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Y3 GP > Contraception > Flashcards

Contraception Flashcards

1
Q

Methods of contraception available in UK

A

Combined hormonal contraception – COCP, combined transdermal patch & combined vaginal ring
Progestogen only contraception – POP, progestogen only implant and progestogen only injectable
Intrauterine contraception – copper intrauterine device (IUD) and levonorgestrel intrauterine system (IUS)
Barrier methods – male condom, female condom, diaphragm or cap
Sterilization methods – vasectomy and tubal occlusion
Natural family planning methods

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2
Q

Barrier methods

A

Male condoms, female condoms, diaphragms and caps
- Condoms: provide a barrier to the ejaculate, pre-ejaculate secretions and cervicovaginal secretions (reduces the risk of STIs)
- Diaphragms and caps: fit into the vagina to cover the cervix, must be used in conjunction with a spermicide

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3
Q

Combined hormonal contraceptives

A

Oral contraceptives, transdermal patch, vaginal ring
Act to inhibit ovulation – reduce the production of LH and FSH
Oestrogen – causes the endometrium to proliferate and grow
Progestogen – prevent hyperplasia of the endometrium by opposing the proliferative effects of oestrogen

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4
Q

COCP mechanism of action

A

Preventing ovulation
Progesterone thickens the cervical mucus
Progesterone inhibits the proliferation of the endometrium

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5
Q

Two types of COCP

A

Monophasic – same amount of hormone in each pill
Multiphasic – varying amounts of hormone to match the normal cyclical hormonal changes more closely

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6
Q

First line COCP

A

Recommend using a pill with levonorgestrel or norethisterone first line
Lower risk of VTE

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7
Q

Premenstrual syndrome first line

A

COCPs containing drospirenone (Yasmin) – first-line for premenstrual syndrome
Anti-mineralocorticoid and anti-androgen activity & may help with symptoms of bloating, water retention and mood changes
Continuous use may be more effective for premenstrual syndrome

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8
Q

Acne and hirsutism contraceptive treatment

A

COCPs containing cyproterone acetate (dianette) – can be considered
Has anti-androgen effects, however greater risk of VTE
Therefore, usually stopped three months after acne is controlled

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9
Q

COCP regimes

A

Equally safe and effective
21 days and 7 days off
63 days on and 7 days off
Continuous use without a pill-free period

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10
Q

COCP side effects and risks

A

Unscheduled bleeding is common in first three months
Breast pain and tenderness
Mood changes and depression
Headaches
HTN
VTE
Small increased risk of breast and cervical cancer
Small increased risk of MI and stroke

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11
Q

COCP benefits

A

Rapid return of fertility after stopping
Improvement in premenstrual symptoms, menorrhagia and dysmenorrhoea
Reduced risk of endometrial, ovarian and colon cancer
Reduced risk of benign ovarian cysts

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12
Q

COCP contraindications

A

Uncontrolled HTN
Migraine with aura
History of VTE
Aged > 35 and smoking > 15 cigarettes per day
Major surgery with prolonged immobility
Vascular disease/stroke
Ischaemic heart disease, cardiomyopathy or AF
Liver cirrhosis and liver tumours
SLE and antiphospholipid syndrome
(BMI>35 risks outweigh the benefits)

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13
Q

COCP starting the pill

A

Start on first day of cycle
Starting after day 5 of menstrual cycle requires extra contraception for the first 7 days
When switching from POP, can switch at any time but 7 days of extra contraception

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14
Q

COCP missed pill rules

A

Missing one pill (<72 hours since last pill was taken):
- Take missed pill as soon as possible
- No extra protection is required provided other pills before and after are taken correctly
Missing more than one pill (> 72 hours since last pill):
- Take the most recent missed pill ASAP
- Additional contraception needed until taken the pill regularly for 7 days straight)
- If day 1-7 of packet = need emergency contraception
- If day 8-14 of packet = no emergency contraception
- If day 15-21 of packet = no emergency contraception, skip pill-free period

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15
Q

COCP other considerations

A

Vomiting, diarrhoea and certain medications (eg. rifampicin) can all reduce effectiveness
Day of D/V – classified as a missed pill day
Stop COCP 4 weeks before a major operation – reduce the risk of thrombosis

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16
Q

POP

A

Only contains progesterone
Taken continuously, unlike the cyclical combined pills
Contraindicated in active breast cancer

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17
Q

POP types

A

1) Traditional progestogen-only pill – cannot be delayed by more than 3 hours
2) Desogestrel-only pill – can be taken up to 12 hours late

18
Q

POP mechanism of action

A

Traditional – thickening the cervical mucus, altering the endometrium & making it less accepting of implantation, reducing ciliary action in the fallopian tubes
Desogestrel – inhibiting ovulation, thickening the cervical mucus, altering the endometrium, reducing ciliary action in the fallopian tubes

19
Q

Starting the POP

A

Starting the POP on day 1-5 of menstrual cycle = women is protected immediately
Can be started at other times (pregnancy excluded) = additional contraception for 48 hours

20
Q

POP side effects and risks

A

Unscheduled bleeding – amenorrhoea or irregular/prolonged/troublesome bleeding
Breast tenderness
Headaches
Acne
Increased risk of – ovarian cysts, small risk of ectopic pregnancy, minimal increased risk of breast cancer

21
Q

POP missed pills rules

A

Take a pill as soon as possible, continue with the next pill at the usual time and use extra contraception for the next 48 hours of regular use
Emergency contraception is required if they have had sex since missing the pill
Episodes of D/V – managed as missed pills & extra contraception is required until 48 hours after the D&V settle

22
Q

Progestogen-only injection

A

Given at 12 to 13 week intervals as an IM or subcut injection of medroxyprogesterone acetate
Can take 12 months for fertility to return after stopping injections

23
Q

Progestogen-only injection contraindications

A

Active breast cancer
Ischaemic heart disease and stroke
Unexplained vaginal bleeding
Severe liver cirrhosis
Liver cancer
Can cause osteoporosis

24
Q

Progestogen-only injection mechanism of action

A

Inhibit ovulation – inhibits FSH secretion by the pituitary gland, preventing the development of follicles in the ovaries
Thickening the cervical mucus
Altering the endometrium and making it less accepting of implantation

25
Q

Progestogen-only injection side effects and risks

A

Changes to the bleeding schedule
Weight gain, osteoporosis = specific to progestogen injection
Acne
Reduced libido
Mood changes
Headaches
Flushes
Hair loss
Skin reactions at injection sites

26
Q

Progestogen-only implant

A

Small flexible plastic rod – placed in the upper arm
Slowly releases progestogen into the systemic circulation
Lasts for three years and then needs replacing
Contraindicated in active breast cancer

27
Q

Progestogen-only implant mechanism

A

Inhibiting ovulation
Thickening cervical mucus
Altering the endometrium & making It less accepting of implantation

28
Q

Progestogen-only implant benefits

A

Effective and reliable contraception
Can improve dysmenorrhea, can make periods lighter/stop all together
No need to remember to take pills
Doesn’t cause weight gain or effect on bone mineral density
No increase in thrombosis or restrictions for use in obese patients

29
Q

Progestogen-only implant negatives

A

Minor op
Lead to worsening of acne
No protection against STIs
Can cause problematic bleeding
Can be bent or fractured
Can become impalpable or deeply implanted -> investigations & additional management

30
Q

Coils types

A

Copper coil (IUD) – contains copper and creates a hostile environment for pregnancy
Levonorgestrel intrauterine system (IUS) – contains progestogen that is slowly released into the uterus

31
Q

Coil contraindications

A

PID or infection
Immunosuppression
Pregnancy
Unexplained bleeding
Pelvic cancer
Uterine cavity distortion

32
Q

Copper coil

A

Long-acting reversible contraception for 5-10 years after insertion
Can be used as emergency contraception, inserted up to 5 days after an episode of unprotected intercourse
Notably contraindicated in Wilson’s disease

33
Q

Copper coil mechanism of action

A

Copper is toxic to ovum and sperm
Alters the endometrium and makes it less accepting of implantation

34
Q

Copper coil benefits

A

Reliable
Can be inserted at any time of cycle and effective immediately
No hormones
May reduce the risk of endometrial and cervical cancer

35
Q

Copper coil drawbacks

A

Procedure is required to insert and remove the coil
Can cause heavy or intermenstrual bleeding
Pelvic pain
No protection against STIs
Increased risk of ectopic pregnancies
Can occasionally fall out

36
Q

IUS mechanism of action

A

Thickening cervical mucus
Altering the endometrium and making it less accepting of implantation
Inhibiting ovulation in a small number of women

37
Q

IUS benefits

A

Can make periods lighter/stop altogether
Improve dysmenorrhea/pelvic pain related to endometriosis

38
Q

IUS drawbacks

A

Procedure required to insert and remove the coil
Cause spotting/irregular bleeding
Experience pelvic pain
No protection against STIs
Increased risk of ectopic pregnancy

39
Q

Emergency contraception options

A

Levonorgestrel – should be taken within 72 hours of UPSI
Ulipristal – should be taken within 120 hours of UPSI
Copper coil – can be inserted within 5 days of UPSI (most effective)

40
Q

Levonorgestrel side effects

A

N&V are common – if vomiting occurs within 3 hours of taking the pill, the dose should be repeated
Other SE: spotting, diarrhoea, breast tenderness, dizziness, depressed mood

41
Q

Ulipristal

A

Ulipristal acetate is a selective progesterone receptor modulator (SERM) – works by delayed ovulation
Wait 5 days before starting the COCP/POP after taking ulipristal
N&V are common – if vomiting occurs within 3 hours of taking the pill, the dose should be repeated
Restrictions: breastfeeding should be avoided for 1 weeks, should be avoided in patients with severe asthma

Y3 GP (5 decks)

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