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Y3 Patient Sem 1 > contraception 1 > Flashcards

contraception 1 Flashcards

1
Q

when was the first synthetic contraception?

A

1974

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2
Q

when is day 1 of the cycle?

A
  • no contraception day 1 is the first day of the period

- with contraception day one is the first day you take the pull

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3
Q

what is HFI?

A

hormone free interval, you have a week without the hormone can sometimes be given placebo pills

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4
Q

what are the types of the combined oral contraception/

A 
all contain oestorgen and progesteron
•	Monophasic pills 
o	21-day cycles
	1 OD for 21 days/7-day break (FHI)
	Tailored regimes
o	28-day cycles 
	21 active + 7 ED pills
	Zoely 24+4
•	Phasic pills 
o	21-day phasic cycle
o	28-day phasic cycle
	Logynon 
	Qlaira 26+2
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5
Q

what are the types of the progesterone only pill?

A 
no free pill period
28 days of taking the active form
•	Traditional POPs
o	Norethisterone (at low doses – 350mcg)
•	Newer POPs
o	Desogestrel
	More commonly used 
•	Progesterone only you do not have a FHI, same amount of each hormone throughout the 28 day cycle. Typically find women who have these have very light / no periods.
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6
Q

do women get periods on POP?

A

typically no

they may experience light bleeding but often no peruod

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7
Q

what is a tailored regime?

A

may be used for another reason other than contraception - often used for irregular bleeding
21 pills active and 7 placebo pulls which do not contain any hormones.

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8
Q

what are examples of non oral combined contraception?

A

contain oestrogen and progesteron

  • patches which release the hormones. 1 patch evry 7 days for 21 days and then 7 day break
  • vaginal ring releasing the hromones, have the ring for 3 weeks then have a week free
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9
Q

what are examples of non oral progesterone contraception?

A
  • injection needed between 8-12 weeks
  • implant lasts for up to 3 years
  • IUS intra uterine system .- slowly releases the hormone which thickens preventing implantation
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10
Q

what is the mechanism of action of a COC?

A

primary - inhibit ovulations and make the ovaries dormant.
thickens the cervical mucus
the oestorgen causes endometrial proliferation whilst progesterone opposes proliferation

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11
Q

are women protected during there 7 days off?

A

provided the woman has taken it effectively she is covered for her 7 days - if any long the ovaries will no longer be dormant

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12
Q

what is endometrial proliferation?

A

overgrowth and this can lead to the production of cancerous cells and this would affect fertility - this is why there is not an oestrogen only pil

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13
Q

what is the mechanism of action of a progestron only?

A
  • suppresses ovulation
  • thickens cervical mucus, delays ovum transport and renders endometrium hostile to implantation
  • reduced cilia activity
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14
Q

why is ovum transport important?

A

the egg needs to move down the fallopian tube, if you reduce the cilia activity then it would slow down how quickly the egg can reach the uterus.

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15
Q

can you get pregnant at any time of the cycle/

A

yes

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16
Q

what is the efficacy of the COC and POP?

A
  • perfect use is 99.7%

- typical use is 92%

17
Q

what is perfect use?

A

used it exactly how it is meant to be and never miss anything

18
Q

what is typical use?

A

people make some mistakes but still use it how they should

19
Q

how effective is the male condom/

A

98% - mainly influenced by user failure

20
Q

how effective is the female condom?

A

95% as they are much harder to use

21
Q

how effective is the diaphragm?

A

96% but it has to be left in for 6 hours after sexual intercourse in order for it to be effective - if taken out before it would be effective

22
Q

what are the condtions for lacation to be used as a contraception method?

A
  • fully breastfeeding (no other liquids or solid foods)
  • you are nearly full breastfeeding ( mainly breastfeding but you may be using some other types of nutrition) AND
  • baby is under 6 months old
  • you have NOT started periods yet
23
Q

how does the risk of pregnancy increase with LAM?

A
  • breastfeeding reduces
  • long intervals between feeds
  • night feeds ceases and you use supplementing feeding
24
Q

what determines the patients contraceptive choice/

A
  • Patient choice
  • Medical conditions ?
  • Medication ? DDI?
  • UKMEC* categories for contraindications
  • Advise on other suitable methods and offer if appropriate
  • Discuss advantages, disadvantages, risks, efficacy, adverse effects and when to seek advice
  • Advise on how to start HC
  • CHC regimens – standard and tailored
  • Advise on missed/late pill/use of vaginal ring
  • Need for ‘Quick-starting’ contraception
25
Q

what are the advantages of combined oral contraception?

A
  • Menstrual period regular, lighter, less painful
  • decrease in acne, functional ovarian cysts, benign ovarian tumours
  • decrease the risk of ovarian, uterine, and colon cancer
26
Q

what are the disadvantages of combined oral contraception?

A
  • Minor ADRs – nausea, breast tenderness, cyclical weight gain?, loss of libido?, vaginal discharge, breakthrough bleeding
  • increase risk blood pressure (angiotensin), MI, stroke, Venous thromboembolism, breast cancer, cervical cancer
27
Q

what are the advantages or progesterone only contraception?

A
  • High efficacy
  • Suitable when COC isn’t
  • decrease risk of endometrial cancer, benign breast disease, uterine fibroids, anaemia (as they cut down periods or stop them altogether)
28
Q

what are the disadvantages of progesterone only contraception?

A
  • ADRs – acne, headaches, depression?, loss of libido?, sustained weight gain?, vaginal dryness?
  • Menstrual irregularities (oligomenorrhoea and menorrhagia)
  • Efficacy – affected by patients weight. Less affected in obesity
  • increase risk of functional ovarian cyst, ectopic pregnancy, breast cancer
29
Q

what is the defintion of a missed pill for COC?

A

> 24 hours
• If starting on day 6 or later, add precautions for 7 days
• Critical at end or start of cycles as PF period elongated
• If 2 or more missed (>24 hrs) and UPSI occurs EHC indicated
• COC - Zoely/Qlaira missed pill = >12 hours

30
Q

what is the defintion of a missed pill for POP?

A
  • > 3/12hrs LATE
  • Continue pills with 2 days extra precautions
  • If 1 or more ACTIVE pills missed (>3/12hrs) [and UPSI before 2 more tablets taken correctly] then EHC indicated
  • POP – Cerazette missed pill = >12 hours
31
Q

what are the 4 catergoies for UK MEC health risk with COC?

A

1 - condition for which no restriction for the use of methods
2- condition where there is advantages of using method outweigh the risks
3 -ncondtion where the risks outweigh the advantages, so you need to refer and try another acceptable method
4 - unacceptable health risk if the method is used

32
Q

what is a catergory 4 condition?

A
  • Breast feeding women < 6 weeks post partum
  • Women>35 + 15 cigarettes a day
  • Multiple CVS risks
  • Consistently elevated BP
  • Vascular disease & history of VTE (inc thrombogenic mutations), IHD and stroke
  • Migraine WITH aura
  • Current breast cancer
  • DM with nephropathy, retinopathy or neuropathy
  • Benign hepatocellular adenoma and malignant hepatoma
  • SLE

Y3 Patient Sem 1 (20 decks)

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