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MC > Family Planning > Flashcards

Family Planning Flashcards

1
Q 
In developed countries of the Western world, the
most widely used methods in order of preference are
the 
1
2
3
4
5
A

male condom, combined oral contraceptive pill,
intra-uterine device (IUD), female sterilisation and
withdrawal

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2
Q

________ methods are defined as non-permanent
contraception administered less frequently than
once a month

A

LARCLong-acting reversible contraception (LARC).

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3
Q

Examples of LARC method

A

They include implants, IUDs and

injectables

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4
Q

LARC methods are the most effective
reversible contraceptives, with failure rates for typical
use _________

A

virtually the same as for perfect use

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5
Q

Examples of Combined hormonal contraceptives

A

— combined oral contraceptive pill (COC or
‘the pill’)
— vaginal ring (NuvaRing)

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6
Q

Examples of Progestogen-only contraceptives

A 
— etonogestrel implant (Implanon NXT)
— levonorgestrel-releasing IUD (Mirena)
— depot medroxyprogesterone acetate
(DMPA
— progestogen-only pill (POP or ‘mini-pill’)
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7
Q

Post-coital contraception

A

— levonorgestrel emergency contraceptive pill

(ECP

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8
Q

Combined hormonal contraceptives contain an
oestrogen and progestogen, and their main mode of
action is ______

A 
inhibition of hypothalamic and pituitary
function leading to anovulation.
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9
Q

COCs in Australia contain ________, _______, ________

Efficacy is 99.7% with perfect use, 91% with typical use.

A

ethinyloestradiol (EE), oestradiol valerate (EV) or oestradiol (E2) and one of a range of progestogens.

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10
Q

The active oestrogen in the newer E2 and EV pills is structurally identical to the E2 produced by the ovaries. They have a theoretical but unproven benefit in terms of _______

A

venous

thromboembolism (VTE) risk

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11
Q

Use of formulations containing _____ is no longer
recommended because there is no known additional
benefit from their use and they are associated with
an increased risk of VTE.

A

50 mcg EE

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12
Q

Women starting on a 20 mcg EE pill have a higher

chance of discontinuation due to ______

A

breakthrough

bleeding

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13
Q

The early progestogens include_____ and ____

A

levonorgestrel and

norethisterone

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14
Q

Newer progestogens have been developed over recent decades to reduce ____

A

androgenic
side effects and to minimise the effect EE has on
lipids.

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15
Q

Nomogestrol acetate, gestodene, desogestrel
and etonogestrel are less androgenic, while
_______, ______, _______
are anti-androgenic

A

cyproterone acetate, drospirenone and dienogest

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16
Q

Drospirenone is an analogue

of ______ and has a mild diuretic effect

A

spironolactone

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17
Q

Starting a pill

Suitable first choice is a:

A

monophasic pill containing 30 mcg or 35 mcg ethinyloestradiol (EE) with levonorgestrel or norethisterone (e.g. Nordette, Microgynon 30, Monofeme, Levlen ED, Brevinor

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18
Q

What is the quickstart technique

A

If commenced at any time other
than day 1–5 of the menstrual cycle, abstinence/
condoms are required for the first 7 days after the
start

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19
Q

The oestrogen in any CHC may improve acne and hirsuitism via______ and ____

A

increased
sex hormone binding globulin (SHBG) levels and
reduction of free testosterone

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20
Q

CHC is not recommended if:

A

a woman is over 35 years and has multiple cardiovascular risk factors, including obesity, smoking, diabetes and
hypertension

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21
Q

Women taking liver enzyme-inducing drugs.
Alternative contraception is strongly advised. The
only hormonal contraceptives not affected by liver
enzyme-inducing drugs are _____ and ____

A

DMPA and IUDs

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22
Q

Current evidence suggests that most antibiotics do not
interact with combined hormonal contraceptives. The
only exceptions are liver enzyme-inducing _____ and _____

A

rifabutin

and rifampicin.

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23
Q

For women who still request

the use of COC while on meds with liver inducing enzyme properties, an _______may be effective

A

extended or tricycling regime
of a higher dose pill (e.g. containing at least 50 mcg
EE)

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24
Q

A number of significant beneficial effects arising
from the use of COCs have now been documented:

• Reduction in most menstrual cycle disorders,
including ______
• Reduction in the incidence of ______

A

dysmenorrhoea, symptoms of endometriosis and heavy menstrual bleeding

functional ovarian cysts and benign ovarian tumours

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25
Q

A number of significant beneficial effects arising
from the use of COCs have now been documented:

• Reduced incidence of \_\_\_\_\_\_
• Can reduce acne
• Can be useful in managing symptoms of
\_\_\_\_\_\_\_
• Can assist with perimenopausal symptoms
A

ovarian and endometrial cancer

polycystic ovarian syndrome

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26
Q

A number of significant beneficial effects arising
from the use of COCs have now been documented:

  • Can be used to manage ____ and ____
  • Can reduce the risk of______
A

premenstrual syndrome (PMS) and its more severe form (PMDD) in some women

bowel cancer

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27
Q

The following circulatory disorders have been

linked with pill usage

A

• Venous deep vein thrombosis, pulmonary embolism,
rarely: mesenteric, hepatic and kidney thrombosis

• Arterial myocardial infarction, thrombotic
stroke, haemorrhagic stroke, rarely: retinal and
mesenteric thrombosis

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28
Q

T or F

in pill use

The risk of circulatory disease has not been related
to duration of use and there is no increased risk in
perpetual users

A

T

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29
Q

The______ content of the pill is considered

to be the aetiological factor in pill associated VTE

A

oestrogen

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30
Q

The progestogen effect on ______ is not
considered significant in the aetiology of circulatory
disease.

A

lipid metabolism

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31
Q 
Venous thromboembolism (VTE) risk is increased
\_\_\_\_\_ times in users of CHCs compared to non-users.

The risk is highest in the first______of use
and gradually decreases with duration of

A

2–3

4 months

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32
Q

Studies have shown that COCs containing
cyproterone, desogestrel, drospirenone or gestodene
have a higher risk of VTE than COCs containing
______ and ______

A

levonorgestrel or other progestogens

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33
Q

T or F

A

the
absolute risk of VTE in users of any CHC is very
low and much lower than the risk associated with
pregnancy and the postpartum period.

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34
Q

Possible very small increased risk of CA in CHC and COC:

A

— cervix (benefits of use outweigh the risk
with a low- or high-grade squamous intraepithelial
lesion)
— breast

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35
Q

• Protective effect in CA:
1
2
3

A

— endometrial
— epithelial ovarian
— bowel

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36
Q

A common nuisance side effec in COCt is _____

A

breakthrough bleeding in the

first 2 months

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37
Q

What to do if woman vomits after taking pill

A

If a woman vomits
within 2 hours of taking an active pill, she should
take an additional active pil

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38
Q

Running packs of ________
together can result in unpredictable bleeding as
a result of the fluctuating dose of hormones.

A

multiphasic pills

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39
Q

A missed pill is defined as one that is taken____

A

more than 24 hours late (>48 hours since last pill was

taken).

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40
Q

What to do if missed pill

A

Condoms or
abstinence should be used for 7 days (the ‘Seven-day
rule’). This

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41
Q

If the pill is missed with <7 pills left before the

next placebo break, ________

A

skip placebos and continue active

pills.

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42
Q

If <7 active pills were taken before the missed pill,

consider ________

A

emergency contraception if unprotected sex

took place in the past 5 days.

43
Q 
Causes of oral contraceptive failure include 
1
2
3
4
A

errors in administration, decreased absorption, missed pills and use of liver enzyme-inducing drugs

44
Q

The first available contraceptive vaginal ring is
______, a flexible polymer ring with 15 mcg
EE and 120 mcg etonogestrel being released per
24 hours

A

NuvaRing®

45
Q

T or F,

In Nuvaring, Metabolic effects and side effects are
virtually the same as for the COC

A

T

46
Q

How to use the vaginal ring

A

It is immediately
protective when inserted on days 1–5 of the
menstrual cycle. It is then removed after 21 days
with a break of 7 days or can be used ‘back-to-back

47
Q

When is Nuvaring post useful?

A

This method may be useful
for women who prefer the COC but are prone to
missing pills, or women with inflammatory bowel
disease or other malabsorption syndromes

48
Q

How to delay a period

A

• prescribe norethisterone 5 mg bd or tds for 3 days
prior to expected period
• period resumes 2–3 days after stopping tablets

49
Q

These methods are safe in women who are
breastfeeding or have a contraindication to taking
oestrogen

A

Progestogen-only contraception

50
Q

Progestogen-only contraception is

contraindicated in women with ______

A

active breast cancer

within the past 5 years

51
Q

The harms outweigh

the benefits in the following conditions (MEC 3):

A

antiphospholipid antibodies with systemic lupus
erythematosus, unexplained vaginal bleeding,
ischaemic heart disease or stroke, severe cirrhosis
or hepatocellular carcinoma.

52
Q

Use of progestogen-only contraception is not

associated with an increased risk of ______

A

VTE

53
Q

If postcoital contraception is

required in patients on POP, a double dose of the _______

A

levonorgestrel-ECP is

recommended.

54
Q

This is a subdermal contraceptive implant; it is a
3-year system consisting of a single rod containing
the progestogen etonogestrel. It inhibits ovulation
and has an anti-cervical mucus effect

A

Etonogestrel implant (Implanon NXT)

55
Q

Approximately ________ of women request the implant to be removed within 12 months and it is important to provide information about expected bleeding patterns prior to insertion

A

20–25%

56
Q

IUD is made of?

A

They are made of an inert material to which may be added a bioactive substance such as copper (e.g. Multiload
Cu375) or a progestogen (e.g. Mirena).

57
Q

Mechanism of IUD

A

All IUDs prevent pregnancy by inhibiting sperm migration

and ovum transport and preventing implantation

58
Q

The levonorgestrel IUD also causes_____ and ____

A

endometrial
suppression and cervical mucus thickening and may
prevent or delay ovulation

59
Q

Absolute contraindications for IUD

A

active PID, undiagnosed abnormal genital tract bleeding and current or past history of breast cancer for those
considering levonorgestrel IUD (MEC 4).

60
Q

Recommended use time: copper IUD ____years

depending on brand, Mirena____ years

A

5–10

5

61
Q

Women with a copper IUD will have their usual
menstrual periods, usually with an increase in
__________.

Spotting, heavier and prolonged bleeding are common in the __________

A

menstrual loss and dysmenorrhoea

first 3–6 months but usually decrease with time.

62
Q

The levonorgestrel IUD results in a reduction

_______

A

of blood loss

63
Q

______ and _______are the most common
reason for IUD discontinuation. Discontinuation
rates for both IUDs are similar

A

Menstrual bleeding and pain

64
Q

SE of IUD

If pregnancy occurs there is an increased risk of
_______ and ______during the second
trimester. Early removal of the IUD is essential

A

abortion and intra-uterine sepsis

65
Q

Since
the IUD prevents intra-uterine rather than tubal
pregnancies, the proportion of ________
is higher in the case of IUD failure, although the
absolute risk is low compared to the risk for women
using no contraceptio

A

ectopic pregnancy

66
Q

IUD

There is a small increased risk of PID in the first
_______ post-insertion. Subsequent risk of PID
reverts to baseline and is related to the risk of STIs

A

20 days

67
Q

IUD

Spontaneous extrusion occurs in about ______with the
highest risk within the first year.

A

5%

68
Q

IUD

Perforation of the uterus occurs in up to ______

A

2.3 in 1000 insertions.

69
Q

IUD

factors that increase risk of perforation include
1
2
3

A

breastfeeding, first 6 months postpartum and previous caesarean section

70
Q

_________ is the only injectable intramuscular contraceptive available in Australia

A

Depot medroxyprogesterone acetate (DMPA)

71
Q

Although DMPA is technically a LARC,
it is not ________ and is less effective
than implants and IUDs due to the need for repeated
injections.

A

immediately reversible

72
Q

Dose of DMPA: ______

A

150 mg by deep IM injection in first
5 days of the menstrual cycle. The same dose
is given every 12 weeks ± 2 weeks to maintain
contraception

73
Q

SE of DMPA

A

Side effects include a disrupted menstrual cycle
(amenorrhoea rate 50–70% by 12 months), weight
gain (average 2–6%), breast tenderness, mood
changes and a delay in return of fertility (mean
time 8 months).

74
Q

DMPA use

Long-term use is associated with
______

A

accelerated bone loss, but this is not clinically

significant and does not translate into fracture risk.

75
Q

_________ is most commonly prescribed
for breastfeeding women for whom an oestrogen
contraceptive would potentially suppress milk supply

A

The POP (mini-pill)

76
Q

The two common formulations of POP are:
1
2

A
  • levonorgestrel 30 mcg/day

* norethisterone 35 mcg/day

77
Q

POP mechanism

A

The primary mechanism of action is cervical

mucus thickening, preventing sperm penetration

78
Q

The POP is considered
to have a more vulnerable efficacy, and it is important that the woman strictly adheres to taking the pill
___________

A

within a daily 3-hour timeframe for maximum

efficacy.

79
Q

Example of post coital contraception

A

• Levonorgestrel 1.5 mg as a single dose
• 25 levonorgestrel POPs (25 × 30 mcg) as an
initial dose, repeating the same dose 12 hours
later

80
Q

What is the Yupze method for post coital contraceptin

A

Yuzpe method: a large initial dose of COC,
which is repeated 12 hours later, with each dose
containing at least 100 mcg of EE and 500 mcg
of levonorgestrel (example: 4 tablets of either
Microgynon 30 or 5 tablets of Microgynon 20)

81
Q

The levonorgestrel emergency contraceptive
pill (LNG-ECP) is a high dose of progestogen that
acts to prevent or delay ovulation by______

A

interfering

with follicular development

82
Q

The ECP is licensed for use up to
______after unprotected intercourse, but may be
effective for up to_____

A

72 hours

120 hours (5 days).

83
Q

The Yuzpe method
has an efficacy of______ and is reserved only for
when levonorgestrel is unavailable

A

57–74%

84
Q

If used correctly, male
condoms are very effective contraceptives with
an efficacy of _____ with perfect use and____ with
typical use

A

98%

82%

85
Q

Diaphragms are inserted at any convenient

time before intercourse and removed after _______

A

6 hours

have elapsed since the last act of intercourse

86
Q

Basal body temperature method

Coitus should occur only after there has been a rise in
basal body temperature of _________
above the basal body temperature measurement
during the preceding 6 days, until the onset of the
next menstrual period

A

0.2 ° C for 3 days (72 hours)

87
Q

How to do calendar method

A

She then subtracts 21 from the shortest cycle and 10 from the longest cycle to work out fertile and safe days

88
Q

Example

Fertility in 26-30 day cycle
Regular : 28 day cycle

A

(i.e. for a 26 to 30-day cycle: fertile days 5–20; for regular
28-day cycle: fertile days 7–18).

89
Q

This method is based on careful observation of
the nature of the mucus so that ovulation can be
recognised and intercourse confined to when the
vagina is dry

A

Billings or mucus method

90
Q

Fertile mucus is _______

A

wet, clear, stringy,

increased in amount and feels lubricative

91
Q

The peak
mucus day is the last day with this oestrogenised
mucus before the abrupt change to thick tacky
mucus associated with the______

A

secretion of progesterone

92
Q

The infertile phase begins on the____

A

fourth day after

the peak mucus day

93
Q

________reliable as hormonal methods of
contraception if the baby is younger than 6 months, is
exclusively breastfed with no long intervals between
feeds (no more than 4 hours during the day or 6 hours
at night) and the woman remains amenorrhoeic
postpartum.

A

Lactational amenorrhoea method (LAM)

94
Q

Women using non-hormonal contraception (i.e.
barrier, copper IUD, rhythm) can be advised that
contraception is no longer required once they ____________

A

have
been amenorrhoeic for 12 months over the age of
50 years and after two years before the age of 50.

95
Q

Oestrogen-containing contraception and DPMA

injections are not recommended after ______

A

50 years.

96
Q

Women over the age of 50 who are amenorrhoeic
while using progestogen-only contraception are
advised to continue the method for a further
12 months if they have_______

A

two follicle stimulating
hormone levels of 30 IU/L or above taken 6 weeks
apart.

97
Q

_______interruption or occlusion of the
vas deferens, preventing the passage of sperm from
the testes to the penis

A

Vasectomy

98
Q

Vasectomy

It is important to confirm the______

A

absence of spermatozoa in the ejaculate 2–3 months after the operation, before ceasing other contraceptive
methods.

99
Q

For the average man undergoing vasectomy

reversal, pregnancy rates range between _____

A

50 and 70%.

100
Q

______is usually performed by minilaparotomy
or laparoscopy, at which time clips are
applied to each fallopian tube

A

Female sterilisation

101
Q

__________involves the placement of
a flexible titanium micro-insert into each fallopian tube. The insert expands and over time reactive tissue
growth occludes the tubes

A

Hysteroscopic transcervical

occlusive sterilisation

102
Q

Up to _______of Australian women have experienced

an unplanned pregnancy

A

51%

103
Q

Surgical abortions can be performed from

______weeks.

A

6–7

104
Q

Medical abortions are usually performed before 9 weeks using

A

mifepristone, an anti-progesterone, and then the
prostaglandin analogue misoprostol 24–48 hours
later.

MC (90 decks)

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