Repro Flashcards
Progesterone implant - how long before it has to be taken out
3 years
Progesterone implant
- how soon after adminsitration is it effective as sole form of contraception
if day 1-5 of cycle - immediate effect
otherwise takes 7 days
UKMEC 4 for prgoesterone implant and progesterone injection?
Current breast ca or within last 5 years
4 side effects of progesterone injection
- abnormal bleeding (80%)
- Mastalgia - common
- Delayed return to fertility - can take 1 year
- Weight gain
pharmacological tx of stress incontinence?
pharmacologcail tx of urge incontinence
stress - duloxetine
urge - mirabegron/oxybutynin/tolteridone
CYP450 inducers
Anticonvulsants
Rifampicin
St Johns Wort
–> remember as women on phenytoin shouldn’t use COCP
CYP450 inhibitors
PPI
Macrolide abx
Quinolones (cirpfloxacin)
Antifungals
Woman is on COCP
She misses 2 pills in during the first 7 ‘active pill’ period. What do you do
Take the missed pill now, even if it means taking 2 pills in one go
- if she has had UPSI sine finishing the last packet, needs emergency contraception
Woman is on COCP
She misses 2 pills in during the last 7 ‘active pill’ period. What do you do
Take the missed pill now even if it means taking 2 pills in one go
- commence the next pill packet without taking a pill free interval
POP: how long would be considered a ‘delayed’ administration for most POPs?
What is the exception?
3 hours
Cerazette (desogestrel)- 12 hours
drospirenone - 24 hours
How long is a mirena effective for
5 years
After administration, how soon is the contraceptive effective for copper coil? for mirena?
copper coil - immediately (copper is toxic)
mirena - takes 7 days - use barrier contraception during this period
Drug causes of infertility in men - name 3
Sulfasalazine
Steroids
Cytotoxic drugs
Initial blood test in suspected infertility in a woman
Mid luteal phase progesterone (confirms ovulation)
- take on 7 days prior to expected period
FSH and LH on day 2-4 on cycle (useful in irregular menses)
What is ‘red degeneration’
In a pregnant woman with fibroids, the rapid growth of the fibroid may lead to increased demand for blood supply which cannot be met
Side effect of GNRH agonists used for fibroids?
menopausal symptoms
osteoporosis
3 types of fibroid
Subserosal - grow into peritoneal cavity –> pressure sx
Submucosal - grow into uterine cavity –> bleeding, pain, infertility
Intramural - within myometrium –> bleeding, pain
Current NHS screening for breast ca?
every 3 yrs from 50-70yo
Current NHS screening for cervical ca
25-49yo: every 3 years
50- 64yo: every 5 years
Physiological changes in breathing and circulation in pregnancy?
Breathing - increased tidal volume.
resp rate does NOT change in pregnancy
Circulation:
- increased HR
- lower BP in 1st and 2nd trimester
- bounding pulse
- ejection systolic murmur
Antepartum haemorhage immediately after artificial rupture of membranes
- likey diagnosis?
vasa praevia
- foetal vessels running close/crossing the inner cervical os
LGV (lymphogranuloma venereum)
Cause?
Typical presentation?
Caused - chlamydia
Presentation
1) painless pustule –>ulcer
2) painful inguinal LNs
3) proctocolitis (tenesmus, PR bloody discharge, diarrhoea)
Chlamydia - treatment?
doxycycline
What is a missed miscarriage
Fetus has died but remains in the uterus, os closed
What is adenomyosis?
ectopic endometrial tissue growing in myometrium
tender breast lump which varies in size during menstrual cycle
breast cyst
in which group of breastfeeding women is COCP contraindicated (UKMEC 4)
if breastffeeding and <6 weeks post partum
in which group of smoking women is COCP contraindicated (uKMEC 4)
> 35yo
smoking >15 cigs/day
HPV types in cervical cancer?
16
18
33
What is Ashermans syndrome
uterine adhesions causing amenorrhoea
most often post D+C
Fat necrosis of the breast tends to occur in…?
Obese women with large fatty breasts
Pharmacological management of menorrhagia
1st: Mirena
2nd: tranexamic acid/NSAIDs/COCP
3rd: norethisterone 15mg TDS from days 5-26 of cycle
Definition of anaemia in pregnancy?
Hb <110
home pregnancy tests become +ve how many days post conception?
11 days post
home pregnancy tests remain +ve how many days post miscarriage?
5 days post miscarriage
pharmacological management of hot flushes if HRT is contraindicated
SSRIs
preferred antithyroid medications in pregnancy
PTU In 1st trimester
Carbimazole in 2nd trimester
painful genital ulcer + lymphadenopathy
Haemophilus ducreyi = chancroid
COCP provides level of protection against which cancers?
endometrial and ovarian
rapidly largening and painful lump on the labia?
bartholins cyst
when is the anomaly scan done?
18-20 weeks
pharmacological mx of stress incontinence
duloxetine - antimuscarinic effect?
Normal physiological changes in pregnancy to:
- WCC
- Albumin
- urea
- creatinine
- ALP
- platelets
- WCC increase
- albumin decreases (dilutes)
- urea and creatinine decreases (increased clearance)
- ALP rises
- platelets decreases
management of menorrhagia?
contraception needed:
- IUS –> COCP –> POP
no contraception needed:
- tranexamic acid
PAINful genital ulcer + lymphadenopathy
–> cause?
haemophilus ducreyi
at what BMI is COCP considered UKMEC 3?
BMI >35
when is smoking considered absolute contraindication to COCP use?
> 35yo
+ smoking >15 cigarettes/day
time period after UPSI for effective administration of copper IUD
5 days
or 5 days after expected ovulation, whichever is later
