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Phase 3a Obstetrics + sexual health > Sexual Health > Flashcards

Sexual Health Flashcards

1
Q

What does the UKMEC stand for?
what are the levels?

A

UK Medical eligibility criteria
1-4

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2
Q

What do the UKMEC levels 1-4 stand for?

A

1 - unrestricted use
2 - benefits outweigh risk
3 - risk outweigh benefits
4 - unacceptable risk - complete CI

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3
Q

what are 4 categories of contraception?

A

Natural/conservative
short acting
longer acting
sterilisation

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4
Q

what are natural/conservative contraceptions and % effective?

A

Family planning
condom use
75-82% effective

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5
Q

What are some shorter acting contraceptions and their theoretic and actual % effectiveness?

A

COCP
POP
HRT Patch
99% theoretic
98% actual

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6
Q

What are some longer acting contraceptions and their actual % effectiveness?
depot effectiveness %?

A

DEPOT provera
Nexoplanon implant
IUS
IUD
99% Actual
Depot = 94%

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7
Q

Sterilisation contraception techniques?
% effectiveness?

A

vasectomy
tubal ligation

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8
Q

is a vasectomy reversible or not?
why is not done by NHS?

A

reversible possible but not NHS done
High complication risk:
Unsuccessful
Bladder Sx
Malignancy
Infection

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9
Q

When do all contraceptions become effective and how quickly?

A

day 1-5 of cycle = IMMEDIATE

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10
Q

Which other contraceptions become effective immediately outside the day 1-5 mark?

A

IUD

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11
Q

Which contraceptions become effective after a few days and how many exactly?

A

POP
After 2 days

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12
Q

Which contraceptions become effective after 7 days and what extra precautions are taken?

A

COCP, Depot, Implant, IUS
7 days and extra barrier (condom)

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13
Q

When can the COCP be taken postpartum?

A

don’t give COCP til >6 weeks PP

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14
Q

When can the IUS/IUD be taken Postpartum?

A

<48 hours or after 4 weeks PP

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15
Q

what factors fall into UKMEC 3 for COCP?

A

Immobile/wheelchair use
BMI >35
BRCA 1 or 2

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16
Q

what factors fall into UKMEC 4 for COCP?

A

Migraine + aura
past Hx VTE
>35y and >15 cigs/day
liver tumours
aPL or SLE
Breast Ca

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17
Q

Which hormones are used in contraceptions and are they high or low?

A

High oestrogen
High progesterone

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18
Q

How is high oestrogen used for contraception?

A

high oestrogen = with progesterone , suppresses HPG axis therefore no LH surge, no follicular development

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19
Q

How is high progesterone used for contraception?

A

High progesterone = maintains endometrium, thickens cervical mucus, decreased cilia flow

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20
Q

What is the first line for emergency. contraception?
how many hours/days can it be done within?

A

IUD (copper coil)
within 120 hours / 5 days

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21
Q

What is the 2nd line for emergency. contraception and dosage?
how many hours/days can it be done within?

A

EllaOne (Ulipristal acetate) 30mg
<120 hours / 5 days
Decreased effectiveness with time

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22
Q

What is the 3rd line for emergency. contraception and dosage?
how many hours/days can it be done within?

A

Levonorgestrel 1.5mg
<72hrs / 3 days

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23
Q

COCP
What does it contain?
Brand name?
Mechanism?

A

High oestrogen and prog
Microgynon
Prevents ovulation. + thickens cervical mucosa (prog) + inhibits endometrial proliferation - reduces chance of implantation

24
Q

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?

A

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)

25
Q

What are the Benefits/Pros and Cons/Risks of the COCP?

A

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)

26
Q

What medication decreases the efficacy of COCP and why?

A

CYP450 Inducer
Carbamazepine

27
Q

What happens when you stop COCP?

What happens in extended COCP use without pill free period?

A

Stopping COCP = lining of uterus sheds = withdrawal bleed

Extended COCP use without pill free period = breakthrough bleed

28
Q

what is regularly checked for a patient on COCP and why?

A

Check BP as it can cause hypertension

29
Q

POP
What does it contain?
2 Examples of POP and how often they are taken?
Mechanism?

A

High Progesterone

Levonorgestrel (3 hour window)
Desogestrel (12 hour window)

Take at same time everyday without pill free period

Mechanism = thickens cervical mucosa

30
Q

What are the Benefits/Pros and Cons/Risks of the POP?

A

Pros:
- Very effective, good were COCP in CI
- Breastfeeding friendly

Cons:
- small window therefore missed pills
- spotting

31
Q

What is UKMEC 4 in POP?

A

Breast Ca

32
Q

What medication is not good to use with POP and why?

A

CYP450 inducer
Rifampicin
Increases POP Metabolism (Increased preg chance)
Other Abx = fine with POP

33
Q

POP
What to do if you miss a pill?
intercourse since missing pill?

A

Missed = take missed pill
Intercourse after missing pill = emergency contraception

34
Q

What does POP increase the risk of?

A

Depression

35
Q

What is the depot, how is it administered?
How often?

A

Depot provera
12 week IM Injection

36
Q

What medication is the depot?
mechanism?

A

Medroxy progesterone acetate
Inhibits ovulation (+ thickens cervical mucosa + endometrial thinning)

37
Q

What can Depot cause so why is it not first line in which group of people?

A

causes low BMD therefore not first Line in teenagers + young women

38
Q

What are some SE of depot?

A

Irregular bleeding, weight gain, high risk osteoporosis

39
Q

What is UKMEC 4 for depot?

A

breast Ca

40
Q

What are the Pros and Cons of depot?

A

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)

41
Q

What does the implant contain?
What is the implant medication and what mg, ages its taken and how often is it changed?

A

Nexplanon
Progesterone only
68mg Etonogestrel (18-40 y/o)
every 3 years

42
Q

what is the mechanism of the implant?

A

Small flexible rod placed in upper arm beneath skin - inhibits ovulation and thickens cervical mucosa and makes endometrium less susceptible to implantation

43
Q

What is UKMEC 4 for the implant?

A

Breast ca + pregnancy

44
Q

if the implant is inserted day 1-8, is protection needed and when is protection needed?

A

Day 1-8 = immediate protection
otherwise, 7 day additional protection

45
Q

When is the implant insertable straight away?

A

as soon as post partum

46
Q

What are the pros and cons of the implant?

A

Pros:
-Long lasting
-effective
-breast feeding friendly

Cons:
-Mood changes
-Spotting

47
Q

What is the IUS?
How often is it changed?
Effective after how long?

A

-Minera coil
-every 5 years
-every 4 years if on oestrogen only HRT

-Effective after 7 days

48
Q

Mechanism of IUS?

A

Inhibiting endometrial proliferation = cervical mucus thickening = difficult for sperm to reach egg

49
Q

what is UKMEC 4 for IUS?

A

PID, Endometrial Ca, Unexplained uterine bleeding, breast Ca, pregnancy

50
Q

Pros and cons of the IUS?

A

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

51
Q

What is an IUD made of?
How long does it work for?

A

Copper coil
5-10 years

52
Q

What is the mechanism of the copper coil?

A

copper = spermicidal
targets sperm Golgi apparatus, decreases sperm motility and survival

53
Q

What is UKMEC 4 for IUD?

A

PID, endometrial Ca, unexplained uterine bleed, Wilsons, pregnancy

54
Q

How fast does IUD provide protection?

A

Immediate protection

55
Q

What are the pros and cons of IUD?

A

Pros:
-Long lasting
-Very effective (good for emergencies)
-good in breast ca

Cons:
-Menorrhagia
-Can move
-ectopic preg risk

56
Q

Contraception is not required for how long after birth?

A

first 21 days (3 weeks) after birth

57
Q

Contraception is needed for how long in 50+y and <50y?

A

12+ months since last period for 50+y
24+ months last period for <50

Phase 3a Obstetrics + sexual health (15 decks)

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