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GUM > Contraception > Flashcards

Contraception Flashcards

1
Q

Copper IUD stats and mechanism

A

99.5% effective
Copper is toxic to sperm
Prevents fertilisation and implantation
Lasts 5-10yrs

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2
Q

Mirena coil IUS stats and mechanism

A
  • Over 99.5% effective
  • Levonorgestrel
  • Thins endometrium to prevent implantation
  • Thickens cervical mucus to prevent fertilisation
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3
Q

SE of Mirena coil

A
  • Irregular, prolonged or frequent bleeding in first 4-6 months
  • Amenorrhoea or oligomenorrhoea
  • Breast tenderness, mood swings, bloating

Ectopic pregnancy is a risk if failure, but overall risk is less than in no contraception
Perforation 2/1000 fittings
Expulsion 1/20 (usually first 3 months)
Infection risk (1st 20 days)

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4
Q

Contraindications to IUD/IUSs

A
  • Can’t fit until 4 weeks post natal
  • Pelvic infection
  • Suspicious unexplained vaginal bleeding
  • Gestational trophoblastic disease with raised hCG levels
  • Cervical cancer
  • Hormonal IUS: breast cancer, endometrial cancer, liver cancer
  • Uterine cavity abnormalities
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5
Q

When can in IUD and IUS be fitted?

A

IUS in days 1-7 of cycle -> Other times if no risk of pregnancy
IUD anytime if no risk of pregnancy, can be used as emergency contraception up to 5 days after unprotected sexual intercourse.

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6
Q

Stats of injectable progestogens

A

• Over 99.5% effective (only 94% effective in typical use)
• Initially days 1-5 of cycle
• At any other time if no risk of pregnancy
Depo Provera (deep IM every 12 weeks)

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7
Q

SE of Depo Provera

A
  • Irregular, prolonged or frequent bleeding (esp in 1st 6-9 months)
  • Amenorrhoea
  • Systemic SE: breast tenderness, mood swings, bloating
  • May take up to a year to become fertile again after stopping
  • Small loss of bone mineral density during treatment
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8
Q

Contraindications of depo-provera

A
  • Multiple cardiovascular risk factors
  • Hypertension with vascular disease
  • Ischaemic heart disease
  • Stroke
  • Breast cancer
  • Liver tumours
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9
Q

Implant stats and mechanism

A
  • Over 99.9% effective
  • Subdermally in arm
  • Prevents ovulation
  • Lasts 3 years
  • Fitted in days 1-5 of cycle or any time if no risk of pregnancy
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10
Q

SE of implant

A

Irregular, frequent bleeding
Amenorrhoea
Breast tenderness, mood swings, bloating
Scarring, bruising, skin infection after fitting or removal

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11
Q

Contraindications of implant

A
  • Ischaemic heart disease
  • Stroke
  • Breast cancer
  • Liver tumours
  • Suspicious unexplained vaginal bleeding
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12
Q

Types of emergency contraception

A
  • Copper IUD
  • Levonelle (levonorgestrel)
  • Ulipristal acetate (Ella One)
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13
Q

Choice of emergency contraception depends on..?

A 
Dates of UPSI
Cannot use EllaOne if taking drugs that induce liver enzymes. 
Last menstrual period and cycle length
Already pregnant?
Need for ongoing contraception?
Individual choice
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14
Q

When can IUD be fitted as an emergency contraception?

A

Can be fitted within 5 days of expected ovulation or within 5 days of unprotected sexual intercourse
Ovulation is 2 weeks before period
-> only works if regular periods!
Give prophylactic Abx if at risk due to UPSI

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15
Q

When can levonelle be used?

A
  • Efficacy demonstrated up to 96 hours but only licenced for 72 hrs
  • Can be used more than once in a cycle
  • Double the dose if taking liver enzyme inducing drugs
  • Repeat if vomiting within 2 hrs
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16
Q

How does levonelle work?

A

High dose progesterone

Primarily inhibits ovulation for 5-7 days

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17
Q

How does EllaOne work?

A

Selective progesterone receptor modulator
Anti glucocorticoid action
Inhibits/delays ovulation and suppresses growth of follicles

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18
Q

When can EllaOne be used?

When can’t it be used?

A

Licensed for 120 hours
Can repeat in a cycle
Repeat dose if vomiting within 3 hrs
Can’t use if progesterone is already in your system
Cannot use with liver enzyme inducing drugs and increased gastric pH drugs
Avoid breastfeeding for 1 week after using EllaOne
Don’t use with oral steroids (eg severe asthma)

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19
Q

If someone finishes the COCP and then has UPSI, what can be done?

A

After stopping COCP, women may ovulate day 8. Can use copper IUD up to day 13.

20
Q 
Case 1
•	21 yr , request EC
•	Not on any contraception
•	Last UPSI 4 days back, multiple UPSI since LMP
•	LMP - 22 days back, regular cycles, 32 day cycle 
•	 Past contraception - condoms
•	Medically fit, Long term relationship 
Which??
A
  • IUD: yes up to day 23 in a 32 day cycle
  • Levonelle: yes (unlicensed)
  • EllaOne: yes
21
Q 
Case 2
•	20 year old Liz is taking Microgynon
•	Missed her D1-5 pills from new pack
•	Had multiple UPSIs since taking her last pill 12 days ago 
•	Last UPSI 12 hours ago
A
  • IUD: yes up to 13 days after stopping COC pill (can ovulate soon after stopped)
  • Can’t take EllaOne due to hormonal contraception
22
Q

Case 3:

30 year old SL, using Carbamazepine for epilepsy and requesting EC for UPSI on day 12 of her regular 28 day cycle.

A
  • IUD: yes, up to day 19
  • Levonelle: 3mg double dose due to Carbamazepine inducing liver enzymes
  • EllaOne: no due to liver enzyme drug
23
Q

COCP mechanism

A
  • Oestrogen and progesterone
  • Prevents ovulation, thickens cervical mucus and thins endometrium
  • 21 days, 7 day break
  • Some have 7 placebo pills
24
Q

Forms of combined hormonal contraception

A

COCP
Transdermal patch
Vaginal ring

25
Q

Risks of combined hormonal contraception?

A
  • Hypertension
  • VTE risk (DVT, PE)
  • Arterial disease (MI, stroke)
  • Drug interactions
  • Breast cancer and cervical cancer with prolonged use
26
Q

Contraindications to combined hormonal contraception?

A
  • Smoking and age over 35
  • Ex-smoker <1yr and aged over 35
  • Obesity (BMI>35)
  • Postpartum less than 6 weeks
  • Hypertension
  • Immobility unrelated to surgery- increased VTE risk
  • Family history of VTE (1st degree relative under 45yrs)
  • Migraine with aura
  • Breast cancer/risk
  • Diabetes with vascular disease
  • Stroke
27
Q

SE of oestrogens

A
  • Nausea
  • Headaches
  • Breast tenderness
  • Altered discharge
  • Loss of libido
  • Fibroids
  • Weight gain
28
Q

SE of progestogens

A
  • Acne
  • Low mood
  • Loss libido
  • Breast tenderness
  • Weight gain
  • Hirsutism
  • (less likely in 3rd and 4th generation)
29
Q

Benefits of COCP/CHC

A
  • Cycle control and amenorrhoea for lifestyle
  • Acne and hirsutism
  • PMS
  • Improves bone mineral density
  • Reduced rates of bowel cancer, ovary, blood loss, anaemia, ectopics
30
Q

COCP liver enzyme effects

A

Reduced efficacy in liver enzyme inducing medications (antiepileptics, HIV)
Lamotrigine levels are reduced with CHC, drug toxicity in pill free interval

31
Q

When should COCP be started?

including post partum and breastfeeding

A

Start days 1-5 or any time if not pregnant, condoms for 7 days
Start day 21 post partum if not breastfeeding and no VTE risk
Start after 6 weeks if breastfeeding

32
Q

What counts as a missed pill with COCP?

What should you do?

A
  • A missed pill is 24hrs late
  • If you miss 1 pill, continue taking. If miss 2 pills take most recent pill and use condoms for 7 days
  • Missed pill in week 3, omit the pill free interval
  • Missed pill in week 1, consider need for emergency contraception if UPSI in interval/1st week of pill
33
Q

Failure rate of female sterilisation?

Pros and cons?

A 
1/200 (0.5%)
Permanent
Periods unaffected
Surgery risks
Mirena coil just as good
34
Q

Failure rate of male sterilisation?

A

1/2000

35
Q

What happens after male sterilisation?

A

Must use contraception until semen test shows no sperm are left (8 weeks)
Testicle pain?

36
Q

What are female and male sterilisation called?

A

Tubal occlusion

Vasectomy

37
Q

What are condoms made from?

A

Latex or polyurethane

38
Q

Condom effectiveness

A

2% failure in perfect use

18% failure in typical use

39
Q

What are fertility awareness based methods of contraception?

A

Calendar-based methods: These involve keeping track of your menstrual cycle to estimate your fertile window. They include the calendar or rhythm method and the Standard Days Method. ONLY IF REGULAR CYCLE

Symptom-based methods: With these methods, you observe and track one or more physical signs associated with fertility, including changes in your basal body temperature (BBT) and cervical mucus consistency.

40
Q

Effectiveness of fertility awareness methods?

A

Perfect use 95-99% effective

Typical use 76% effective

41
Q

If no contraception is used, what is the % chance of an unintended pregnancy in 1st year?

A

85%

42
Q

Effectiveness of COCP & POP

A

99.7% perfect use

91% typical use

43
Q

How effective is a diaphragm?

A

92-96% effective if used with spermicide

44
Q

How is a diaphragm used?

A

Inserted into vagina to cover cervix before you have sex
Needs to be left in for 6 hrs after sex
Need more spermicide if having sex again

45
Q

Cons of diaphragm

A 
Some people are sensitive to spermicide
Can take time to learn to use correctly
Need correct size
Need a different size after baby/miscarriage/abortion
Needs to be left in for 6hrs after sex
46
Q

What is persona?

A

Small handheld computer with urine dipstick
Measures hormonal changes
Predicts fertile and infertile periods of menstrual cycle
94% effective if used correctly

47
Q

What contraception can cause hirsutism?

A

Any progesterone unopposed by oestrogen

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