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Y3/4 OBS + GYNAE > Sex Hormones And Contraception And HRT > Flashcards

Sex Hormones And Contraception And HRT Flashcards

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1
Q

Mentstual cycle

A

FSH secreted by pituitary recruits follicle and mature eff to graph Ian follicle this secretes oestrogen making endometrium thick to receive egg , ovulation, peak of fsh ans lh, grpahian rupture and release of egg and corpus luteum , now entering Luteal phase maintains healthy thick endometrium able to receive blastocyst .
If not fertilised drop in progesterone causes endometrial lining to be shed

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2
Q

Contraception is broken into 4 groups
What are the hormonal oral group

A

COCP
POP

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3
Q

Long acting reversible cotraceptives LARC

A

Implant
Injection
IUS
IUD

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4
Q

Barrier methods are obvs and are condom and ring and diaphragm what are natural

A

Rhythm methods and withdrawal

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5
Q

COCP suppress the sec reaction of LH and FSH and ovulation. Thickens the cervical mucous and thins the endometrium
It is taken for 21 days then break for 7
Pros and cons

A

Effective in treating menorrhagia nand may reduce PID good for acne and PMS too
Reduce hormonal related pathology , cystic breast disease, ovarian cysts, endometrial and ovarian cancer

Cons
Increased risk of VTE , MI and stroke with migraine aura
Breast cancer risk
Not for overweight, hypertensive, post natal older women

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6
Q

Progesterone only pill taken every day without break and thickens cervical mucous and thins the endometrium and may inhibit obvulation pros and cons

Suitable for breastfeeding

A

Avoids the cardiovascular and VTE risks of oestrogen and COCP improve menstueal problems
Cons is must be taken in 3hr window, irregular bleeding, headaches breast tenderness and acne

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7
Q

Implant is progesterone only sub-dermal implant inserted for 3 years on upper arm and inhibits ovulation and thickens the cervical mucous and thins the endometrium
Pros and cons

A

Lasts 3 yrs and reversible fertility , suitable for breast feeding women and reduce menstueal problems
Cons is cause irregular bleeding in first year, acne breast tender and mood changes and headaches and surgical insertion

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8
Q

Injection is progesterone only depot injection last 12 weeks inhabiting ovulation thickening cervical mucous and thins endometrium
Pros and cons

A

Suitable for breast feeding and can cause amenorrhea
Cons is delay in return of fertility for up to year
Loss of bone density and menstrual irregular
Weight gain

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9
Q

IUS are t shaped devices which release levonorgestrel (progesterone) over 5 years also called the miruna coil it causes endometrial atrophy and cervical mucus thickening

A

Reduces chances of menorrhgaia and dysmenorrhea
Good for heavy periods and no weight gain
Cons is unpleasant insertion, risk of PID, ectopic preg , expulsion and uterine per formation

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10
Q

IUD is a t shaped coppemdevice lasting 10 years

A

Free from hormonal side effects and effective immediately after fitting
It’s unpleasant to insert, risk of PID, spotting and heavy bleeding, increased blood loss and painful periods reported, pelvic pain and ectopicmprrg

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11
Q

Natural rhythm methods calendar and apps and temperature

A

Perfect use not much failure and good for religious beliefs
25% failure rate
Abstinence in fertile window
Irregular cycles

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12
Q

What is the menopause

A

12 months of spontaneous amenorrhea

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13
Q

Early menopause

A

Under 45

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14
Q

Premature menopause

A

Under 40

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15
Q

Why does the menopause occur

A

Due to depletion of ovarian follicles causing a drop in oestrogen and progesterone with a resulting spike in FSH and LH SX include menstueal irregularity etc

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16
Q

Sx of menopause

A

Menstrual irregularity
Casokotor such as sweats and flushes
GI symptoms
Sleep disturbances
Mood changes
Loss of sex drive

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17
Q

Types of HRT

A

Oestrogen only - only use in women without a uterus , hysterectomy to risk of endometrial cancer

combined HRT

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18
Q

Combined HRT two types

A

Cyclical periods under 12 months ago
Continuous - amenorrhoeic
Form of tablets, patches gels and topical vaginal gels

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19
Q

Even is asymptomatic for early menopause

A

For cardiovascular and osteoporotic protection

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20
Q

HRT benefits

A

Release of Sx
Reduction in osteoporosis
Reduce cardiovascular risk
Reduce risk of colorectal cancer

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21
Q

HRT cons

A

Increased VTE - oral forms
Breast cancer risk 20 per 1000 over 10yr
Endometrial cancer increase with only oestrogen forms progesterone protects against it

22
Q

HRT considerations for prescribing

A

Lowest dose for shortest time to control sx gradullay withdraw
Oestrogen only ever prescribed for women without uterus
Consider risks
HRT is not a form of contraception

23
Q

side effect of IUD

A

heavier and longer peierods

24
Q

side effects of progesterone only pill and injection

1/3 rule

A

3rd stop having periods, 3rd continue and 1/3 experience irregular bleeding in the form of irregular bleeds, light bleeding between periods to through the cycle called spotting

25
Q

A 22 year old dancer attends the sexual health clinic to discuss contraception. She is unhappy on her current contraceptive, the Nexplanon implant, as it has made her periods erratic. She also experiences spotting throughout her cycle. The irregular bleeding interferes with her work and she requests a method that will bring back regularity of her periods as soon as possible.

Her past medical history includes acne, for which she uses topical Benzoyl peroxide. There is no relevant family history. She is a non-smoker and has a normal blood pressure.

Which of the following is the most suitable option to offer?

A

COCP

main concern is irregularity

improves regualarity of cycles

26
Q

contraindication to COCP

A

less than 6 weeks postpartum breastfeeding
less than 3 week postpartum with other factors like VTE
cardiac function imparidee
AF
current breast cancer
high blood pressure earn vascular disease
migraine with aura

27
Q

what guidelines
people under 16 years old can be prescribed contraceptives so Lon as they
- demonstatre understanding
- they cannot be persuaded to discuss with parents
likely to have sex anyway with or without conception
their physical and or mental health may suffer without it
it is in their best interests

A

Fraser guiltiness

28
Q

rules for starting the pill

if the patient starts the pull on the first day of her period she will be protected …..

A

immediately

29
Q

if the patient stats any time in her cycle when will the COCP become affective

A

7 dyas

30
Q

if a mother is not breastfeeding when can she begin to take the pill

A

21 days after birth

31
Q

if someone has breast cancer what is the only form of contraception they can have

A

IUD - copper coil
this is a non-hormonal method

so condoms could also work too

32
Q

the combined oral contraceptive pill protects against what cancer and increases what others

A

reduces risk of ovarian , endometrial and colorectal cancer and increases the risk of breast and cervical

33
Q

is the IUD suitable for someone with a current infection or someone with STI

A

no

34
Q

infertility can be causes by Cushing if this is suspected what test would you do

A

dexamethasone supresion test

35
Q

Which of the following is an advantage of HRT given through a skin patch compared to HRT given in the form of tablets?

A

reduced risk of VTE

36
Q

two types of HRT regimes

A

Combined HRT can be given either:
Cyclically: for perimenopausal women who are still having menstrual periods
Continuous: for postmenopausal women who are not having menstrual periods

37
Q

three risks of HRT

A

Increased risk of breast cancer
Increased risk of endometrial cancer if oestrogen given alone
Increased risk of venous thromboembolism

38
Q

missed pill procedure

what happens if vomit

in week 1
week 2
week 3

A

If vomiting within 2 hours of taking a pill, another one should be taken as soon as possible.

The pill free week is the 7 days between taking packets of pills. There is occasionally a breakthrough bleed, a small bleed similar to a period, however the absence of a breakthrough bleed does not indicate pregnancy.

Missed pill rules:

If pills are missed in week 1: use emergency contraception if she had UPSI in pill free interval for 1 week

If pills are missed in week 2: no need for emergency contraception

If pills are missed in week 3: Take the last pill that was missed, finish the current pack and start the next pack immediately after.

39
Q

explain

monophonic regime

phasic regime

what happens if you start oil on first day of cycle - how long till protected

what happens if you start any other day in cycle - how long protected

new mothers can begin to take the pill 21 day after giving brith - providing not breastfeeding

A

Types of oral contraceptive pill instructions
Guidance relating to taking the pill is dependent on the regimen that has been prescribed:

Monophasic 21 day pills require 21 days of administration, followed by 7 days off

Phasic 21 day pils require all 21 pills to be taken in the correct order

Everyday pills require one pill to be taken each day. The packets include 21 active pills and 7 inactive pills

Rules for starting the pill
There is specific advice to give patients regarding starting taking the pill:

If the patient starts her pill on the first day of her period (up to 5 days), she will be protected from pregnancy immediately

If the patient starts at any other time in her cycle, she will need to use condoms for 7 days.

New mothers can begin to take the pill 21 days after giving birth, providing they are not breastfeeding.

40
Q

woman is going for surgery and is on COCP what should she do

A

stop 4 weeks prior, start another form of contraception and then restart pill 2 weeks after as they both contribute to VTE

41
Q

advantages and disadvantages UKMEC of COCP

A

Absolute Contraindications to Contraception (UKMEC 4)
Known or suspected pregnancy, smoker over the age of 35 who smokes >15 cigarettes, obesity, breast feeding <6 weeks post partum, Fx of thrombosis before 45 years old, breast cancer or cancer within last few years, BRCA genes

Disadvantages of a contraceptive outweigh the advantages (UKMEC 3)
Breast feeding >6weeks post partum, Previous arterial or venous clots, continued use after heart disease or stroke, migraines with aura, active disease of liver or gallbladder

Advantages of a contraceptive outweigh the disadvantages (UKMEC 2)
Initiation after current or past history of MI or stroke, multiple risk factors for arterial cardiovascular disease

42
Q

A 25 year old lady attends the walk-in sexual health clinic after forgetting to take her Progesterone only pill yesterday. She usually takes Cerazette (desogesterel) once a day. Her last pill was due 15 hours ago. She has not had any unprotected sexual intercourse this month.

What is the most appropriate advice to give?

A

considered late over 12 hours

( microns late after 3 Horus)

so take the missed pill continue the pack as usual and jus use condoms for the next 2 days

43
Q

Missed pill rules in week 1,2,3

A

Week one emergency in pill freee interval week
No need in 2
In 3 take missed pills and finish pack and start next pill imemediatly

44
Q

most effective form of contraception

A

IUD

45
Q

cystocele present with anterior bulge and stress incotnicne

what about rectocele and enterocele

A

uterine prolapse - abnromal cervix
vaginal vault prolapse post hysterectomy
rectocele - A rectocele is the prolapse of the rectum into the vagina. Instead, this would typically present with a posterior wall bulge and difficulty with defecation, tenesmus or sensation of pressure in the rectum

An enterocele is the prolapse of the small bowel into the vagina. It would typically present with a posterior vaginal wall bulge and lower back pain

46
Q

if group b strep found what do you give to mother

A

given IV abx for pregnancy and labour to prevent transmission

47
Q

if group b strep found what do you give to mother

A

given IV abx for pregnancy and labour to prevent transmission

48
Q

A 33-year-old lady presents to the gynaecology clinic with dysmenorrhoea and menorrhagia. On questioning, she also reports dyspareunia and an inability to conceive for the last 3 years.

A transvaginal ultrasound scan is normal and she, therefore, undergoes a diagnostic laparoscopy that reveals endometriosis.

Which of the following treatment options would be most appropriate?

A

Laparoscopic diathermy and adhesiolysis

This patient has infertility that is likely secondary to endometriosis. The only treatment option that has been shown to improve fertility in endometriosis is surgery. Laparoscopic diathermy and adhesiolysis is a procedure that removes the endometrial deposits and adhesions from the pelvic cavity

49
Q

fribroids tx

A

LNG IUS - not if
LNG-IUS is often the 1st-line treatment; however in this case where the patient has several large pedunculated submucosal fibroids there will be uterine distortion making the insertion of an intrauterine system inappropriate
COCP - This would be a 2nd-line treatment option. However, its use holds an unacceptable health risk (UK Medical Eligibility Criteria for Contraceptive Use category 4) as this lady is aged over 35 and smokes more than 15 cigarettes a day. Tranexamic acid or NSAIDs are other 2nd-line options, but are not choices here

Oral norethisterone

This is the correct answer. It is a 3rd line option when the above treatments are deemed unsuitable, such as in this case

surgical
Myomectomy involves removing the fibroid from the uterine wall, and is generally fertility-sparing.

Ablation involves using a laser or radiofrequency(generates heat) to induce necrosis of the fibroid, and so the dead vessels no longer bleed.

Uterine artery embolisation may provide a targeted degeneration of the fibroid. This may also preserve fertility.

Hysterectomy involves removing the uterus. It is obviously extremely effective but will not preserve fertility.

50
Q

when not to do TVUS

A

if they havent had sex or are young

Y3/4 OBS + GYNAE (42 decks)

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