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1
Q

basal body temperature rise is due to?

A

high oestrogen levels?

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2
Q

how long is it sustained for?

A

3 days after ovulation

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3
Q

how much is the temperature raised by?

A

increase over 0.2 degrees

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4
Q

observing mucous, what is it like after ovulation?

A

thick

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5
Q

before ovulation?

A

thin and watery - egg white is ideal

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6
Q

cervix position when fertile?

A

high in vagina, soft and open?

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7
Q

when less fertile?

A

low and closed

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8
Q

in 28 day cycle - which days are most fertile?

A

8 -18

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9
Q

conditions for breast feeding - how effective is it? the three conditions?

A

98%. you are exclusively breastfeeding, baby is less than 6 months old. you are amenorrheic

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10
Q

UKMEC 1-4?

A

1 - no restriction, 2 advantages outweigh disadvantages, 3 risks outweigh advantages, 4 unacceptable risk

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11
Q

what is the pearl index?

A

number of failures out of 100 women users per year

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12
Q

LARC contraception?

A

depo provera

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13
Q

VLARC?

A

implant, IUD, IUS

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14
Q

how does depo proverb work?

A

inhibits ovulation

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15
Q

what does it have an effect on?

A

cervical mucus and endometrium

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16
Q

3 things you need to check before starting (going in)?

A

blood pressure, smear status, osteoporosis risk factors

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17
Q

underweight, steroid use, anorexia, excess alcohol, immobility, family history, smoking, low trauma fractures are risk factors, as well as hypothyroid, coeliac, RA, hyperparathyroidism, IBD, renal disease

A

ceoliac and IBD - not absorbing calcium

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18
Q

when can depo be started up to and including(which day of cycle?) without need for any more contraception?kev

A

day 5

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19
Q

beyond 5 days, can start the deep at any time, providing “relatively certain” she is not pregnant and?

A

use condoms/abstinence for 7 days

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20
Q

reasonably certain - what does this mean?

A

no sex since last period, reliable and consistent with last contraception, less than 7 days of normal period, less than 4 weeks post part, fully breastfeeing, amennorrheic and 6 months post partum. negative pregnancy test after 3 weeks after last episode of UPSI

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21
Q

if pregnancy can’t be excluded, what do you do?

A

do a pregnancy test after 3 weeks, then start depo

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22
Q

side effects?

A

weight gain - PROVEN, irregular bleeding, delay in return to fertility, risk of osteoperosis

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23
Q

IUD - when can it be fitted?

A

within the first 7 days of a period or ANYTIME providing reasonably certain not pregnant

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24
Q

can be fitted up to _____ days after UPSI or predicted date of ovulation

A

5

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25
what does it contain?
copper and plastic
26
how dies it work? 2 things?
prevents ferTilisaTion, causes inflammatory response in endometrium
27
what can it cause?
endometritis
28
is it hormonal?
no
29
licesnsed for how long?
5-10 years IIIII
30
when can it be given in terms of childbirth/TOP?
within 48 hours of childbirth or after 4 weeks post partum or immediately after TOP
31
IUS - T shaped device with?
elastmorer core
32
______mg LNG IUS?
52 (sim, blackett)
33
how much is released daily?
20mcg
34
decreasing to _____mcg per day at 5 years?
10
35
has an effect on? 2 things
implantation and an effect on cerival mucus
36
renders endometrium?
unfavourable for implantation
37
failure rate?
0.2%
38
same as IUD, can be given in first 7 days, or anytime if reasonably certain not pregnant. can be given within 48hrs of giving birth or later 4 weeks post part, or immediately after TOP
y
39
contraindications to IUD/IUS?
current pelvis infection, pregnancy, infection, endometrial carcinoma, gestational trophoblastic disease (b hcg levels abnormal), abnormal uterine anatomy
40
side effects IUD?
pain, heavy prolonged menses, infection increased in first 20 days, perforation and expulsion
41
side effects of IUS?
lighter less frequent bleeding, pain and increased risk of infection, perforation and expulsion
42
implant ____mg ENG?
68
43
licensed for how long?
3 years
44
releases 60/70mg per day in weeks?
5-6, then 25-30/day by end of 3rd year use
45
how does it work?
inhibits ovulation
46
failure rate?
0.01%
47
when can it be fitted?
within first 5 days of cycle, up to day 5 post 1st/2nd trimester abortion, ON or BEFORE day 21 post partum
48
***there is need for additional precautions in the first 7 days
y
49
when is it immediately effective if fitted
after last active pill in pack taken, depo still within 14 weeks, or if in week 2-3 of COC, patch or ring
50
side effects of implant?
wight gain, acne, irregular bleeding
51
can cause nerve damage or vascular injury, if inserted too deep
y
52
risk of what 3 cardiovascular complications?
CV, MI, VTE
53
when do you need additional precautions for first 7 days? when switching from?
Progesterone only pill or LNG IUS . POP LNG, switching from non hormonal method such as IUD
54
what drugs does the implant have interactions with?
enzyme inducers
55
3 types of short acting contraception?
CHC, POP and EHC
56
advantages of combined hormonal contraceptive?
can fix heavy menstrual bleeding, painful periods, acne, irregular periods, pre menstrual symptoms, endometriosis, menstrual migraine
57
short acting contraception all contain oestrogen in which form?
ethinyl estradiol
58
combined pill has _______ugEE?
20-35
59
vaginal ring?
15
60
patch ?
33
61
failure rate - typical? perfect?
9, 0.3%
62
how does the CHC work?
inhibits ovulation via action on hypothalamic - pituitary ovarian axis to decrease LH and FSH
63
what does it also do?
alters cervical mucus and renders endometrium unfavourable to implantation
64
standard regime?
21days on, stop for 7 and get a bleed
65
patch - how does it work with timings?
1 patch applied for 1 week to suppress ovulation, reapplied for 2 weeks. 4th week is patch free
66
factors that effect effectiveness of CHC?
impaired absorption, GI conditions, increased metabolism, liver enzyme induction, drug interactions
67
what does CHC reduce levels of which increases risk of thrombus?
anti thrombin 3 and protein s
68
in patients with significant arterial wall disease, EE may also promote
superimposed arterial thrombosis
69
risks in terms of arterial/venous/cancer?
risk of venous and arterial thrombosis and can have an adverse effect on some cancers
70
cyproterone acetate, which patients would this be given to?
patients with acne/hirsutism
71
name of the drug?
co-cyprindiol
72
the risk of VTE varies between products, depends on type of ?
progesterone
73
risk of MI in COC? particularly?
small increased risk, particularly in smokers
74
hypertensives are at much higher risk of MI and stroke if using the COC
y
75
increased risk of stroke when using the pill
y
76
migraine with aura is contraindicated, why?
it increases the risk of having an ischaemic stroke
77
being over 35 - what UKMEC is this?
UKMEC 2
78
what does this mean?
benefits outweigh risks, but consider other risks
79
breast cancer - what is the increased relative risk? how long does it take to return to normal after stopping?
1.24 x increased relative risk, 10 years
80
UKMEC for family history of breast cancer?
UKMEC 1 (no restriction)
81
personal history of breast cancer\?
contraindicated
82
BRACA?
UKMEC 3 (risks outweigh benefits) (ladder)
83
risk of cervical cancer?
small increased risk with long term use
84
reduces to baseline?
10 years after stopping
85
what do you have to discuss with these patients?
HPV/condom use/up tp date with cervical screening
86
breastfeeding women less than 6 months post partum?
UKMEC3
87
benefits of CHC? cancers
protection against ovarian cancer and endometrial cancer
88
all CHC show a beneficial effect on acne
decreased risk of cyst recurrence
89
also very good for ?
PCOS and pre menstrual syndrome
90
if bleeding (happens in up to 20%), when do you not change before?
3 months
91
can cause mood changes, but no evidence....?
it causes depression
92
other side effect?
weight gain
93
side effects of patch?
more breast pain, nausea, painful periods
94
ring?
less bleeding problems, acne. irritability and mood changes
95
CHCs that contain (3), have lowest risk of VTEs?
nnl, levonngrestel, norehisterone or norgestimate
96
when can you start CHC?
up to day 5, without need for further contraception
97
OR?
any time after day 5, BUT, condoms or abstinence for 7 days
98
after 7evonelle, need to abstain/use condoms for ?
7 days
99
ullipristol acetate/ella one?
5 days tv
100
if one pill missed >24 hours, but less than 48 hours, what needs to be done?
take pill as soon as remembered, remaining taken at normal time
101
is EC required?
no
102
more than 48 hours without pill?
take most recent pill, use condoms or abstain until 7** pills have been taken consecutively
103
if its in the first week?
consider emergency contraception
104
day 8-14?
no extra instructions
105
day 15-21?
omit pill free interval
106
patch can remain off up to 48 hours without efficacy being reduced. how long can the patch free period be extended up to?
9 days
107
how long can the ring be left out the vagina without efficacy being reduced
48 hours
108
can be worn up to ____weeks without efficacy being reduced?
4 weeks
109
ring free period can be extended to ___days?
9 days
110
progesterone only pill...
levonorgestel, norethisterone LENOR
111
primary mechanism?
thickens cervical mucus
112
what is the newer POP called?
etonorgestrel - longer acting. eton, pack
113
2y mechanism? frid
suppression of ovulation, decrease in receptor activity to blastocyst and reduction in cilia activity in fallopian tube
114
current breast cancer is UKMEC?
4
115
has interactions with?
liver enzyme inducers
116
what pathway is involved?
P450
117
the effect continues for how long after stopping ?
28 days
118
older pills and newer pills - when do they need to be taken?
older 24-27 hours, newer 24-36 hours
119
one missed dose plus UPSI, what happens?
emergency contraception (plus 2 extra days protection)
120
emergency contraception...
7evonelle, ella one, copper IUD
121
when can 7evonelle be given?
72 hours after unprotected sex
122
when can ella one be given?
120 hours post UPSI
123
copper IUD?
up to 5 days
124
which is more reliable? ella one or levonelle?
levonelle
125
what kind of drug is ella one?
ant acid
126
levonelle?
enzyme inducer
127
what do they both do?
inhibit/delay ovulation
128
side effect of 7evonelle?
increased BMI

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