A

decreases sperm motility and survival
prevents fertilisation

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5
Q

IUS mode of ation

A

levonorgestrel prevents endometrial proliferation and causes cervical mucous thickening

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6
Q

IUD copper coil can be relied on after how long

A

immediately

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7
Q

IUS can be relied on after how long

A

after 7 days

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8
Q

If mirena IUS coil is used for endometrial protection in HRT for women taking oestrogen-only HRT, how long is the coil licensed for

A

4 years

(it is 5 years when for contraception)

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9
Q

which contraceptive is most associated with weight gain

A

depo-provera injection

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10
Q

Depo Provera is the main injectable contraceptive used in the UK. It contains ..?

A

medroxyprogesterone acetate 150mg

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11
Q

How often is Depo Provera (injectable progesterone contaception) given

A

Every 12 weeks - IM injection

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12
Q

Depo Provera is given every 12 weeks. It can be given up to what timeframe after the last dose WITHOUT the need for extra precautions

A

14 weeks

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13
Q

Noristerat is another injectable progesterone contraception. Depo Provera is the most common in the UK given every 12 weeks. How often is Nortisterat given?

A

every 8 weeks

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14
Q

Mode of action of Depo Provera (injectable contraceptive)

A

Inhibits ovulation
Secondary effects: cervical mucous thickening, endometrial thinning

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15
Q

What is the main contraindication (UKMEC 4) for injectable contraceptions (i.e. Depo Provera)

A

Current breast cancer - UKMEC 4
Past breast cancer - UKMEC 3

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16
Q

Obesity increases the risk of VTE in women taking the COCP. What are the UKMEC rules for COCP and obesity:

A

BMI 30-34 - UKMEC 2
BMI >35 - UKMEC 3

ALL OTHER METHODS OF CONTRACEPTION WITH OBESITY ARE UKMEC1 (ACCEPTABLE)

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17
Q

Which form of contraception is the only one that obesity BMI 30+ is classed as not UKMEC1

A

COCP

BMI 30-34 - UKMEC 2
BMI >35 - UKMEC 3

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18
Q

What form of contraception has UKMEC 2-4 with regards to smoking?

A

COCP

Age <35 and smokes - UKMEC2
Age >35 , smokes <15/day - UKMEC3
Age >35 , smokes >15/day - UKMEC4

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19
Q

What effect does smoking have on UKMEC of POP?

A

NO EFFECT

Classed as UKMEC1
As no increased risk of cardiovascular disease with age/smoking

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20
Q

Migraines with aura

COCP - what is UKMEC

A

UKMEC4

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21
Q

Migraines without aura

COCP - what is UKMEC

A

UKMEC3

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22
Q

3 factors to consider with women with epilepsy and starting contraception

A
  1. Contraception making epilepsy medication less effective
  2. Epilepsy medication making contraception less effective
  3. Teratogenic effects of epilepsy medication if woman becomes pregnant
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23
Q

Migraine with aura

POP - what is the UKMEC

A

UKMEC2

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24
Q

Migraine with aura

Progesterone implant - what is the UKMEC

A

UKMEC2

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25
Q

Migraine with aura

Progesterone injection (depo provera) - what is the UKMEC

A

UKMEC2

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26
Q

What do FSRH recommend for patients with epilepsy when using contraception

A

Consistent use of condoms
In addition to other forms of contraception

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27
Q

For women taking:
phenytoin
carbamazepine
barbiturates
topiramate
oxcarbazepine
primidone

(PCBTOP)

what contraception options are UKMEC3

A

COCP and POP - UKMEC3

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28
Q

For women taking:
phenytoin
carbamazepine
barbiturates
topiramate
oxcarbazepine
primidone

(PCBTOP)

what contraception options are UKMEC2

A

Implant - UKMEC2

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29
Q

For women taking:
phenytoin
carbamazepine
barbiturates
topiramate
oxcarbazepine
primidone

(PCBTOP)

what contraception options are UKMEC1

A

Depo-provera, IUS, IUD - UKMEC1

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30
Q

For patients taking lamotrigine, what contraception is UKMEC 3

A

COCP

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31
Q

For patients taking lamotrigine, what contracpetion is UKMEC1

A

POP
Implant
Depo-provera
IUD
IUS

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32
Q

If a COCP is chosen for a patient who takes anti-epileptic medication, what level of ethinylestradiol should it contain as a minimum

A

minimum of 30 µg of ethinylestradiol

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33
Q

when starting the COCP, what additional contraception is needed

A

If COCP is started in first 5 days of menstrual cycle then no need for additional

If after, then for first 7 days use condoms

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34
Q

3 situations where efficacy may be reduced

A
  1. Vomiting within 2 hours of taking COCP pill
  2. Medication e.g. orlistat - causing diarrhoea or vomiting
  3. If taking liver enzyme inducing drugs
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35
Q

precautions of COCP should be taken when taking enzyme inducing antibiotics such as

A

rifampicin

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36
Q

patients with starting COCP 2 months ago having irregular bleeds. what should be advised?

A

NO EXAMINATION NEEDED
Continue pill at same dose and review at 3 months.
Most bleeding settles after 3 months.

After 3 months - can examine and consider changing COCP/dose to increase ethinylestradiol to max of 35 micrograms

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37
Q

After taking ulipristal acetate (EllaOne) women should wait how long before starting ALL (COCP/POP) regular hormonal contraception

38
Q

Levonorgestrel (Levonelle) mechanism of action

A

Stops ovulation
Inhibits implantation

39
Q

Take levonorgestrel (Levonelle) within how many hours of unprotected sexual intercourse

A

Within 72 hours

40
Q

Dose of levonorgestrel (Levonelle) for emergency contraception

A

Single dose of 1.5mg levonorgestrel

Double dose if BMI >26 or weight >70

41
Q

Levonorgestrel (Levonelle) - dose should be repeated if vomiting occurs within how long after taking it…?

A

Within 3 hours of taking it

42
Q

How many times can levonorgestrel (Levonelle) be taken in one cycle?

A

More than once!

43
Q

When can you start hormonal contraception after using:
1. Levornogestrel (Levonelle)
2. Ullipristal (EllaOne)

A
  1. Levornogestrel (Levonelle) - immediately
  2. Ullipristal (EllaOne) - after 5 days, then use extra precaution for 7 days (COCP) or 2 days (POP)
44
Q

Ulipristal (EllaOne) mechanism of action

A

Selective progestrone receptor modulator
Inhibits ovulation

45
Q

What dose of Ulipristal (EllaOne) is given and up to what timeframe can it be given

A

30mg oral dose
Up to 120 hours after UPSI

46
Q

Patients with severe asthma should be cautious when taking which emergency contracpetion

A

Ullipristal (Ellaone)

47
Q

When can breastfeeding be restarted after taking:
1. Levornogestrel (Levonelle)
2. Ullipristal (EllaOne)

A
  1. Levornogestrel (Levonelle) - immediately
  2. Ullipristal (EllaOne) - after 1 week
48
Q

When can copper IUD coil be inserted after UPSI?

A
  1. Within 5 days of UPSI; or
  2. Up to 5 days after expected ovulation in cycle (i.e. cycle length = 28. Then do 28-14 = 14 and then add 5, so day 19 would be the latest)
49
Q

If 1 COCP pill is missed (at any time in the cycle) what should you do

A

Take the last pill even if it means taking 2 pills in one day
continue taking pills daily
no additional contraceptive protection neededI

50
Q

If 2 COCP pills or more missed in week 1 (days 1-7)

A

emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1

take the last pill even if it means taking 2 pills in one day, then continue taking pills daily
use condoms or abstain from sex until pills have been taken for 7 days in a row

51
Q

If 2 COCP pills or more missed in week 2 (days 8-14)

A

there is no need for emergency contraception (after taking 7 consecutive days of taking COCP)

take the last pill even if it means taking 2 pills in one day, then continue taking pills daily

52
Q

If 2 COCP pills or more missed in week 3 (days 15-21)

A

finish pills in current pack (if have to take 2 pills in one day from yesterdays)

start a new pack straight after - omitting the pill free interval

no need for emergency contraception

53
Q

For patients assigned female at birth, who are taking testosterone therapy, which contraceptives are not recommended?

A

Contraceptives containing oestrogen

This is because oestrogen can antoganise the effect of testosterone therapy

54
Q

patients assigned male at birth engaging in vaginal sex wishing to avoid the risk of pregnancy should be advised on what contraception

55
Q

COCP in women aged over 40 may offer what 2 benefits

A
  1. Maintain bone mineral density in perimenopause
  2. Reduce menopausal symptoms
56
Q

Pill containing how much ethinylesteradiol may be more suitable for women >40 yers

A

<30 micrograms

After 50 years, they should stop using COCP for contraception and use alternative methods that are non-hormonal or progesterogen-only

57
Q

What two contraceptions should be stopped after woman reaches over 50 years

A

COCP
Depo-provera

58
Q

Women who are using COCP/depo-provera and reach the age of 50 or older should stop these and switch to…

A

Progestogen-only methods (and stop at 55 years, or if FSH >30 after amonorrhoeic for 1 year)

Or non-hormonal methods (and stop after 2 years of amenorrhoea)

59
Q

When should non-hormonal contraception options e.g. IUD, condoms, be stopped in women?

A

After 2 years of amenorrhoea if <50 years
Or after 1 year of amenorrhoea if >50 years

60
Q

If a woman is using POP as contraception and peri- or post-menopausal, do they need another progestogen component in HRT?

A

YES

POP is not enough o protect the endometrium
IUS can provide progestogen component of HRT, or another combined oral/patch option

61
Q

When should the progesterone implant, POP or IUS be stopped in women?

A

After 55 years
Or if amenorrhoeic after 1 year and FSH >30

62
Q

family history of thromboembolic disease in first degree relatives < 45 years - UKMEC for COCP

63
Q

breast feeding < 6 weeks post-partum - COCP

UKMEC?

64
Q

History of thromboemoblic disease/ thrombogenic mutation

COCP - what UKMEC?

65
Q

Breastfeeding 6 weeks to 6 months post-partum

COCP - what UKMEC

66
Q

Examples of UKMEC4 for COCP

A
  1. migraine with aura
  2. age >35 and >15cigs/day
  3. BMI >35
  4. history of VTE/clotting disease
  5. breastfeeding <6 weeks post-partum
  6. current breast cancer
  7. uncontrolled HTN
  8. history of stroke/IHD
  9. major surgery with prolonged immobilisation
67
Q

COCP increases risk of which cancers

A

Breast
Cervical

68
Q

COCP decreases risk of which cancers

A

Endometrial
Ovarian

69
Q

Progesterone implant (Nexplanon) mechanism of action

A

Prevents ovulation
And thickens cervical mucous

70
Q

How long does the implantable progesterone (Nexplanon/Implanon) last for

71
Q

How quickly does the implantable progesterone (Nexplanon/Implanon) work?

A

If inserted in first 5 days of cycle - immediately
If afterwards - after 7 days, extra contraception is needed for that

72
Q

Main side effect with the implantable progesterone (Nexplanon/Implanon)

A

Irregular/heavy bleeding

73
Q

Irregular/heavy bleeding that sometimes occurs with the implantable progesterone (Nexplanon/Implanon) can be managed with?

A

COCP co-prescription
Or speculum/STI if bleeding continues for >3 months after starting the implant

74
Q

What medications may reduce efficacy of the implantable progesterone (Nexplanon/Implanon)

A

Antiepileptics
Rifampicin

  • advised to use additional contraception until 28 days after stopping above medications
75
Q

UKMEC4 for the implantable progesterone (Nexplanon/Implanon)

A

Current breast cancer

76
Q

Contraceptives - time until effective (if not first day period):
instant
2 days
7 days

A

instant: IUD
2 days: POP
7 days: if not day 1-5: COC, injection, implant
if not inserted day 1-7: IUS

77
Q

lactational amenorrhoea method (LAM) of contraception effectiveness decreases after…?

78
Q

After giving birth, women require contraception after what day

A

after day 21

note that progesterone implant or POP can be given sooner

79
Q

When can POP be started postpartum

A

Anytime
After day 21 - additional contraception is needed for the first 2 days

80
Q

When can COCP be started postpartum

A

After 6 weeks postpartum if breastfeeding
After 21 days if not breastfeeding

Use 7 days condoms!

UKMEC 2 - 6 weeks - 6 months breastfeeding postpartum

81
Q

When is COCP contraindicated postpartum

A

UKMEC 4 if breastfeeding <6 weeks
Contraindicated also in first 21 days due to increased VTE risk
Use condoms for 7 days afterwards

82
Q

Lactational amenorrhoea method (LAM) is 98% effective if what 3 conditions

A

Fully breast feeding
Amenorrhoeic
<6 months post-partum

83
Q

When can a Levonorgestrel-IUS be inserted during the cycle to ensure that no additional contraception required?

A

day 1-7 of cycle

84
Q

COCP choice of pill for first time users

A

30 mcg ethinyloestradiol with 150mcg levonorgestrel/norethisterone

85
Q

Qlaira missed pills are complicated
If a pill is taken how many hours late is it classed as “missed”

A

12 hours = missed pill
If a woman has missed more than 2 pills, emergency contraception may be needed

86
Q

Following Faculty of Sexual and Reproductive Health (FRSH) guidelines, what is the most appropriate time to test for STIs after UPSI

A

2-12 weeks after UPSI incident

87
Q

In a woman who has an undiagnosed breast mass continuing the combined hormonal contraceptive pill is classified as UKMEC…

88
Q

When switching from a traditional POP to COCP (with correct prior use) how many days of barrier contraception is needed

89
Q

The combined contraceptive transdermal patch may be less effective in patients over what weight

90
Q

if inserted at 45 years or over, the levonorgestrel intrauterine system (LNG-IUS) can be used for contraception until the age of …?

91
Q

The VTE risk of Dianette is around how many times more versus standard COCPs

A

1.5-2 times more

92
Q

Co-cyprindiol (dianette) is licensed for the following conditions:

A

Severe acne in women refractory to prolonged oral antibacterial therapy
Moderately severe hirsuitism

93
Q

Coils can be inserted post-partum after what timeframe

A

Between 48hours - 4 weeks postpartum is UKMEC 3

Therefore <48hours or after 4 weeks, coils can be inserted

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