Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Obstetrics and Gynaecology > Contraception - done > Flashcards

Contraception - done Flashcards

1
Q

What are the key contraceptive methods available?

A

Natural family planning (“rhythm method”)

Barrier methods (i.e. condoms)

Combined contraceptive pills

Progesterone only pills

Coils (i.e. copper coil or Mirena)

Progesterone injection

Progesterone implant

Surgery (i.e. sterilisation or vasectomy)

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

What is the UKMEC (medical eleigibility criteria) for contraception?

A

UKMEC 1: No restriction in use (minimal risk)

UKMEC 2: Benefits generally outweigh the risks

UKMEC 3: Risks generally outweigh the benefits

UKMEC 4: Unacceptable risk (typically this means the method is contraindicated)

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

What contraception should be avoided in the following conditions:

Breast cancer

Cervical / endometrial cancer

Wilsons

A

Breast cancer: avoid hormonal (copper coil / barrier)

Cervical / endometrial cancer: avoid IUS

Wilsons: avoid copper coil

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

When should the COCP be avoided (UKMEC 4)?

A

- Uncontrolled HTN

- Migraines

- History of VTE

- >35 and smoking

- Surgery with prolonged immobilisation

- Stoke

- SLE / antiphospholipid syndrome

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

When can the combined oral contraceptive pill be used up until?

A

50 years (treats perimenopausal symptoms)

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

How long is contraception advised for after last period?

A

2 years in women <50 and 1 year in women >50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Does HRT prevent preganancy?

A

No - added contraception is required

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

When should the depo-injection be stopped?

A

50 to prevent osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When should women who are amenorrhoeic when taking progesterone-only contraception continue till?

A

Either:

FSH blood test results are above 30 IU/L on two tests taken six weeks apart (continue contraception for 1 more year)

55 years

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

What should be considered as contraception in women < 20?

A

COCP and POP

Progesterone only implant (injection is avoided due to concerns over bone density UKMEC2)

Coils are UKMEC2 as they have a higher rate of expulsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When does fertility return after birth?

A

21 days (condoms needed for 7 days after starting COCP and 2 days for progesterone only pill)

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

What is the natural contraception which occurs after birth?

A

Lactational amenorrhea for 6 months (must be fully breastfeeding and amenorrhoeic)

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

What contraceptions in breastfeeding?

A

Progesterone only pill / implant (COCP should be avoided before 6 weeks in women that are breastfeeding - UKMEC4 before 6 weeks and UKMEC2 after 6 weeks)

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

When can coils be inserted after child birth?

A

Up to 48 hours after and then 4 weeks after

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

What is the only contraception effective against STIs

A

Barriers

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

What forms of barrier contraception are there?

A

Condoms (using oil-based lube can damage latex condoms - polyurethane condoms can be used in latex allergy)

Diaphragms (sit at cervix, used with spermicidal gel, leave in place for 6 hours after sex)

Dental dams (oral sex)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which infections can be spread through oral sex?

A

Chlamydia

Gonorrhoea

Herpes simplex 1 and 2

HPV (human papillomavirus)

E. coli

Pubic lice

Syphilis

HIV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When is the COCP licensed for use until?

A

50 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How does the COCP work?

A
  • Prevents ovulation (primary MOA)
  • Thickens cervical mucus
  • Inhibits proliferation of the endometrium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What effect does oestrogen and progesterone have on the HPG axis?

A

Negative feedback

Suppresses GnRH, LH and FSH (without the effects of LH and FSH ovulation does not occur)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Is the “withdrawal bleed” when a break is had in COCP a menstrual period?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Whats the difference between monophasic and multiphasic pills?

A

Monophasic = same amout of hormone

Multiphasic = varying amounts of hormone to match normal cyclical hormonal changes more closely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What type of pills are everyday formulations?

A

Monophasic pills (e.g. microgynon 30 ED) - pack contains seven inactive pills making it easier for women to keep track

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the 1st line recommended COCP? Why

A

Microgynon or leostrin (lower risk of VTE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How do different form of the COCP vary?

A

Amount of oestrogen (ethinylestradiol) and type of progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are some examples of monophasic combined contraceptive pills?

A

Microgynon contains ethinylestradiol and levonorgestrel

Loestrin contains ethinylestradiol and norethisterone

Cilest contains ethinylestradiol and norgestimate

Yasmin contains ethinylestradiol and drospirenone

Marvelon contains ethinylestradiol and desogestrel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What conditions can the COCP help with?

A

PMS

Acne

Hirsutism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What COCP is used first line for PMS?

A

Yasmin and others containing drospirenone (continuous use may be more effective for PMS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Which COCP has an anti-mineralcorticoid and anti-androgen activity?

A

Drospirenone (may help with bloating, water retention and mood changes) - continuous use is more effective for PMS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Which COCP can be used for acne and hirsutism? What is a side effect?

A

Dianette and others containing cyproterone acetate (i.e. co-cyprindiol) as it has anti-androgen effects

Oestrogenic effect means that co-cyprindiol has a 1.5-2 times greater risk of VTE compared to the first-line combined pill (e.g. microgyron)

Normally stopped 3 monts after acne is controlled due to VTE risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the different regimes for taking the COCP?

A

21 days on and 7 days off

63 days on (three packs) and 7 days off (“tricycling”)

Continuous use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are some side effects of the COCP?

A

Unscheduled bleeding is common in the first three months and should then settle with time

Breast pain and tenderness

Mood changes and depression

Headaches

Hypertension

Venous thromboembolism (the risk is much lower for the pill than pregnancy)

Small increased risk of breast and cervical cancer, returning to normal ten years after stopping

Small increased risk of myocardial infarction and stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the benefits of the COCP?

A

Rapid return of fertility after stopping

Improvement in premenstrual symptoms, menorrhagia (heavy periods) and dysmenorrhoea (painful periods)

Reduced risk of endometrial, ovarian and colon cancer

Reduced risk of benign ovarian cysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Why should someone avoid the COCP?

A
  • Uncontrolled HTN
  • Migraine with aura
  • History of VTE
  • Aged over 35 and smoking more than 15 cigarettes a day
  • Major surgery with prolonged immobility
  • Vascular disease or stroke
  • SLE / antiphospholipid syndrome

BMI ABOVE 35 is UKMEC3 for COCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

When to start the COCP?

A

1st day of period (if started after day 5 of period requires condoms for 1st week)

ENSURE NOT PREGNANT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

When switching from POP to COCP is extra protection required?

A

Yes, condoms for 7 days (when switching COCP finish one pack then immediately start the new pack)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

When switching from desogestrel (POP) to COCP is extra contraception required?

A

No as desogestrel inhibits ovulation (differs from traditional POP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What to discuss in a COCP consultation?

A
  • Different options
  • Contraindications
  • STIs (not protective)
  • Side effects
  • Safeguarding (particularly in under 16)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What needs to be recorded when starting the COCP?

A
  • Age
  • Weight and height
  • BP
  • Smoker?
  • FH of migraine / CVD
  • FH of VTE/breast cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What to do when missed one pill:

  • last one was < 72 hrs ago

More than 1 pill:

  • last one was > 72 hrs ago
A
  • last one was < 72 hrs ago: take the last pill ASAP (no extra protection)
  • most recent one was > 72 hrs ago: take last pill ASAP (additional condoms for 1 week). Regarding unprotected sex:

Day 1-7 of packet need emergency contraception

Day 8-14 no emergency contraception (extra protection is recommended)

Day 15-21 back to back (extra protection is recommended)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What can reduce the efficacy of the combined oral contraceptive?

A

Vomiting

Diarrhoea (day of vomiting / diarrhoea is classified as a missed pill)

Rifampicin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How is the progesterone only pill taken?

A

Back to back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

When is the POP absolutely contraindicated (UKMEC4)?

A

Active breast cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What are the 2 types of POP?

A

Traditional (cant delay > 3hours when taking daily)

Desogestrel only pill (cant delay > 12 hours when taking daily)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

How does the traditional POP work?

A
  • Thickens cervical mucus
  • Alters the endometrium: less accepting of implantation
  • Reduces ciliary action in the fallopian tubes
46
Q

How does desogestrel work?

A

Inhibits ovulation

Thickens cervical mucus

Alters endometrium

Reduces ciliary action in the fallopian tubes

47
Q

When to start the POP?

A

Day 1 of menstural cycle (starting after day 5 requires barrier for 48 hrs)

Can be started in pregnancy (although the woman should do a pregnancy test 3 weeks after the last unprotected intercourse)

48
Q

When is the best time to switch from COCP to POP

A

During “break period” (no additional contraception will be needed)

(POPs can be switched without any need for extra contraception)

49
Q

What are some side effect of POP?

A

Irregular bleeding

Breast tenderness

Headaches

Acne

Ectopic pregnancy (with traditional POP due to reduced ciliar function)

50
Q

What are patients on POP at increased risk of?

A

Ovarian cysts

Small risk of ectopic pregnancy with traditional POPs (not desogestrel) due to reduced ciliary action in the tubes

Minimal increased risk of breast cancer

51
Q

What to do if POP is missed?

A

Take missed pill and additional contraception for 48 hrs (emergency contraception if sex since missed pill)

  • Classed as missed if more than 3 hour late for traditional POP or more than 12 hours late for teh desogestrel-POP
52
Q

Can diarrhoea / vomiting be classified as missed pills?

A

YES - extra POP contraception for 48 hr until after settles

53
Q

What does DMPA stand for? When is it given?

A

Depot medroxyprogesterone acetate - IM / sub cut every 12 - 13 weeks

54
Q

What is a down side of the depot injection?

A

Takes 12 months for fertility to return

55
Q

What Depot version is given intramuscularily?

A

Depo-Povera

56
Q

What is the other type of a Depot injection?

A

Sayana Press: a subcutaneous injection device which can be self injected

57
Q

What is used as an alternative to DMPA which contains norethisterone and works as a short term interim contraception, around 8 weeks (e.g. after partner has had a vasectomy)?

A

Noristerat

58
Q

When is the Depot injection contraindicated?

A

Active breast cancer (UKMEC 4)

Ischaemic heart disease, unexplained vaginal bleeding, severe liver cirrhosis, liver cancer (UKMEC3)

59
Q

What are some other negative side effects of the Depot injection?

A

Osteoporosis (not suitable for older age >50)

60
Q

How does the Depot injection work (similarly to desogestrel)?

A
  • Inhibits ovulation (inhibits development of follicles by inhibiting FSH)
  • Thickens cervical mucus
  • Alters endometrium
61
Q

When can the depot injection be started?

A

Day 1-5 of cycle (> day 5 requires 1 week of contraception)

If starting after day 5 of the menstrual cycle then 7 days of extra contracrption is needed before the injection is reliably effective.

62
Q

What are some side effects of the Depot injection?

A

Irregular bleeding

WEIGHT GAIN (unique to progesterone injection only)

Mood changes

Headaches

Flushes

Acne

Hair loss (alopoecia)

Osteoporosis (oestrogen maintains bone mineral density but is no longer produces by the follicles in the ovaries)

63
Q

What medication can be used to treat heavy periods?

A

Mefanemic acid

64
Q

What are the benefits of Depot injection?

A

Improves dysmenorrhoea / heavy periods / endometriosis

Reduces risk of ovarian and endometrial cancer

Reduces the severity of sickle cell crisis in patients with sickle cell anaemia

65
Q

When can the depot injection be given?

A

As early as 10 weeks and as late as 14 weeks after last injection

66
Q

How long does the progesterone only implant last for?

A

3 years then needs replacing (4cm flexible rod)

67
Q

When should the progesterone only implant not be used?

A

Active breast cancer (UKMEC4)

68
Q

Which progesterone implant is used in the UK?

A

Nexplanon which contains 68mg of etonogestrel (licensed for use between ages of 18 and 40 years)

69
Q

How does the progesterone-only implant work?

A

- Inhibit ovulation

  • Thickens cervical mucus
  • Alters the endometrium
70
Q

When can the implant be fitted?

A

Days 1-5 of cycle (>day 5 means extra contraception for 1 week)

71
Q

How is the implant inserted?

A

Special qualifications are required, inserted one third the way up the upper arm on the medial side

Lidocaine (local anaesthetic) is used

Specially designed device is used to insert the implant horizontally (removal is similar although small incision is made in the skin at one end)

72
Q

What are some benefits of the implant?

A

Reliable

Improves dysmenorrhoea

Makes periods lighter

No weight gain/osteoporosis (unlike injection)

No risk of thrombosis / can be used on obese people (unlike COCP)

73
Q

What are some drawbacks of the implant?

A
  • Minor operation
  • Worsening of acne
  • No protection against STI
  • Causes problematic bleeding
  • Implant can be bent or fractured
74
Q

How to locate an impalpable implant?

A

Ultrasound / xray - barium sulphate is added to implants which makes them radio-opaque (use extra contraception in the mean time)

Women should be able to palpate the implant occasionally

May have travelled in vessel to a pulmonary artery

75
Q

What can be done to settle the bleeding from implant in the first 3 months?

A

Take COCP at the same time for 3 months

The FSRH guideline on the implant (2014) state approximately:

1/3 have infrequent bleeding

1/4 have frequent or prolonged bleeding

1/5 have no bleeding

The remainder have normal regular bleeds

76
Q

What are the two kinds of coil?

A

Copper coil

Levonorgestrel-intrauterine system: contains progesterone which is slowly released into the uterus

77
Q

What are some contraindications to coils?

A

- PID

- Immunosuppression

- Pregnancy

- Pelvic cancer

- Unexplained bleeding

78
Q

How is the implant inserted?

A

Specific qualifications are required to insert the implant - bimanual is performed before the procedure to check position and size of the uterus

Speculum inserted and special equipment is used to insert the device - forceps can be used to stabalise the cervix whilst the device is inserted.

Blood pressure and HR are recorded before and after insertion.

May be temporary crampy period type pain after insertion, NSAIDs may help.

Review needed 3-6 weeks after insertion to ensure the coil remains in place

79
Q

What are coil fitting risks?

A
  • Uterine perforation
  • Pain on insertion
  • PID
  • Bleeding
80
Q

What do patients need to do before coil removal?

A

Abstain from sex for 7 days (then strings are located and slowly pulled to remove the device)

81
Q

What can cause coil strings to disappear?

A
  • Explusion
  • Pregnancy
  • Perforation
82
Q

What is the first investigation for missing coil?

A

Ultrasound

THEN xray

Hysteroscopy / laparoscopic surgery may be required depending on the location of coil

(extra condoms until the coil is located)

83
Q

When is the copper coil contraindicated?

A

Wilson’s disease

84
Q

How does the copper coil work?

A

Toxic to sperm

Alters endometrium

(can be used as emergency contraception inserted up to 5 days after an episode of unprotected intercourse)

85
Q

What are the benefits of the copper coil?

A
  • Inserted at any time in menstrual cycle and effective immediately
  • No hormones (no risk of VTE and no added risk with hormone related cancer)
86
Q

What are some drawbacks of the copper coil?

A
  • A procedure is reuired
  • Heavy bleeding
  • Sometimes causes pelvic pain
  • No protection from STIs
  • Increased risk of ectopic pregnancies
87
Q

What does the IUS contain?

What are the four types (which all contain the same progestogen)?

A

Levonorgestrel (progestogen

Mirena: effective for 5 years for contraception, and also licensed for menorrhagia and HRT

Levosert: effective for 5 years, and also licensed for menorrhagia

Kyleena: effective for 5 years

Jaydess: effective for 3 years

88
Q

What is the Mirena coil commonly used for?

A

Contraception (licensed for 5 years)

Menorrhagia

Endometrial protection for women on HRT (licensed for 4 years)

89
Q

How does the IUS work?

A
  • Thickens mucus
  • Alters endometrium
  • Inhibits ovulation in a small number of women

(releases levonorgestrel - progestogen into the local area)

90
Q

When can IUS be inserted?

A

Up to day 7 (if inserted after then need condoms for 7 days)

91
Q

What are the benefits of the Mirena coil?

A
  • Lighter periods
  • Improves dysmenorrhoea / pelvic pain related to endometriosis
  • Can be used in risk of thrombosis / obese (unlike COCP)
  • No risk of osteoporosis
  • Additional uses e.g. HRT and menorrhagia
92
Q

What are the problems with the IUS?

A
  • Procedure required
  • Irregular bleeding
  • No STI protection
  • Increased risk of ectopics
  • Can worse pelvic pain
  • Increased risk of ovarian cysts
  • Systemic absorption causing side effects of acne, headaches or breast tenderness
93
Q

What investigations for irregular bleeding are there?

A

Sexual health screen

Pregnancy test

Cervical screening

(could take COCP inaddition to the LNG-IUS for three months where problematic bleeding occurs)

94
Q

What are actinomyces-like organisms?

A

Organisms which are discovered incidentally during smear tests in women with intrauterine device (coil) do not require treatment unless they are symptomatic

If symptomatic e.g. pelvic pain / abnormal bleeding then removal of the intrauterine device may be considered

95
Q

What are the 3 emergency contraception choices?

A

- Levonorgestrel (72 hours)

- Ulipristal (120 hours)

- Copper coil (5 days)

96
Q

Why is the copper coil the most effective?

A

Not affected by BMI, enzyme inducing drugs or malabsorption

Oral contraception is unlikely to be effective after ovulation has occured

Insertion may lead to PID particularly in women that are high risk of STIs - consider empirical treatment of pelvic infections where there is high risk

Should be kept in until at least the next period after which it can be removed

Alternatively, left in as long term contraception

97
Q

What things to consider when giving emergency contraception?

A
  • STIs
  • Future contraception
  • Safeguarding, rape and abuse
98
Q

What is levonorgestrel? How does it work in emergency contraception?

A

Type of progestogen (prevents/delays ovulation) - same hormone as in IUS

Works by preventing or delaying ovulation - not known to be harmful to the pregnancy if pregnancy does occur

COCP or POP can be started immediately after taking levonorgestrel (extra contraception is required for the first 7 days of taking the COCP or first 2 days of the POP)

99
Q

What is the recommended dose of levonorgesterel when used for emergency contraception?

A

1.5mg as a single dose

3mg as a single dose in women above 70kg or BMI above 26

100
Q

What are some side effects of levonorgestrel?

A

N&V

Spotting

Diarrhoea

Breast tenderness

101
Q

What is Ulipristal acetate?

A

SERM (selective oestrogen receptor modulator) (EllaOne)

Works by delaying ovulation

WAIT 5 DAYS BEFORE STARTING THE COCP or POP extra contraception (i.e. condoms) for first 7 days of COCP or first 2 days of POP

102
Q

What is the dose of ulipristal acetate?

A

30mg

103
Q

What are some side effects of ulipristal acetate?

A

N&V

Spotting

Abdo pain

Back pain

Mood changes

Headache

Dizziness

Breast tenderness

104
Q

When should ulipristal be avoided?

A

Patients with severe asthma

Breastfeeding should be avoided for 1 weeks after taking ulipristal (milk should be expressed and discarded)

105
Q

Does the NHS offer reversal procedures after sterilisation?

A

No ( can be private - low success rate )

Essential to throughly counsel patients about the permanence of the procedure and ensure they have made a fully informed decision

106
Q

What is the difference between female and male sterilisation?

A

Men - local anaesthetic takes 15 mins to cut the vas deferens (test semen to confirm absence of sperm 12 weeks after procedure - alternative contraception is required for 2 months after the procedure)

Women - General anaesthetic - tubal occlusion via laparoscopy, using “filshie clips” (alternative contraception is required until the next menstrul period as an ovum may have already reached the uterus during that cycle)

107
Q

When can children under the age of 16 make a treatment decision?

A

Under gilick competence (unusual for this to be used in children under 13 years old) - assess for coercion or pressure e.g. coercion by an older partner (safeguarding concerns)

108
Q

What is Gilick competence?

A
  • Judgement about whether the understanding and intelligence of the child is sufficient to consent to treatment
  • Needs to be voluntary
  • Check for coercion
109
Q

What are the Frazer guidelines?

A

Specific guidelines for giving contraception to patients under 16 without parental input

  • Mature and intelligent enough to understand treatment?
  • Can’t be persuaded to talk to parents
  • Likely to have intercourse regardless
  • Physical or mental health likely to suffer without treatment
  • Treatment is in their best interest
110
Q

Can children under the age of 13 give consent for intercourse?

A

No

Obstetrics and Gynaecology (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions