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Fire Through Finals > Women's Health: Contraception and infertility > Flashcards

Women's Health: Contraception and infertility Flashcards

1
Q

What are the benefits of the COC pill?

A

Lightens and regulates periods

Protective for endometrial and ovarian cancer

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2
Q

What are the side effects of the COC pill?

A

Spotting

Clotting

Breast and cervical cancer risk

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3
Q

How does breast cancer affect prescription of COC pill?

A

BRCA: relatively contraindicated

Hx: Completely contraindicated

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4
Q

What neuro condition is COC pill not recommended in?

A

migraine with aura (MEC 3)

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5
Q

What is the advantage of the POP pill?

A

Can take if oestrogenergic methods are not available

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6
Q

What are the downsides of POP?

A

Irregular bleeding

Acne, headache

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7
Q

Who cannot have the progesterone only pill?

A

Current breast cancer

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8
Q

What is the advantage of injectable contraception (medroxyprogesterone acetate, Depo Provera)

A

Given every 3 months rather than daily

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9
Q

What contraceptive is most associated with weight gain?

A

Injectable

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10
Q

How long does restoration to normal fertlity take when stopping the injectablet?

A

12 months

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11
Q

What are the advantages of the SD implant (etonestergel, nexplanon)

A

Lasts 3 years

Does not contain oestrogen

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12
Q

What are the disadvantages of the implant?

A

Heavy or irregular bleeding

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13
Q

Who can’t have the injectable?

A

Current of past breast cancer

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14
Q

Who cant have the SD implant?

A

Current or past breast cancer

Gynae: unexplained vaginal bleeding

Systemic: IHD, liver cirrhosis/cancer

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15
Q

How do the IUS and coil compare in terms of advantage, disadvantage and contraindications?

A

IUS // IUD

Both long lasting

Both can expulse within 3 months, small infection risk or perforation too

lighter/irregular periods // heavy periods

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16
Q

How quickly will you get contraceptive cover with…

Copper coil

POP/desogestrel (cerazette)

COC pill

SD implant

Injectable

IUS

A

Copper: Immediate any time

POP: immediate <5 days < + 2 days barrier

COC pill, implant, injectable: Immediate < 5 days < + 7 days barrier

IUS: After 7 days

17
Q

If taking the COC pill, what timeframe do you need for switching to…

POP

Desogestrel

A

POP: 7 days barrier

Desogestrel: Immediate

18
Q

How long does it take to gain cover if switching from POP to COCP?

A

Immediate if during packet completion (day 21)

19
Q

What do with COC pill if you missed

1 pill missed

>=2 pills missed

A

1 pill

Take missed regardless of point

>=2 pills

Take missed pill, barrier/abstain for 7 days

Week 1: + emergency contraception if UPSI in wk4/1

Week 2: No emergency needed if 7 days continous pills

Week 3: + continue taking pills through the pill free interval

20
Q

For the POP and desogestrel…

What are the cut off times for each pill

What do if under the time

What do if over the time

A

3 hours for POP, 12 for deso

Under

Continue as normal for both

Over time

Take missed immediately, take next at usual time

Continue with rest of pack

Use condoms for 48 hours while pill taking re-established

21
Q

When is post-partum contraception required and what timescale can you start…

POP

IUS/IUD

A

None needed until day 21

POP: Immediate but need 48hrs barrier if >21 days

IUS/IUD: <48hrs or 4 weeks after birth

Other forms: After day 21 with 7 days barrier

22
Q

Under what conditions is the lactational amenorrheic method effective

A

Fully breast feeding

Amenorrheic

< 6 months post-partum

23
Q

What contraceptive is most associated with breastfeeding benefits?

A

Injectable

24
Q

When can breast feeding recommence if taking the COC pill?

A

After 6 weeks

25
Q

Regarding emergency contraception, how do the following compare in terms of time frame, dosage and follow up?

Levonogestrel

Ulipristal acetate (EllaOne)

Intrauterine device

A

Levonogestrel // UA // IUD

<72hrs // <120 hrs // <5 days of UPSI/ovulation date

1.5mg (3mg if BMI >26, over 70kg) // 30mg // NA

Take hormonal straight after // Start COCP 5 days after if compliant + outside week 1 // Give prophylactic antibiotics

26
Q

Which emergency contraceptive is cautioned in asthmatics and disallows breastfeeding for a week?

A

Ulipristal acetate

27
Q

When can you stop the following contraceptives before and after 50?

IUD

COCP

Depo-provera (injectable)

Implant/POP/IUS

A

Before 50

Stop non-hormal after 2 years amenorrhea

Continue rest

50 and over

Stop non-hormonal after 1 year amenorrhea

Swtich COCP to POP/non-hormonal

Switch depo to non-hormonal then stop after 2 years amenorrhea

Continue others until amenorrhea with either 55yrs or FSH >30

28
Q

What is the beneficial side effect of POP in over 40s?

A

Can preserve bone density and perimenopausal symptoms

29
Q

For trans/non-binary folk what should be done regarding…

Barrier methods

Cervical screening

HPV vaccinations

prEP

A

Condoms and dams should be used

Offered to those with a uterus

vaccinate all sexually active indviduals

prEP for those at risk

30
Q

What should you advise for trans patients wanting contraception regarding hormonal therapy

A

Hormonal replacement NOT contraception

Avoid COC pill in testosterone takers

POP/Injection/Implant thought to be fine

31
Q

For epilepsy patients, what drugs

Cannot provide contraception if using lamotrigene

Increase metabolism of contraceptives

Reduce metabolism of contraceptives

A

COC pill

P450 inducers: Phenytoin, carbamazepine, phenobarbitone (PCP)

P450 inhibitors: Sodium valproate

32
Q

For infertility, what lifestyle recommendations should be made

A

BMI 20-25

smoking, alcohol cessation

Sex every 2-3 days

Folic acid for females

33
Q

What initial investigations should be performed for infertility in

Females

Males

A

LH, FSH on days 2-5

Progesterone on day 7 (repeatedly <16 then refer)

+ Prolactin (inhibits ovulation)

+ TFTs (low increases prolactin)

+ AMH (rule out congenital)

Males

Seme analysis, refer if any low

34
Q

When can UPSI proceed following vasectomy

A

When 8 week semen analysis shows azoospermia

Fire Through Finals (32 decks)

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