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Finals > O&G: Contraception > Flashcards

O&G: Contraception Flashcards

1
Q

Emergency contraception

what are the 3 options

A
  1. Levonorgestrel
  2. Ulipristal
  3. copper coil
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2
Q

Emergency contraception

when can levonorgestrel be taken

A

within 72 hours of UPSI

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3
Q

Emergency contraception

when can Ulipristal be taken

A

within 120 hours of UPSI

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4
Q

Emergency contraception

when can the copper coil be inserted

A

within 5d of UPSI

or within 5d of the estimated ovulation

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5
Q

Emergency contraception

can levonorgestrel and ulipristal be used more than once in a menstrual cycle

A

yes

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6
Q

Emergency contraception

when is ovulation in a 26 day cycle

A

14d before the end of the cycle so day 12

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7
Q

Emergency contraception

what may insertion of copper coil lead to

A

pelvic inflammatory disease

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8
Q

Emergency contraception

when can copper coil be removed

A

until at least the next period or can be left in as long term contraception

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9
Q

Emergency contraception

what is in levonorgestrel

A

progestogen (it delays or prevents ovulation)

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10
Q

Emergency contraception

what can be started immediately after levonorgestrel

A

COCP or progestogen only pill

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11
Q

Emergency contraception

dose of levonorgestrel if woman >70kg or BMI>26

A

double the dose!

usually 1.5mg so give 3mg

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12
Q

Emergency contraception

woman vomits within 3h of taking levonorgestrel, what should you do

A

dose should be repeated

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13
Q

Emergency contraception

can breastfeeding continue after taking levonorgestrel

A

NICE CKS advise that breastfeeding is avoided for 8 hours

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14
Q

Emergency contraception

what is Ulipristal (EllaOne)

A

a selective progesterone receptor modulator (SERM) that works by delaying ovulation.

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15
Q

Emergency contraception

how long should you wait before started the COCP or progestogen only pill after taking ulipristal

A

5d

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16
Q

Emergency contraception

woman vomits within 3h of taking Ulipristal, what should you do

A

repeat dose

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17
Q

Emergency contraception

can breastfeeding continue with ullipristal

A

avoid for 1w

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18
Q

Emergency contraception

which condition is Ullipristal CI’d in

A

pts with severe asthma

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19
Q

COCP

what does it contain

A

oestrogen and progesterone

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20
Q

COCP

3 ways it prevents pregnancy

A
  1. preventing ovulation (primary mechanism of action)
  2. progesterone thickens cervical mucus
  3. progesterone inhibits proliferation of endometrium, reducing chance of successful implantation
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21
Q

COCP

how does it prevent ovulation

A

Oestrogen and progesterone have a negative feedback effect on the hypothalamus and anterior pituitary, suppressing the release of GnRH, LH and FSH

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22
Q

COCP

what are the 2 types

A
  • monophasic pills

- multiphasic pills

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23
Q

COCP

what are monophasic pills

A

contain the same amount of hormone in each pill

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24
Q

COCP

what are multiphasic pills

A

contain varying amounts of hormone to match the normal cyclical hormonal changes more closely

25
Q

COCP

what is oestrogen aka

A

ethinylestradiol

26
Q

COCP

1st line (lower risk of VTE)

A

pill with levonorgestrel or norethisterone first line (e.g. Microgynon or Leostrin).

27
Q

COCP

1st line for premenstrual syndrome

A

Yasmin and other COCPs containing drospirenone

Drospirenone has anti-mineralocorticoid and anti-androgen activity, and may help with symptoms of bloating, water retention and mood changes

28
Q

COCP

what pill to consider for acne and hirsutism

A

Dianette and other COCPs containing cyproterone acetate (i.e. co-cyprindiol)

Cyproterone acetate has anti-androgen effects

29
Q

COCP

SEs

A
  • Unscheduled bleeding is common in the first 3m
  • Breast pain and tenderness
  • Mood changes and depression
  • Headaches
  • Hypertension
30
Q

COCP

Risks

A
  • VTE
  • small increased risk of breast and cervical cancer
  • small increased risk of MI and stroke
31
Q

COCP

reduces risk of?

A

endometrial, ovarian and colon cancer

benign ovarian cysts

32
Q

COCP

what are the specific RFs that should make you avoid it (UKMEC 4)

A
  • Uncontrolled HTN (particularly ≥160 / ≥100)
  • Migraine with aura (risk of stroke)
  • History of VTE
  • Aged >35 and smoking more than 15 cigarettes/day
  • Major surgery with prolonged immobility
  • Vascular disease or stroke
  • IHD, cardiomyopathy or AF
  • Liver cirrhosis and liver tumours
  • SLE and antiphospholipid syndrome
33
Q

COCP

BMI above 35 is UKMEC 3. Should you take the pill

A

probably not as risks generally outweigh the benefits

34
Q

COCP

if you start on the 1st day of your menstrual period, what contraception is required

A

No additional contraception is required if the pill is started up to day 5 of the menstrual cycle.

35
Q

COCP

if you start after day 5 of the menstrual cycle , what contraception is required

A

extra contraception (i.e. condoms) for the first 7 days of consistent pill use

36
Q

COCP

when switching between COCPs, when do you start the new one

A

immediately start the new pill pack without the pill-free period.

37
Q

COCP

advice when switching from POP

A

can switch at any time but 7 days of extra contraception (i.e. condoms) is required.

38
Q

COCP

why does switching from desogestrel require no additional contraception compared to a traditional POP

A

because desogestrel inhibits ovulation

39
Q

COCP

definition of missing one pill

A

when the pill is >24h late

40
Q

COCP

advice to give if one pill was missed (<72h since last pill was taken)

A
  • Take the missed pill as soon as possible (even if this means taking two pills on the same day)
  • No extra protection is required provided other pills before and after are taken correctly
41
Q

COCP

advice to give if >1 pill missed (>72h since the last pill was taken)

A
  • Take the most recent missed pill as soon as possible (even if this means taking two pills on the same day)
  • Additional contraception (i.e. condoms) is needed until they have taken the pill regularly for 7 days straight
  • consider emergency contraception depending what day of the packet
42
Q

COCP

if >1 pill missed (>72h since the last pill was taken) and on day 1-7 of the packet, do they need emergency contraception

A

yes if they have had UPSI

43
Q

COCP

if >1 pill missed (>72h since the last pill was taken) and on day 8-14 of the packet, do they need emergency contraception

A

no

44
Q

COCP

if >1 pill missed (>72h since the last pill was taken) and on day 15-21 of the packet, do they need emergency contraception

A

no, they should go back-to-back with their next pack of pills and skip the pill-free period.

45
Q

COCP

which medication may reduce the effectiveness of the pill

A

rifampicin

46
Q

COCP

is a day of vomiting or diarrhoea classes as a missed pill

A

yes

47
Q

COCP

how long should you stop the pill before a major operation (lasting >30 minutes) or any operation or procedure that requires the lower limb to be immobilised

A

4 weeks

48
Q

postpartum and wants to start contraception immediately, what can be used?

A

POP

49
Q

what is the only suitable option for a postpartum woman actively breast-feeding

A

POP

50
Q

when can an IUS or IUD be inserted after giving birth

A

within 48 hours of birth, or four weeks postpartum

51
Q

why can’t COCP be given to women <6 weeks postpartum who are breast-feeding

A
  • increased risk of VTE in the post-pregnancy state
  • contamination of breast milk
  • After 6 weeks, it becomes a UK MEC2
52
Q

when can the lactation amenorrhea method for contracteption be used

A
  • <6m postpartum
  • solely breastfeeding
  • has no periods
53
Q

Absolute Contraindications to Contraception (UKMEC 4)

A
  • Known or suspected pregnancy
  • smoker >35y who smokes >15 cigarettes
  • obesity
  • breast feeding <6 weeks post partum
  • Fx of thrombosis before 45y
  • breast cancer or cancer within last few years
  • BRCA genes
54
Q

Disadvantages of a contraceptive outweigh the advantages (UKMEC 3)

A
  • Breast feeding >6weeks post partum
  • Previous arterial or venous clots
  • continued use after heart disease or stroke
  • migraines with aura
  • active disease of liver or gallbladder
55
Q

Advantages of a contraceptive outweigh the disadvantages (UKMEC 2)

A
  • Initiation after current or past history of MI or stroke

- multiple risk factors for arterial cardiovascular disease

56
Q

what is the the only acceptable form of contraception in women with active breast cancer or PMH of it

A

Copper intra-uterine device (IUD).

57
Q

when should you double emergency contraception dose

A

In women with a BMI >26 or a weight >70kg, the dose of Levonelle must be doubled

the dose of ellaOne should not be changed according to weight

58
Q

when can the Copper intrauterine device (IUD) be used for emergency contraception

A

5d post UPSI or 5d post earliest possible ovulation - whichever is later.

59
Q

how to calculate earliest possible ovulation

A

e.g. if 28 day cycle

(28-14) + 5 = day 17

Finals (47 decks)

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