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GP > Sexual Health - Coils > Flashcards

Sexual Health - Coils Flashcards

1
Q

What are the two types of IUD?

A

Copper
Levonorgestrel IUS

Both more than 99% effective

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2
Q

How long does it take for fertility to return after removal of coils?

A

Immediate return

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3
Q

Why is the Mirena coil called the IUS?

A

Intra-uterine system

Contains hormones which make it a system

Copper doesn’t so just a device

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4
Q

What are the contraindications of coil use?

A

PID
Immunosuppression
Pregnancy
Unexplained bleeding
Pelvic cancer
Fibroids

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5
Q

Who is screened for chlamydia and gonorrhoea before coil insertion?

A

Women at increased risk
e.g. under 25 years old

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6
Q

What is required before coil insertion?

A

Bimanual to check position and size of the uterus

Speculum inserted and device then used to fit coil

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7
Q

What should women be made aware of after insertion?

A

May be temporary crampy period type pain

NSAID use

Need to be seen after 3-6 weeks to check threads, should be taught to feel to ensure coil is in place

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8
Q

What are the risks of coil insertion?

A

Bleeding
Insertional pain
Vasovagal reactions
Uterine perforation (1/1k higher in breastfeeding women)
PID (especially in first 20 days)
Expulsion rate highest in first 3 months

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9
Q

What advice is given before removal?

A

Women need to abstain from sex or use condoms for 7 days

Pregnancy risk

Strings located and slowly pulled to remove device

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10
Q

What needs to be excluded when threads are not seen or palpated?

A

Expulsion
Pregnancy
Uterine perforation

Extra contraception must be used until coil located

Pelvic USS first line
Abdominal and pelvic x-ray
Hysteroscopy or laparoscopic surgery needed depending on coil location

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11
Q

How long does the copper coil last?

A

Long-acting reversible contraception

5-10 years

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12
Q

What is the period that the copper coil can be used as emergency contraception for?

A

5 days

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13
Q

When is the copper coil contraindicated?

A

Wilson’s disease

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14
Q

How does the IUD work?

A

Copper is toxic to the ovum and sperm

Alters endometrium and less receptive

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15
Q

What are the benefits of the IUD?

A

Reliable
Inserted at any time in cycle and effective
No hormones, so safe for women with VTE risk or hormonal cancers
Reduces risk of endometrial and cervical cancer

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16
Q

What are the drawbacks of the copper IUD?

A

Procedure required
Can cause heavy or intermenstrual bleeding
Some women get pelvic pain
No STI protection
Increased risk of ectopic pregnancy
IUDs can fall out (5%)

17
Q

What is the Mirena coil used for?

A

Contraception
Menorrhagia
Endometrial protection for women on HRT

18
Q

How long does the Mirena coil last?

A

5 years

19
Q

What IUS can be given for a shorter period of time than the Mirena coil?

A

Jaydess

3 years

20
Q

How does the IUS work?

A

Releases levonorgestrel (progestogen)

  • Thickens cervical mucus
  • Reduces endometrium receptiveness
  • Inhibits ovulation in small number of women
21
Q

When can the LNG-IUS be inserted?

A

Up to day 7 with no additional contraceptive need

After day 7, need to exclude pregnancy and used additional contraception for next 7 days

22
Q

What are the benefits of the IUS?

A

Makes periods lighter or stop
Improves dysmenorrhoea
No effect on bone mineral density
No increase in thrombosis risk
No restrictions for use in obese patients
Can be used for HRT and menorrhagia

23
Q

What are the drawbacks of the IUS?

A

Procedure
Can cause spotting or irregular bleeding
Some women get pelvic pain
No STI protection
Increased ectopic pregnancy risk
Increased ovarian cysts
Can be systemic absorption, acne, headaches or breast tenderness
Expulsion (5%)

24
Q

What can be used for problematic bleeding in the LNG-IUS?

A

COCP for 3 months

25
Q

What are actinomyces-like organisms?

A

Often discovered incidentally during smears in women with IUD

Do not need treating if asymptomatic

May get pelvic pain or abnormal bleeding
Device removal may be considered

GP (37 decks)

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