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MRCOG > Sexual Health > Flashcards

Sexual Health Flashcards

1
Q

Levonogestrel for Emergency Contraception

A
  1. Synthetic progesterone
  2. 1.5mg single dose as soon as possible after sexual intercourse
  3. Licensed up to 72 hours after SI
  4. If vomiting within 2 hours, rpt dose can be given
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2
Q

Ulipristal (EllaOne)

A
  1. Selective progesterone receptor modulator
  2. 30mg single dose
  3. Effective up to 5 days after SI
  4. If vomiting within 3 hours, rpt dose can be given

Avoid in enzyme inducing drugs!

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3
Q

Recommended advice if 2 or more pills have been missed (> 48 hours late)
1. Pills 1-7 (first week)
2. Pills 8-14 (second week)
3. Pills 15-21 (third week)

A

The most recent missed pill should be taken as soon as possible.
The remaining pills should be continued at the usual time.
Use condoms or avoid sex until 7 consecutive pills have been taken.

Week 1 - EC should be considered if UPSI occurred in the pill free interval or in the first week of pill taking.

Week 2 - No indication for EC if the pills in the preceding 7 days have been taken correctly.

Week 3 - omit the pill free interval by running back to back.

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4
Q

Contraceptive patch removed or detached for < 48 hours?

A

No additional precautions required.

If contraceptive patch has been removed or become detached for > 48 hours, additional precautions should be used for 7 days and EC considered.

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5
Q

Advice following Ulipristal acetate (Ella One) for emergency contraception ?

A

Can be used up to 5 days after UPSI.

As it blocks progesterone, there is a risk of reducing the efficacy of contraceptives that contain progesterone and therefore COCP users should use additional precautions for 14 days after use of Ulipristal acetate.

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6
Q

Mechanism of action of POP?

A

Thickening of cervical mucous

Ovulation inhibited in up to 97% of cycles with new generation POP’s containing desogestrel.

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7
Q

Examples of traditional and new generation POPs ?

What progestogen do the contain ?

A

Traditional POPs
- Levonorgestrel (30 micrograms)
- Norethisterone (350mcg)
- Norgestron, Micronor, Noriday

New Gen POPs
- Desogestrel (75 mcg)
- Cerazette, Cerelle, Nacrez

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8
Q

Failure rate of vasectomy vs tubal sterilisation?

A

Vasectomy - 1/2000
Tubal sterilisation - 1/200

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9
Q

Bleeding pattern on POP:
1. Amenorrhoea
2. Regular bleeding
3. Irregular bleeding

A
  • 20% amenorrhoea
  • 40% regular bleeding
  • 40% irregular bleeding
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10
Q

UKMEC 3 - relative contraindication to POP?

A
  • Current or previous IHD
  • Stroke
  • Prev breast Ca with no evidence of recurrence for 5 years
  • Severe decompensated liver cirrhosis
  • Benign or malignant tumours
  • SLE with severe thrombocytopaenia and +ve antiphospholipid antibodies
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11
Q

UKMEC 4 - relative contraindication to POP

A

Current breast cancer

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12
Q

Additional precautions if starting POP > D5 of menstrual cycle?

A

Additional precautions or abstinence for 48 hours only.

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13
Q

Missed pill advice for POP?

A
  1. Traditional pills containing levonorgestrel or norethisterone are considered ‘late’ if taken > 3 hours late
  2. New gen POP’s containing desogestrel are considered missed if taken > 12 hours late

The missed pill should be taken as soon as it is remembered.

The next pill should be taken at the usual time which may mean taking 2 pills in one day.

Additional precautions should be used for 48 hours.

Em contraception may be required if UPSI has occurred in the 48 hour period after the missed pill.

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14
Q

Advice of DEPO contraceptive injection commenced after D5 of the menstrual cycle?

A

POI can be started after D5 of the menstrual cycle but barrier contraception should be used for the first 7 days after the injection.

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15
Q

A repeat depo can be given up to how long after missed repeat dose without need for additional precautions ?

A

2 weeks - risk of ovulation is low.

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16
Q

Mechanism of action of copper IUD?

A

Inhibits fertilisation - toxic to sperm + ovum

17
Q

Levonorgestrel (Levonelle) for Em Contraception.
1. Dose
2. Effect
3. Pregnancy rate following use
4. Contra indications

A
  1. 1.5mg single dose orally
  2. Delays ovulation for 5-7days
  3. Pregnancy rate 2.2% following use
  4. Liver enzyme inducing drugs may reduce its efficacy and this effect persists for 28 days after.
18
Q

How long should women be advised to continue contraception for after sterilisation?

A

7 days

19
Q

Abortion Act:
1. Clause A
2. Clause B
3. Clause C
4. Clause D
5. Clause E

A
  1. Clause A - the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated
  2. Clause B - the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
  3. C - the pregnancy has not exceeded 24/40 and the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman
  4. Clause D - the pregnant has not exceeded 24/40 and continuing the pregnancy would involve risk of injury to the physical or mental health of any existing children of the family of the pregnant woman
  5. Clause E - there is substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped
20
Q

Risk of needing surgical intervention after MTOP?

A

5%

21
Q

Risk of pregnancy after vaginal rape ?

A

5%

22
Q

When to stop contraception in women > 40
1. Women > 50 not on hormonal contraception
2. Women < 50
3. Women > 50 using POP
4. Women > 55

A
  1. Stop contraception after 1 year of amenorrhoea
  2. Continue contraception for 2 years after amenorrhoea
  3. Contraception can be stopped after 1 year and 2x FSH levels > 30, 6 weeks apart
  4. Stop contraception

If using COCP - stop for 2 weeks to check FSH levels.

23
Q

Once a woman is established on HRT, how often should she be reviewed?

A

Annually

24
Q

What % of subfertility is male factor?

A

30%

25
Q

Mirena IUD releases levonorgestrel at what rate/day?

A

20mcg/day

26
Q

Risk of continuing pregnancy in Medical vs Surgical abortion?

A

Medical: 1-2:100
Surgical: 1/1000 (higher < 7/40)

27
Q

Antibiotic regime for surgical abortion prophylaxis?

A

Oral Doxy 100mg BD for 3-7 days starting in within 2 hours of the procedure.

28
Q

Mife/Miso regime for MTOP (< 12/40)

A

Mife 200mg orally

Miso 800mcg (PO/PV/buccal/SL) 24/48 hours later

Miso 400mcg 4 hours after if pregnancy not passed (will likely need if > 9/40)

MRCOG (15 decks)

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