Contraception and LARC Flashcards

1
Q

Outcomes/ options for an unwanted pregnancy

A
  1. Keep the baby
  2. Terminate the pregnancy
  3. Give up the baby for adoption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Methods and MOA of contraception

A
  1. Prevention of ovulation- hormonal methods (including EC)
    - Suppress LH and FSH
  2. Prevention of fertilisation - mechanical or surgical barrier by direct toxicity
    - condoms
    - diaphragm + spermicide
    - Sterilisation (M & F)
    - IUD
    - hormonal methods (cervical mucous effect)
  3. Prevention of implantation - “hostile” endometrium or direct toxicity
    - IUD (especially copper coil as EC)
    - hormonal methods
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Can spermicides be used alone?

A

No. Only to be used with diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Contraception classifications

A
  1. Hormonal and non-hormonal
  2. Male and Female
  3. Long acting and short acting
  4. Reversible and Permanent
  5. Combined and progesterone only
  6. Based on mechanism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Average age of sexual activity in the UK

A

15-16

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Factors influencing choice of contraceptive method

A
HER PERSONAL PREFERENCE
Age
Mental Capacity
Frequency and type of sex
Relationship status
Pregnancy risk
STI risk
Previous experience with contraceptive method
Future pregnancy plans: short and long term
Child protection or wellbeing concerns
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the major complication/CI of contraceptive pills?

A

Migraines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Non contraceptive benefits of hormonal contraception

A
Period pain
Heavy menstrual bleed
Irregular PV bleed
Ovulation pain
PMS
Cyclical breast tenderness
Ovarian cysts (if ovulation is suppressed)
Endometriosis
Ovarian cancer (if ovulation is suppressed)
Acne or hirsutism (CHC only)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Contraceptive effectiveness: method vs user failure

A

Method failure - problem with the method
User failure - problem with the use
= PERFECT USE VS TYPICAL USE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Reasons for user failure - condom

A
used too late
wrong lube (oil based)
Wrong technique
inconsistent use 
wrong storage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Reasons for user failure - diaphragm

A

used too late
removed too early
wrong technique
inconsistent use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the two types of IUD?

A

Mirena: contains progesterone which thickens the cervical plug and prevents the entry of sperm

Copper: No hormones, prevents sperm from fertilising egg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the lifeline of IUD contraception?

A

Copper: 5-10 years
Mirena: 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Does the coil interfere with regular periods?

A

Mirena: yes
Copper: no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is UK MEC

A

UK Medical Eligibility Criteria

Guidance for contraception

Categorisation of all methods into 4 groups (ABCD)
I. Always useable
II. Broadly usable
III. Counsel/caution
IV. Don't use it

Used for contraception ONLY
Guide not a replacement for clinical judgement
More pro choice compared to BNF and MIMS
Less relevant for therapeutic use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Risks of UKMEC

A

VTE
CVD
Liver problems

17
Q

Hormones and copper coils

A

LARCs
 Long lasting (between 3- 10 years, depending on device)
 Very effective (< 1 % failure rate)
 Invasive
 Quick but often painful insertion
 Average insertion pain: pain scale 3/10 for parous women and 5/10 for nulliparous women
 Mainly prevent fertilisation but also effect to prevent implantation

18
Q

Risk of copper coils

A

Perforation (small risk, 1:1000-1500)
PID (1:200)
Malposition/expulsion (1:20)

19
Q

CI of copper coils

A

Submucosal fibroids

20
Q

Copper IUD

A

Can last up to 10 years (depending on device)
If inserted ≥ 40 years can be kept in till menopause
Non-hormonal
Can be used as emergency (post-coital) contraception

21
Q

SE of copper coil

A

Especially in the first 3 months post insertion:
Heavier periods
More painful and longer periods

22
Q

How to manage SE of copper coil?

A

NSAIDs (ex. Ibuprofen)

Help with pain and bleeding

23
Q

Which method of contraception to recommend to women post breast cancer?

A

Copper coil

24
Q

Which is more effective, IUS (hormone) or IUD?

A

IUS

25
Q

List the 5 brands of IUS and their duration

A

5 YEAR:
Mirena
Levosert
Kyleena

3 YEAR:
Jaydess

26
Q

What is the common SE of IUS

A

Spotting (weeks or months post insertion)

Reduced systemic hormones (hormonal SE rarely a problem)

27
Q

Which is the most effective LARC

A

SDI, Nexplanon

28
Q

Duration of nexplanon

A

3 years

29
Q

What factors increase safety level of SDI

A

Low and stable level of hormones- less hormonal side effects

Progestogen only- safe for most women

30
Q

Main SE for SDI

A

Prolonged bleeding

31
Q

What are the differential diagnoses for prolonged PV bleeding other than SE of SDI?

A

Cervicitis/endometritis - due to STI
Cervical Ca
Cervical polyp
Other gynae pathology