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O&G > Contraception > Flashcards

Contraception Flashcards

1
Q

What is the MOA of COCP?

A

Inhibition of ovulation

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2
Q

What is the MOA of POP (except desogestrel)?

A

Thickens cervical mucous

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3
Q

What is the MOA of desogestrel?

A

Inhibition of ovulation

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4
Q

What is the MOA of the injectable contraceptive (medroxyprogesterone acetate)?

A

Main MOA:
- Inhibits ovulation

Other MOAs:
- thickens cervical mucous

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5
Q

What is the MOA of the implantable contraceptive (Nexplanon)?

A

Main MOA:
- Inhibits ovulation

Other MOAs:
- thickens cervical mucous

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6
Q

What is the MOA of IUD (copper coil)?

A

Decreases sperm motility and survival

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7
Q

What is the MOA of IUS (Mirena coil)?

A

Main MOA:
- Prevents endometrial proliferation

Other MOAs:
- Thickens cervical mucous

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8
Q

What is the MOA of levonorgestrel emergency contraception?

A

Inhibits ovulation

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9
Q

What is the MOA of ulipristal acetate emergency contraception?

A

Inhibits ovulation

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10
Q

What is the MOA of IUD emergency contraception?

A

Main: toxic to sperm and ovum
Other: inhibits implantation

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11
Q

What are the UKMEC 4 contraindications to COCP?

A
  • > 35 years old and smoking >15 cigarettes/day
  • Migraine with aura
  • History of thromboembolic disease or thrombogenic mutation
  • History of stroke or ischaemic heart disease
  • Breastfeeding < 6 weeks post-partum
  • Uncontrolled hypertension
  • Current breast cancer
  • Major surgery with prolonged immobilisation
  • Positive antiphospholipid antibodies (e.g. in SLE)
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12
Q

What are the UKMEC 3 contraindications to COCP?

A
  • > 35 years old and smoking <15 cigarettes/day
  • BMI > 35 kg/m^2*
  • Family history of thromboembolic disease in first degree relatives < 45 years
  • Controlled hypertension
  • Immobility e.g. wheel chair use
  • Carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
  • Current gallbladder disease
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13
Q

What are UKMEC2 contraindications to COCP?

A

Breastfeeding 6 weeks to 6 months post-partum

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14
Q

What are the benefits of the COCP?

A
  • Less strict “missed pill rules” than the progestogen-only pill
  • May make periods more regular, lighter and less painful
  • May reduce the risk of ovarian, endometrial and bowel cancer
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15
Q

What are the limitations of COCP?

A
  • Side effects may include headaches, nausea, breast tenderness and mood swings
  • Vomiting and diarrhoea may affect the effectiveness
  • Certain drugs including anti-epileptic drugs may affect the effectiveness
  • Increases the risk of VTE and stroke
  • Potentially increases the risk of breast cancer while using the COCP
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16
Q

What are the indications for COCP use besides preventing pregnancy?

A
  • Hyperandrogenism (PCO/PCOS)
  • Menorrhagia
  • Dysmenorrhoea
  • Endometriosis
  • Leiomyomas
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17
Q

What is the Pearl Index?

A

A statistical estimate of the number of unintended pregnancies in 100 woman-years of exposure

  • 100 women over 1 year of 1
  • 10 women over 10 years of use
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18
Q

What is the Pearl index score of COCP?

A

9%

  • Out of 100 women using COCP over 1 year period, 9 would have unintended pregnancy
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19
Q

What should a woman do if she has missed 1 COCP in week 1?

A
  • EC not required
  • take the missed pill ASAP
  • continue remaining pill at same time (2 pills in 1 day)
  • no additional precautions
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20
Q

What should a woman do if she has missed 1 COCP in week 2 or 3?

A
  • EC not required
  • take missed pill ASAP
  • continue remaining pill at same time (2 pills in 1 day)
  • no additional precautions
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21
Q

What should a woman do if she has missed 2-7 COCPs in week 1?

A
  • Consider EC if UPSI has taken place during hormone-free interval or week 1
  • take most recent pill ASAP
  • continue the remaining pills at the same time
  • condoms/avoid sex until pill has been taken for 7 consecutive days
  • consider follow-up pregnancy test
22
Q

What should a woman do if she has missed 2-7 COCPs in week 2 or 3?

A
  • EC not required
  • take most recent pill ASAP
  • continue the remaining pills at the same time
  • Omit the hormone-free interval if 2+ pills missed in the 7 days before it was supposed to occur
  • condoms/avoid sex until pill has been taken for 7 consecutive days
23
Q

What should a woman do if she has missed >7 COCPs in any week of pill taking?

A
  • Consider EC if UPSI at any point
  • Manage as new start contraception
  • Consider immediate pregnancy test
  • Quick start new COC packet
  • Condoms/avoid sex until pill has been taken for 7 consecutive days
  • Consider follow-up pregnancy test
24
Q

What are the benefits of the POP?

A
  • Suitable for patients where oestrogen is contraindicated or those who are intolerant to oestrogen
  • Taken without breaks so don’t have to remember to start and stop pills
25
Q

What are the limitations of the POP?

A
  • Protection from pregnancy affected if a pill is forgotten
  • More strict “missed pill rules” than COCP
  • May cause irregular bleeding, amenorrhoea or more frequent bleeding
  • Vomiting and diarrhoea may affect protection
  • Certain drugs including some enzyme-inducers may affect the effectiveness
26
Q

When can initiation of the POP provide immediate protection?

A
  • If started up to and including day 5 of the cycle

- If switching directly from the end of a COC packet

27
Q

If the POP is initiated after day 5 of the cycle, how long does it take to become protected?

A

2 days

28
Q

What is the missed pill advice for the POP?

A

Cerazette (desogestrel):

  • 12h period allowed
  • <12h late: continue as normal
  • > 12h late: take missed pill ASAP, continue with rest of pack, extra precautions for 48h

All other POPs (micronor, noriday):

  • 3h period
  • <3h late: continue as normal
  • > 3h late: take missed pill ASAP, continue with rest of pack, extra precautions for 48h
29
Q

Which abx can affect the effectiveness of the POP?

A

Rifampicin

30
Q

What is the Pearl index of the POP?

A

9%

31
Q

What are the contraindication to injectable contraceptives?

A
  • Current and past breast cancer
32
Q

What are the adverse effects of Depo Provera?

A
  • Irregular bleeding
  • Weight gain
  • Delay in return to fertility (1 year)
  • Potentially increased risk of osteoporosis
33
Q

How often is Depo Provera given?

A

Every 12 weeks

34
Q

What is the Pearl index of Depo Provera?

A

6%

35
Q

What are the UKMEC 4 contraindications to Nexplanon?

A

Current breast cancer

36
Q

What are the UKMEC 3 contraindications to Nexplanon?

A
  • IHD/Stroke
  • Unexplained, suspicious vaginal bleeding
  • Past breast cancer
  • Severe liver cirrhosis
  • Liver cancer
37
Q

What are the adverse effects of Nexplanon?

A
  • Irregular/heavy bleeding
  • Acne
  • Progestogen effects: headache, nausea, breast pain
38
Q

Which drugs can interact with Nexplanon?

A
  • Rifampicin

- AEDs: phenytoin, carbamazepine

39
Q

What is the Pearl index of Nexplanon?

A

0.05% –> most effective method of preventing pregnancy

40
Q

How long can Nexplanon be kept in for?

A

3 years

41
Q

How long does it take for Nexplanon to offer protection from pregnancy?

A

7 days

42
Q

How long does it take for the IUS to offer protection from pregnancy?

A

7 days

43
Q

How long can the IUS be kept in for?

A

5 years - Mirena and Kyleena

3 years - Jaydess

44
Q

What are the adverse effects of the IUS?

A
  • Irregular bleeding and amenorrhoea
  • Acne, headaches, breast tenderness
  • Small risk of uterine perforation (2 per 1000) and uterine infection
  • Expulsion (1 in 20)
  • If pregnancy does occur, more likely to be ectopic
45
Q

How long does it take for the IUD to offer protection from pregnancy?

A

Works immediately

46
Q

How long can the IUD be kept in for?

A

5-10 years depending on how much copper is on the device

47
Q

What are the adverse effects of the IUD?

A
  • Heavier, longer, and more painful periods
  • Small risk of uterine perforation (2 per 1000) and uterine infection
  • Expulsion (1 in 20)
  • If pregnancy does occur, more likely to be ectopic
48
Q

What is the Pearl index of the IUS?

A

0.2%

49
Q

What is the Pearl index of the IUD?

A

0.8%

50
Q

What are the best contraceptive options for women 50+ years old?

A

Implant
POP
IUS
IUD

O&G (17 decks)

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