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Reproduction and Sexual Health > Contraception (1 and 2) > Flashcards

Contraception (1 and 2) Flashcards

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1
Q

In general, the poorly educated have less money and less access to contraception. This leads to an _________ birth rate!

A

INCREASED

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2
Q

What is the most used contraception worldwide?

A

Withdrawal

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3
Q

When does ovulation occur?

A

14 days before menstruation

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4
Q

What hormones peak in ovulation?

A

LH and FSH

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5
Q

How can contraceptions work?

A
  • Can stop ovulation.
  • Can block the fallopian tubes, or slow the transport of the ovum down the tube so that it is dead by the time it gets to the uterus.
  • Prevent the endometrium from becoming thick enough for implantation.
  • Block at the cervix.
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6
Q

How long does sperm live in the female genital tract?

A

5 days

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7
Q

How long does a ovum survive in the female genital tract?

A

24 hours (17-24 hours)

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8
Q

What is used to express contraceptive failure rates?

A

Pearl index

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9
Q

What does the Pearl Index represent?

A

The number of contraceptive failures per 100 women users per year.

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10
Q

How is the pearl index calculated?

A

No. of accidental pregnancies x 1200 / total number of months of exposure.

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11
Q

What are the 5 main areas of natural family planning?

A

1) Basal body temperature
2) Cervical mucous
3) Cervical position
4) “Standard” days
5) Breast feeding

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12
Q

When should basal body temperature be taken?

A

In the morning, before rising !!

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13
Q

A sudden increase in basal body temperature by > 0.2oC suggests what?

A

That ovulation has taken place

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14
Q

For how long should this raised basal body temperature be sustained for to be indicative of ovulation? After what?

A

Sustained for 3 days after at least 6 days of lower temperature

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15
Q

Around ovulation, what is cervical mucous like?

A

Thin and watery. (to allow sperm to swim)

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16
Q

After ovulation, what is cervical mucous like?

A

Thick and sticky

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17
Q

Before you can quite safely say that a woman is not fertile anymore, what is required? (in terms of cervical mucous)

A

There must be thick and sticky post-ovulation mucous for at least 3 days after thinner, watery, ‘stretchy’ mucous.

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18
Q

When fertile, what is the cervix like?

A

High in the vagina, soft and

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19
Q

When less fertile, what is the cervix like?

A

Low in the vagina, firm and closed

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20
Q

What does the standard days method do?

A

Identifies the most fertile days in a female’s 28 day cycle

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21
Q

On what days are women most fertile?

A

Days 8 to 18.

ovulation usually happens at day 14, and sperm can survive for 5 days, while the ovum can survive 1 day

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22
Q

What is the criteria for lactational amenorrhoea?

A
  1. Exclusively breast feeding.
  2. Less than 6/12 post-natal.
  3. Amenorrhoeic.
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23
Q

What does the combined pill do?

A

Inhibits ovulation

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24
Q

What 2 things does the combined pill have an effect on?

A
  • Cervical mucous.

* Endometrium.

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25
What is the failure rate of the combined pill?
Pearl index – 0.3%.
26
What is Desogestel?
Progesterone only pill
27
What is the mode of action of the POP?
Inhibit ovulation
28
What does the POP have an effect on?
* Cervical mucous * Fallopian tube transport * Endometrium
29
What do older POP's have an effect on?
* Cervical mucous * Fallopian tube transport * Endometrium
30
What is the failure rate of the POP?
pearl index – 0.3%.
31
How long is the implant left in for?
3 years
32
Why is the implant more reliable than the pill?
It is not user dependant
33
What is the primary mode of action of the implant?
Inhibition of ovulation
34
Apart from inhibition of ovulation, what are the other actions of the implant?
* Effect on endometrium. | * Effect on cervical mucous.
35
What is the failure rate of the implant?
Pearl index 0.05%.
36
What is the primary mode of action of the depot injection?
Inhibits ovulation
37
How often is the depot injection given? How long does it last?
Given every 13 weeks. | Will last 14 weeks.
38
What are the other functions of the depot injection?
* Effect on cervical mucous. | * Effect on endometrium.
39
What is the failure rate of the depot injection?
Pearl index – 0.2%.
40
What is the primary mode of action of the IUS?
Effect on implantation - endometrium is rendered unfavourable for implantation
41
What other effects does the IUS have?
Impact cervical mucous – makes it thick and sticky. | Also has other pre-fertilisation effects.
42
What is the failure rate of the IUS?
Pearl index – 0.2% (approx. 1/500).
43
How long does the IUS last?
5 years
44
What is the primary mode of action of the IUD?
To prevent fertilisation. | toxic to an egg and sperm joining
45
IUS releases ....?
Progesterone
46
IUD releases ....?
Copper
47
What kind of response does the IUD cause in the endometrium?
An inflammatory response
48
How long is the IUD licenced for use?
5-10 years
49
What is the failure rate of the IUD?
pearl index 0.6-0.8%. (1/200)
50
What do barrier contraceptives do?
Block sperm from getting to the female genital tract
51
What does female sterilisation do?
Blocks the fallopian tubes
52
Via what 2 methods can female sterilisation be done?
1. Filshie clips. | 2. Essure (permanent coil springs put in fallopian tubes).
53
What is ESSENTIAL to check before carrying out female sterilisation? Why?
That female isn’t at risk of pregnancy in the cycle where sterilisation is performed – could cause an ectopic pregnancy.
54
Vasectomy is the division of ....
Vas deferens
55
Female sterilisation has a higher failure rate than the coil
TRUE
56
What should always be recorded when prescribing someone a contraceptive?
BP and BMI
57
What must you check before you put a coil in?
That someone isn't already pregnant
58
What is 'Quick starting Contraception'?
Starting contraception when patient presents ie. not waiting until next period.
59
What is 'quick starting contraception possible with?'
* Some CHC’s. * POP. * Implant. * (Depo).
60
What is 'quick starting contraception' not possible with?
IUD, pills containing cyproterone acetate
61
What should be done 2/3 weeks after starting 'quick starting contraception'?
Pregnancy test
62
What factors affect a persons choice of contraception?
Effectiveness. Control. Long/short term. Non-contraceptive benefits.
63
Give examples of non-contraceptive benefits of contraception. (ie. factors which can be improved by contraception)
``` Heavy menstrual bleeding Painful periods Acne Irregular periods Premenstrual symptoms Endometriosis Menstrual migraine (no aura) ```
64
What is one of the most commonly used contraceptive methods in the UK (25%)?
Combined oral contraceptive (COC)
65
There are now 3 types of CHC (pill, patch, ring) in the UK. What do all of these contain?
Ethinyl estradiol (EE) and a progesterone (various).
66
Outline the 3 types of CHC, giving the amount of EE in each.
* Combined oral contraceptive pill (COC) – 20-35μg EE. * Combined transdermal patch (CTP) - 33 μg EE. * Combined vaginal ring (CVR) - 15 μg EE.
67
What is the failure rate of CHC with perfect use?
0.3%
68
What is the failure rate of CHC with typical use?
9%
69
The combined transdermal PATCH is affected by what?
Weight ≥ 90 kg  therefore, use something else
70
Some COC’s are now marketed to be used continuously, or have pill-free internals of <7days
True
71
Describe tri-cycling packs of the COC.
Tri-cycling – 3 ‘packs’ taken back to back then 4-7 days off
72
What factors require consideration for safe prescribing of CHC?
* Absorption. * Metabolism. * Metabolic effects.
73
What factors may affect effectiveness of CHC?
* Impaired absorption- ie. in GI conditions. (COC) * Increased metabolism - liver enzyme induction, drug interaction. * Forgetting.
74
What are the 3 main risks to be aware of with CHC?
* Venous thrombosis. * Arterial thrombosis. * Adverse effects on some cancers.
75
The alteration in what, induced by EE, may be thrombogenic? What does this do?
Alteration in clotting factor levels  reduces levels of antithrombin III and protein S
76
In who may EE also promote superimposed arterial thrombosis?
Patients with significant arterial wall disease.
77
(In people who take COC's) There is an increase in what activity? Who is this reversed in, however?
Fibrinolytic activity – but reversed in heavy smokers
78
According to UKMEC, what are the risk factors for VTE?
* Obesity. * Smoking. * Age. * Known thrombophilia. * VTE in first degree relative <45years. * Up to 6 weeks postnatal. * Trekking > 4,500 m for > 1 week * Long-haul flights * Reduced mobility * Antiphospholipid syndrome
79
The risk of VTE in COC users is increased over non-users and varies according to what?
EE dose and progesterone type
80
What is the VTE risk in pregnancy per 10000 women?
29/ 10,000
81
And in the first weeks postnatally, per 10,000 women?
300-400/ 10,000
82
What is - Co-cyprindiol - used in the treatment of?
Acne and hirsutism
83
What are the components of Co-cyprindiol?
Ethinyl-estradiol 35μg/cyproterone acetate 2mg.

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