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Year 3 - GP > SLA 12 - Contraception and Sexual Health > Flashcards

SLA 12 - Contraception and Sexual Health Flashcards

1
Q

What is the mode of action of the contraceptive implant?

A

A small, flexible rod put under the skin of the upper arm releases progesterone.

Under the actions of progesterone, ovulation is prohibited, the cervical mucus becomes thick the endometrial lining thins.

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2
Q

What is the effectiveness of the contraceptive implant?

A

Over 99%

Highly reliable as effectiveness is not dependent upon concordance.

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3
Q

Give the advantages and disadvantages of the contraceptive implant.

A

Advantage: Works for up to three years but can be removed sooner if patient wishes, with natural fertility returning quickly.

Disadvantages: Requires a small procedure to fit and remove it; no STI protection.

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4
Q

What are the indications of the contraceptive implant?

A

Can be used in menorrhagia or dysmenorrhoea, as well as for contraception.

Indicated if a patient cannot use oestrogen-based contraception.

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5
Q

What are the contraindications of the contraceptive implant?

A
  • pregnancy
  • take other medications that may affect the implant
  • unexplained bleeding between periods or after sex
  • have arterial disease or a history of heart disease or stroke
  • have liver disease
  • have breast cancer or have had it in the past
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6
Q

Suggest some medications that can make the implant less effective.

A
  • St John’s Wort OTC
  • medicines for HIV, epilepsy and tuberculosis
  • abx (rifampicin)
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7
Q

What are the side effects of the contraceptive implant?

A
  • headaches
  • nausea
  • breast tenderness
  • mood swings
  • amenorrhoea
  • acne
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8
Q

What is the mode of action of the intrauterine device (IUD)?

A

IUD is placed into the uterus.

IUD releases copper into the uterus, which thickens the cervical mucus. This makes it more difficult for sperm to reach the oocyte, and for the fertilised oocyte to implant.

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9
Q

What is the effectiveness of the IUD?

A

Over 99%

Highly reliable as effectiveness is not dependent upon concordance.

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10
Q

Give the advantages and disadvantages of the IUD.

A

Advantages: Protects against pregnancy for 5 to 10 years; no hormonal side-effects; possible to get pregnant as soon as removed; no evidence that an IUD affects weight or increases risk of cancers.

Disadvantages: Periods may become heavier, longer or more painful; does not protect against STIs; risk of infection

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11
Q

What are the side-effects of the IUD?

A
  • heavier and more painful periods (although improves after a few months)
  • spotting between periods
  • irregular periods
  • heavier or longer periods
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12
Q

What is the mode of action of the intrauterine system (IUS)?

A

IUS is placed into the uterus.

IUS releases progesterone, which thins the endometrium and thickens the cervical mucus.

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13
Q

How effective is the IUS?

A

Over 99%

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14
Q

What are the advantages and disadvantages of the IUS?

A

Advantages: safe; provides long-term contraception; normal fertility returns as soon as the device is removed; periods become lighter, shorter and less painful.

Disadvantages: Procedure required to insert and remove device; does not protect against STIs; internal pelvic examination required prior to insertion.

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15
Q

What are some common side effects of the IUS?

A
  • pain upon insertion
  • acne
  • breast tenderness
  • headache
  • weight gain
  • decreased libido
  • unscheduled bleeding for first 6 months

Note there is no evidence that IUS increases risk of breast cancer, VTE or MI.

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16
Q

What is the mode of action of the contraceptive injection?

A

An injection of progesterone, which prevents ovulation, thickens the cervical mucus and thins the endometrium.

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17
Q

Name and outline the procedure that provides sterilisation in:

a) males

b) females

A

a) Vasectomy - the vas deferens are cut, sealed or blocked to prevent sperm entering the semen.

b) Tubal ligation - the fallopian tubes are cut, sealed or blocked to prevent oocytes entering the uterus.

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18
Q

Give the failure rate of:

a) vasectomy

b) tubal ligation

A

a) 1 in 2000

b) 1 in 200

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19
Q

Outline the advantages and disadvantages of sterilisation.

A

Advantages: A permanent contraceptive method, with no long or short-term serious side effects.

Disadvantages: Should be avoided if any doubt about having children in the future.

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20
Q

What is the mode of action of the combined contraceptive patch?

A

Oestrogen and progesterone is released, which negatively feedback to the HPA axis to reduce production of LH and FSH.

With no surge in LH and FSH to stimulate the ovaries, ovulation does not occur.

Note the oestrogen also causes the endometrium to proliferate and grow, but is opposed by progesterone to prevent hyperplasia.

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21
Q

What advice should be provided on using the combined contraceptive patch?

A
  • only one patch should be worn at a time
  • patches should be applied to clean, dry, lotion-free, hairless skin (e.g. upper outer arm, buttock, lower abdomen)
  • patch is very adherent and can be used in the shower, bath, sauna, hot tub and exercise (incl. swimming)
  • apply a new patch once weekly for 3 consecutive weeks, have a patch-free interval on week 4, then start a new cycle
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22
Q

What advice should be provided if the combined contraceptive patch becomes detached?

A

If there has been detachment for less than 48 hours, put on a new patch as soon as possible and continue with cycle as normal.

23
Q

Does vomiting and diarrhoea affect the contraceptive effect of the combined contraceptive patch?

A

They do not affect the bioavailability of the combined contraceptive patch.

24
Q

How should a woman be managed who becomes pregnant while using the combined contraceptive patch?

A

Advise her to stop the patch immediately.

25
Q

What are the common side effects of the combined contraceptive patch?

A
  • skin irritation at site of application
  • breast discomfort
  • dysmenorrhoea
  • nausea
  • vomiting

Risks include VTE, breast cancer and cervical cancer.

26
Q

What are the contra-indications of the combined contraceptive patch?

A
  • hx of VTE
  • FHx of breast cancer
  • FHx of cervical cancer
27
Q

What is the mode of action of the combined vaginal ring?

A

Releases oestrogen and progesterone, which negatively feedback onto the HPA axis to reduce the production of FSH and LH.

With no FSH and LH surge, ovulation is prohibited.

Oestrogen also thickens the endometrial lining, with progesterone preventing hyperplasia.

28
Q

How should the combined vaginal ring be used?

A
  • insert one ring high into the vagina for three weeks of continuous use per cycle, have a 7 day break, then start a new cycle
  • check the presence of the ring regularly
  • ring can be kept in during tampon use and sexual intercourse
29
Q

Does vomiting and diarrhoea affect the contraceptive efficacy of the combined vaginal ring?

A

No affect on the bioavailability of the combined vaginal ring.

30
Q

What are the advantages and disadvantages of the combined vaginal ring?

A

Advantages: Convenient to use; does not become less effective if vomiting / diarrhoea.

Disadvantages: Foreign body sensation in the vagina; delay in return to normal fertility after stopping treatment (months).

31
Q

What are the common side effects and risks of using the combined vaginal ring?

A

Side effects include vaginal irritation and discharge.

CVR users report less nausea, vomiting, acne, irritability and depression than those taking COCP.

Risk of venous thromboembolism.

32
Q

What is the mode of action of the combined oral contraceptive pill (COCP)?

A

Progesterone and oestrogen negatively feedback onto the HPA, reducing production of FSH and LH.

With no LH surge, ovulation is prohibited.

33
Q

How should vomiting or diarrhoea be managed in women taking COCP?

A

If a woman vomits within 3 hours of taking COCP, advise her to take another pill as soon as possible.

If vomiting or diarrhoea persists for longer than 24 hours, a barrier contraceptive method should be used during the illness period and for 7 days after.

34
Q

Discuss the advantages and disadvantages of COCP.

A

Advantages: menstrual bleeding is usually regular, lighter, and less painful; reduced risk of ovarian and endometrial cancer.

Disadvantages: does not protect against STIs; less effective than long-acting reversible methods.

35
Q

How effective are COCP at preventing pregnancy?

A

If used correctly, 99%

36
Q

What are the most commonly reported side effects to COCP?

A
  • nausea
  • abdominal pain
  • headache
  • breast pain / tenderness
  • menstrual irregularities
37
Q

What are the risks of COCP?

A
  • hypertension
  • increased risk of MI / stroke
  • VTE
  • breast cancer
  • cervical cancer
38
Q

What advise should be given to women taking COCP when:

a) 1 pill is missed

b) 2-7 pills are missed

A

a) take the missed pill as soon as possible

b) take the most recent missed pill as soon as possible; use barrier contraception for several days; consider follow-up pregnancy test.

39
Q

What is the mode of action of the progesterone only pill (POP)?

A

Under the action of progesterone, the cervical mucus thickens to prevent sperm penetration into the upper reproductive tract.

They also suppress ovulation by suppressing mid-cycle peaks of LH.

40
Q

What are the advantages and disadvantages of POP?

A

Advantages: Can be used if COCP is not suitable; no delay in fertility when stopped; alleviate dysmenorrhoea.

Disadvantages: does not protect against STIs.

41
Q

What are some common side effects of the POP?

A
  • prolonged menstrual bleeding
  • breakthrough bleeding
  • breast tenderness
  • libido changes
  • headaches

Note there is no evidence to suggest increased risk of breast cancer or CVD.

42
Q

What are a woman’s options for post-coital (emergency) contraception (3)?

A
  1. IUD
  2. Oral ulipristal acetate
  3. Oral levonorgestrel
43
Q

Outline the mode of action of IUD in emergency contraception (EC).

A

Releases copper which has a toxic effect upon the sperm and ova. If fertilisation does occur, the local endometrial inflammatory reaction prevents implantation.

Can be inserted for EC within 5 days after first unprotected sexual intercourse (UPSI).

44
Q

Outline the mode of action of ulipristal acetate in EC.

A

Suppresses LH surge to inhibit or delay ovulation.

Can be taken for EC within 5 days after UPSI.

45
Q

Outline the mode of action of levonorgestrel in EC.

A

Inhibits ovulation, delaying follicular rupture and causing luteal dysfunction.

Can be taken for EC within 3 days after UPSI (efficacy decreases with time).

46
Q

Outline the treatment options for menorrhagia.

A
  • IUS
  • COCP
  • TXA
47
Q

Outline the mode of action of TXA in menorrhagia.

A

Inhibits the activation of plasminogen from plasmin, preventing fibrinolysis.

48
Q

What forms of contraception should be avoided in a patient who wans to use contraception for a short period before starting a family?

A

Vasectomy / tubal ligation

49
Q

Outline the treatment options for dysmenorrhoea.

A
  • IUS
  • COCP
  • contraceptive implant
  • contraceptive injection
50
Q

What is Gillick competence?

A

Gillick competence outlines whether a child (age <16 years) can consent to their own medical treatment without their parents having to know or giving permission.

If a child does not have the capacity to consent, someone with parental responsibility can do so on their behalf (e.g. parents, legally appointed guardian, local authority designated to care for the child).

51
Q

What are the Fraser guidelines?

A

Outline the scenario in which advice can be given to an under 16 about contraception and sexual health without parental consent.

  1. Is the child mature enough to understand the nature and implications of the treatment proposed?
  2. Is it impossible to persuade the child to tell their parents, or let the doctor tell them?
  3. Are they likely to begin or continue having sexual intercourse with or without contraception?
  4. Are their physical or mental health likely to suffer unless they get the advice or treatment?
  5. Is the advice or treatment in their best interest?
52
Q

Outline when a safeguarding concern would arise if a child is asking about contraception.

A

If a child aged under 13 years asks about contraception, the healthcare professional must escalate concerns of safeguarding as a child under 13 is not able to consent to sexual activity.

53
Q

What forms of contraception might make periods heavier?

A

IUD

54
Q

What forms of contraception should be used with caution/avoided in migraine?

A

Combined hormonal contraceptives (ie. COCP, CVR, CCP).

Year 3 - GP (17 decks)

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