Sexual Health Flashcards
What does the UKMEC stand for?
what are the levels?
UK Medical eligibility criteria
1-4
What do the UKMEC levels 1-4 stand for?
1 - unrestricted use
2 - benefits outweigh risk
3 - risk outweigh benefits
4 - unacceptable risk - complete CI
what are 4 categories of contraception?
Natural/conservative
short acting
longer acting
sterilisation
what are natural/conservative contraceptions and % effective?
Family planning
condom use
75-82% effective
What are some shorter acting contraceptions and their theoretic and actual % effectiveness?
COCP
POP
HRT Patch
99% theoretic
98% actual
What are some longer acting contraceptions and their actual % effectiveness?
depot effectiveness %?
DEPOT provera
Nexoplanon implant
IUS
IUD
99% Actual
Depot = 94%
Sterilisation contraception techniques?
% effectiveness?
vasectomy
tubal ligation
is a vasectomy reversible or not?
why is not done by NHS?
reversible possible but not NHS done
High complication risk:
Unsuccessful
Bladder Sx
Malignancy
Infection
When do all contraceptions become effective and how quickly?
day 1-5 of cycle = IMMEDIATE
Which other contraceptions become effective immediately outside the day 1-5 mark?
IUD
Which contraceptions become effective after a few days and how many exactly?
POP
After 2 days
Which contraceptions become effective after 7 days and what extra precautions are taken?
COCP, Depot, Implant, IUS
7 days and extra barrier (condom)
When can the COCP be taken postpartum?
don’t give COCP til >6 weeks PP
When can the IUS/IUD be taken Postpartum?
<48 hours or after 4 weeks PP
what factors fall into UKMEC 3 for COCP?
Immobile/wheelchair use
BMI >35
BRCA 1 or 2
what factors fall into UKMEC 4 for COCP?
Migraine + aura
past Hx VTE
>35y and >15 cigs/day
liver tumours
aPL or SLE
Breast Ca
Which hormones are used in contraceptions and are they high or low?
High oestrogen
High progesterone
How is high oestrogen used for contraception?
high oestrogen = with progesterone , suppresses HPG axis therefore no LH surge, no follicular development
How is high progesterone used for contraception?
High progesterone = maintains endometrium, thickens cervical mucus, decreased cilia flow
What is the first line for emergency. contraception?
how many hours/days can it be done within?
IUD (copper coil)
within 120 hours / 5 days
What is the 2nd line for emergency. contraception and dosage?
how many hours/days can it be done within?
EllaOne (Ulipristal acetate) 30mg
<120 hours / 5 days
Decreased effectiveness with time
What is the 3rd line for emergency. contraception and dosage?
how many hours/days can it be done within?
Levonorgestrel 1.5mg
<72hrs / 3 days
COCP
What does it contain?
Brand name?
Mechanism?
High oestrogen and prog
Microgynon
Prevents ovulation. + thickens cervical mucosa (prog) + inhibits endometrial proliferation - reduces chance of implantation
COCP
How often do you take it?
what happens if you miss 1 pill or 2 pills?
For 2 pills, what do you do on week 1, 2 or 3?
Take everyday
Missed Pill:
1 = take 2
2 = Depends on week
Week 1 = emergency contraception
Week 2 = Nothing
Week 3 = Omit pill free period and use condoms for 7 days (until 7 consecutive pills taken)
What are the Benefits/Pros and Cons/Risks of the COCP?
Pros:
-Very effective
-Decreased risk of non screened cancers (endometrial and ovarian)
-Immediate fertility returned
Cons:
- Missed pills
-Increased risk of screened cancers (breast and cervical)
- VTE risk (not in patch)
What medication decreases the efficacy of COCP and why?
CYP450 Inducer
Carbamazepine
What happens when you stop COCP?
What happens in extended COCP use without pill free period?
Stopping COCP = lining of uterus sheds = withdrawal bleed
Extended COCP use without pill free period = breakthrough bleed
what is regularly checked for a patient on COCP and why?
Check BP as it can cause hypertension
POP
What does it contain?
2 Examples of POP and how often they are taken?
Mechanism?
High Progesterone
Levonorgestrel (3 hour window)
Desogestrel (12 hour window)
Take at same time everyday without pill free period
Mechanism = thickens cervical mucosa
What are the Benefits/Pros and Cons/Risks of the POP?
Pros:
- Very effective, good were COCP in CI
- Breastfeeding friendly
Cons:
- small window therefore missed pills
- spotting
What is UKMEC 4 in POP?
Breast Ca
What medication is not good to use with POP and why?
CYP450 inducer
Rifampicin
Increases POP Metabolism (Increased preg chance)
Other Abx = fine with POP
POP
What to do if you miss a pill?
intercourse since missing pill?
Missed = take missed pill
Intercourse after missing pill = emergency contraception
What does POP increase the risk of?
Depression
What is the depot, how is it administered?
How often?
Depot provera
12 week IM Injection
What medication is the depot?
mechanism?
Medroxy progesterone acetate
Inhibits ovulation (+ thickens cervical mucosa + endometrial thinning)
What can Depot cause so why is it not first line in which group of people?
causes low BMD therefore not first Line in teenagers + young women
What are some SE of depot?
Irregular bleeding, weight gain, high risk osteoporosis
What is UKMEC 4 for depot?
breast Ca
What are the Pros and Cons of depot?
Pros:
-Long lasting
-Good where COCP is CI
-Won’t forget to take it
Cons:
-Weight gain
-mood change
-low BMD therefore bad In older Px (>50)
-Delayed fertility return (<12 months)
What does the implant contain?
What is the implant medication and what mg, ages its taken and how often is it changed?
Nexplanon
Progesterone only
68mg Etonogestrel (18-40 y/o)
every 3 years
what is the mechanism of the implant?
Small flexible rod placed in upper arm beneath skin - inhibits ovulation and thickens cervical mucosa and makes endometrium less susceptible to implantation
What is UKMEC 4 for the implant?
Breast ca + pregnancy
if the implant is inserted day 1-8, is protection needed and when is protection needed?
Day 1-8 = immediate protection
otherwise, 7 day additional protection
When is the implant insertable straight away?
as soon as post partum
What are the pros and cons of the implant?
Pros:
-Long lasting
-effective
-breast feeding friendly
Cons:
-Mood changes
-Spotting
What is the IUS?
How often is it changed?
Effective after how long?
-Minera coil
-every 5 years
-every 4 years if on oestrogen only HRT
-Effective after 7 days
Mechanism of IUS?
Inhibiting endometrial proliferation = cervical mucus thickening = difficult for sperm to reach egg
what is UKMEC 4 for IUS?
PID, Endometrial Ca, Unexplained uterine bleeding, breast Ca, pregnancy
Pros and cons of the IUS?
Pros:
-Long lasting
-effective
-breast feeding friendly
-Good Tx for menorrhagia
-can be used as HRT for 4 years
Cons:
-spotting
-can move
-ectopic preg risk
What is an IUD made of?
How long does it work for?
Copper coil
5-10 years
What is the mechanism of the copper coil?
copper = spermicidal
targets sperm Golgi apparatus, decreases sperm motility and survival
What is UKMEC 4 for IUD?
PID, endometrial Ca, unexplained uterine bleed, Wilsons, pregnancy
How fast does IUD provide protection?
Immediate protection
What are the pros and cons of IUD?
Pros:
-Long lasting
-Very effective (good for emergencies)
-good in breast ca
Cons:
-Menorrhagia
-Can move
-ectopic preg risk
Contraception is not required for how long after birth?
first 21 days (3 weeks) after birth
Contraception is needed for how long in 50+y and <50y?
12+ months since last period for 50+y
24+ months last period for <50
