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Primary Care > Women's Health > Flashcards

Women's Health Flashcards

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?

A

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

24
Q

CHC/POP and medication interactions?

A

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

25
Q

Short course <7d antibiotics?

A

Use additional contraception 4wks after stopping it

Omit pill/patch/ring free week

26
Q

For longer course medications with CHC/POP?

A

Alternative method of contraception (rifampicin)
Increase to >50micrograms ethinylestradiol
shorten pill/patch/ring free to 4 days

27
Q

Anticonvulsants that don’t effect the pill?

A

Sodium Valproate

Lamotrigine- seizure frequenct may worsen

28
Q

Ulipristal acetate
Tx fibroids
Emergency Contraception

A

Additionnal contraception for 14days

29
Q

CHC and surgery

A

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
Q

Reasons not to prescribe progestogen only contraception?

A 
Current breast cancer, disease free > 5yrs?
Trophoblastic Disease
Liver Disease 
IHD
stroke/TIA
Migraine w/t aura
SLE
31
Q

Progestogen only pills are useful for women who?

A

Older women
Heavy Smokers
Patients w/t HTN, valvular diseas, DM, migraine
Breastfeeding < 6mnths postpartum, delay until <3wks to avoid heavy bleeding

32
Q

When should you use desogestrel? (progestogen)

A

Compliance problems - 12hr window
Hx ectopic pregnancy, ovarian cysts-stronger ovarian suppressive effect)
weight >70kg

33
Q

Side effects POP?

A 
Higher failure rate
Menstrual Irregularities 
Increased risk of ectopic pregnacy
Small increased risk of breast cancer
progestogen side effects
34
Q

Starting the POP

A
  • 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
Q

Missed pill POP?

A

> 3hrs delayed use additional contraception for 2days

12 hrs with desogestrel

36
Q

Injectable Progestogens failure rate

A

<4/1000 women over 2yrs

37
Q

Advantages of injectable progestogens?

A

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
Q

Disadvantages of injectable progestogens?

A

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
Q

Administration of injectable progestogen?

A

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
Q

Progestogen Implant

A

Radio-opaque rod
Inserted day 1-5 of cycle
If after day 5, check pregnancy status, use contraception for 7days after
Lasts 3yrs

41
Q

Advantages and Disadvantages of the Progestogen Implant

A

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
Q

Intrauterine Contraceptive Device- Copper Coil is useful for?

A

Older parous women
2nd line- young nulliparous women
Emergency Contraception

43
Q

IUCD failure rate?

A

<20/1000 over 5yrs

44
Q

Intrauterine System- Mirena is used for?

A

Contraception
Primary Menorrhagia
Prevention endometrial hyperplasia during oestroogen therapy

45
Q

Contraindications IUCD?

A

Allergy to copper
Heavy/ painful periods
Wilsons disease

46
Q

Contraindication IUCD/IUS?

A

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
Q

Advantages of IUS

A

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
Q

Problems with IUCD

A

Ectopic Pregnancy: 0.02/100- 1/20 if pregnancy occurs

Increased menorrhagia/dysmenorrhoea (tx. w/t NSAIDS or tranexamic acid)

49
Q

Problems with IUS

A

Spotting/Prolonged Bleeding
Mastalgia, mood changes, loss of libido
Ovarian Cysts
Cannot be used for emergency contraception

50
Q

Risks associated with fitting of IUS/IUCD

A

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
Q

Insertion of IUS/IUCD

A

6wk postpartum

52
Q

Removal of IUCD/IUS

A

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
Q

Sterilization- Additional care taken when counselling

A 
<30yrs 
Without children 
Decisions during pregnancy
Decisions in reaction to loss of relationship
Risk of coercion
54
Q

Sterilization

A

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
Q

Natural Methods of Contraception

A

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
Q

Vaginal Diaphragm

A

Spermicides applied > 3 hrs before sex
Left in situ > 6hrs post intercourse

Change Diaphragm: yearly, weight change >4kg, postpartum, pelvic surgery

57
Q

Cervical caps is useful instead of vaginal diaphragm when?

A

poor muscle tone
absent retropubic ledge
recurrent cystitis

Primary Care (9 decks)

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