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Women's Health Flashcards

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1
Q

Exclusion of Pregnacy before prescribing contraception:

A

Using a reliable method of contaception correctly
Has not had unprotected intercourse since her last period
Is <7d after the start of a normal period, <4wk postpartum, <7d post-termination or miscarriage, fully breastfeeding + ammenorrhoeic and <6mnths postpartum

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2
Q

Emergency Contraception

A

Cu IUCD: <120h after UPSI, >99% effective
Levenorgestrel: <72hr after UPSI, used >1/cycle
Progesterone Receptor Modulator: Ulipristal acetate, <120hr after UPSI, only 1x/cycle

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3
Q

Efficacy of oral emergency contraceptives may be reduced by what medications?

A

anti-epileptics
St. Johns Wort
Consider using IUCD

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4
Q

Low strength preparations COC pill

A

20 microgram ethinylestradiol

Risk factors: circulatory disease, oestrogenic side effects

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5
Q

Phased prepartions COC pill

A

Dose oestrogen/progestogen varies

Bleeding problems- monophasic products

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6
Q

Desogestrel/ gestodene are progestogen type COC pills associated with?

A

Increased clotting risk

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7
Q

Cyproterone acetate is licensed for treatment of?

A

acne, continue use 3-4mnths after symptoms resolve

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8
Q

Contraceptive Patch-20microgram ethinylestradiol + norelgestromin

A

Apply day 1
Change day 8, day 15
Remove 22
Replace after 7 patch free days

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9
Q

Contraceptive Vaginal Ring - 15micrograms/ 24hr ethinyestadiol + etonogestrel

A

Insert Day 1
Remove day 22
7day ring free interval

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10
Q

Reasons not to prescribe CHC

A 
Venous Disease
Arterial Disease
Liver Disease
Cancer
Pregnanacy-Related issues 
Drug interactions 
Others: acute porphyria, acute haemolytic syndrome
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11
Q

Reasons not to prescribe CHC relating to venous disease

A 
Sclerosing treatment for varicose veins or Hx VTE
Risk Factors for VTE: caution if 1. >1 avoid;
Age >35yrs avoid >50
Smoker <1yr 
BMI >30 avoid >35
FHx first degree relative < 45
Immobility 
Hx superficial thrombophlebitis
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12
Q

Reasons not to prescribe CHC relating to arterial disease

A

Avoid valvular/congenital heart disease w/t hx of complications
Hx CVD
Risk Factors for CVD 1-caution, >1 avoid;
Age >35 avoid >50
Smoker avoid >40/day
BMI >30, avoid >35
FHx arterial disease first degree relative <45yrs
DM
HTN >140/90 avoid > 160/95
Migraine without aure, avoid- migraine with aura within 5yrs, severe migraine >72hrs, treated dihydroergotamine

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13
Q

Reasons not to prescribe CHC relating to liver disease?

A 
active viral hepatitis 
liver tumour
severe cirrhosis 
gall bladder disease 
contraceptive-ass cholestasis
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14
Q

Reasons not to prescribe CHC relating to cancer

A

Current breast cancer

No evidence of disease >5yrs, no gene mutation- BRCA

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15
Q

Reasons not to prescribe CHC relating to pregnancy history?

A

Hx pruritis, cholestatic jaundice, chorea, pemphigoid gestationis
Postpartum and breastfeeding

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16
Q

Should also avoid the CHC in what other conditions?

A

Acute porphyria

Haemolytic uraemic synndrome

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17
Q

Effect of CHC on different types of cancer?

A

Breast and Cervical: Small increase in risk, disappears < 10yrs after stopping
Ovarian, Bowel and Endometrial: decreases risk, persists

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18
Q

Reasons to stop CHC immediately?

A 
Sudden severe chest pain 
Sudden breathlessness (haemoptysis)
Unexplained swelling and severe calf pain
Acute abdominal pain
Neuro effects;
severe, prolonged headaches
Sudden dysphagia, partial/complete loss of vision, perceptual disorders
bad fainting attack or unexplained collapse
first unexplained epileptic seizure 
symptoms of stroke
Hepatitis, jaundice, liver enlargement 
BP >160/95
Prolonged immobility
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19
Q

Missed pills

A

1 missed pill- take as soon as possible, continue as normal
>/= 2 missed pills- take most recent as soon as possible, take extra contraceptive precautions- next 7days
if < 7active pills left finish current pack and start next pack without a break or start the 7day break

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20
Q

Oestrogen side-effects

A 
Breast tenderness
nausea 
dizziness
cyclical weight gain
bloating
vaginal discharge without infection
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21
Q

Progestogen side-effects

A 
Mood swingd
Pre menstraul tension
dry vagina
sustained weight gain
decreased libido 
lassitude
acne
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22
Q

Breakthrough Bleeding

A

Normal, does not decrease efficacy
If abdo/pelvic pain, post coital bleeding or > 3mnths;
Check compliance-diarrhoea or vomiting?
Gynae patholgy- STIs, smear upto date?

If persists;
Increase oestrogen content
Persists- change progestogen
Persists- Increase progestogen

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23
Q

Co-pyrindiol is used for?

Study These Flashcards
A

Acne treatment, not licensed contraceptive
Increased risk thromboembolism
4-4 mnths after symptoms have cleared switch

24
Q

CHC/POP and medication interactions?

Study These Flashcards
A

decrease the efficacy of the CHC;
Rifampicin, Griseofulvin, Nelfinavir, Ritonavir
St Johns Wort
Phenytoin, Carbamazepine, Phenobarbital, Primidone, Topirimate, Modafinil

25
Short course <7d antibiotics?
Use additional contraception 4wks after stopping it | Omit pill/patch/ring free week
26
For longer course medications with CHC/POP?
Alternative method of contraception (rifampicin) Increase to >50micrograms ethinylestradiol shorten pill/patch/ring free to 4 days
27
Anticonvulsants that don't effect the pill?
Sodium Valproate | Lamotrigine- seizure frequenct may worsen
28
Ulipristal acetate Tx fibroids Emergency Contraception
Additionnal contraception for 14days
29
CHC and surgery
Stop 4wks before major elective surgery, surgery to legs and prolonged immobilization Start again on the first day of the next period > 2wks following surgery
30
Reasons not to prescribe progestogen only contraception?
``` Current breast cancer, disease free > 5yrs? Trophoblastic Disease Liver Disease IHD stroke/TIA Migraine w/t aura SLE ```
31
Progestogen only pills are useful for women who?
Older women Heavy Smokers Patients w/t HTN, valvular diseas, DM, migraine Breastfeeding < 6mnths postpartum, delay until <3wks to avoid heavy bleeding
32
When should you use desogestrel? (progestogen)
Compliance problems - 12hr window Hx ectopic pregnancy, ovarian cysts-stronger ovarian suppressive effect) weight >70kg
33
Side effects POP?
``` Higher failure rate Menstrual Irregularities Increased risk of ectopic pregnacy Small increased risk of breast cancer progestogen side effects ```
34
Starting the POP
- No previous contraception: day 1-5 of cycle - Changing from COC: No pill-free days - Changing from IUD: >2 days before CIUD removal(7d prior and 2days after if started at time of removal), removal IUS no additional contraception - After Childbirth: >3wk postpartum does not affect lactation
35
Missed pill POP?
>3hrs delayed use additional contraception for 2days | 12 hrs with desogestrel
36
Injectable Progestogens failure rate
<4/1000 women over 2yrs
37
Advantages of injectable progestogens?
Used upto age 50 Decreased risk ectopic pregnancy, ovarian cysts and sickle cell crisis Decreased risk of endometrial cancer May alleviate PMS and menorrhagia
38
Disadvantages of injectable progestogens?
C/I DM with complications or multiple CVD risk factors Decreases bone density- First 2-3yrs of use Delay in return of fertility upto 1 yr Decreased efficacy with liver inducing enzymes
39
Administration of injectable progestogen?
Upto day 5 cycle- IM Injection After day 5: check women is not pregnant, advise additional contraception for 7days Postpartum delay >6wks If not breastfeeding can give <5d afer childbirth but may cause heavy bleeding Repeat every 12 wks If >12wks + 5days; Alternative contraception for 14dyas If sexual intercourse offer emergency contraception
40
Progestogen Implant
Radio-opaque rod Inserted day 1-5 of cycle If after day 5, check pregnancy status, use contraception for 7days after Lasts 3yrs
41
Advantages and Disadvantages of the Progestogen Implant
A: Doesn't decrease bone density Used in women with risk of ectopic pregnancy Fertility returns to normal immediately ``` D: Minor Operation Infection, Scarring Decreased efficady with liver inducing drugs Can cause menstrual disturbances ```
42
Intrauterine Contraceptive Device- Copper Coil is useful for?
Older parous women 2nd line- young nulliparous women Emergency Contraception
43
IUCD failure rate?
<20/1000 over 5yrs
44
Intrauterine System- Mirena is used for?
Contraception Primary Menorrhagia Prevention endometrial hyperplasia during oestroogen therapy
45
Contraindications IUCD?
Allergy to copper Heavy/ painful periods Wilsons disease
46
Contraindication IUCD/IUS?
Pregnancy or <4wks postpartum High risk of STI or PID (don't insert <3mnths after tx) Undiagnosed uterine bleeding Distorted uterine cavity Endometrial, Ovarian or Cervical Cancer or Trophoblastic Disease Caution- anticoagulation
47
Advantages of IUS
Reduced mennorrhagia/dysmennorhagia Reduced risk of PID Reduced risk of ectopic pregnancy compared to IUCD If 45yrs and amennorrhoeic can be left in situ for 7yrs, change after 4yrs if using for endometrial protection + IUCD: Can be used in women who are breastfeeding, obese, migraine, thromboembolism, DM, CVD, taking enzme inducing drugs HIV +ive women, advise condom use
48
Problems with IUCD
Ectopic Pregnancy: 0.02/100- 1/20 if pregnancy occurs | Increased menorrhagia/dysmenorrhoea (tx. w/t NSAIDS or tranexamic acid)
49
Problems with IUS
Spotting/Prolonged Bleeding Mastalgia, mood changes, loss of libido Ovarian Cysts Cannot be used for emergency contraception
50
Risks associated with fitting of IUS/IUCD
Expulsion: 1/20, usually <3mnths after insertion Perforation: <1/1000 PID: Increased risk <21d after insertion Intrauterine Pregnancy: remove <12wks gestation Cervical Shock(IUS): Pallor, Sweating, Bradiacardia- Tip head down, persists- atropine IV Women with Epilepsy: Increased risk of seizure
51
Insertion of IUS/IUCD
6wk postpartum
52
Removal of IUCD/IUS
Pregnancy not desired- hormonal method aqcuired 7d prior to removal Offer emergency contraception if removal ,7d following hormonal contraception Remove 1yr following amenorrhoea >50yrs or after 2 yrs amenorrhoea if <50yrs Difficulty removing device - 5d course of oestrogen
53
Sterilization- Additional care taken when counselling
``` <30yrs Without children Decisions during pregnancy Decisions in reaction to loss of relationship Risk of coercion ```
54
Sterilization
Laporoscopic Tubal Occlusion: Failure rate = 1/200 Vasectomy : Failure rate = 1/2000 2 consecutive semen analysis 2-4 wks apatr >8wks post procedure Increased risk of ectopic pregnancy
55
Natural Methods of Contraception
Urine Testing Temperature: Increase 0.2-0.4 progesterone release Day 3 until next period Mucus Texture:Billing's Method- slippery prior to ovulation. 3 days after it becomes thicker
56
Vaginal Diaphragm
Spermicides applied > 3 hrs before sex Left in situ > 6hrs post intercourse Change Diaphragm: yearly, weight change >4kg, postpartum, pelvic surgery
57
Cervical caps is useful instead of vaginal diaphragm when?
poor muscle tone absent retropubic ledge recurrent cystitis

Primary Care (9 decks)

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