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Year 3 GP > Contraception > Flashcards

Contraception Flashcards

1
Q

COCP mechanism and use

A

• Oestrogen and progesterone

o Inhibit LH and FSH
o Prevent ovulation

  • Start on day 1 of the menstrual cycle
  • 21 days consecutively with 7 days breaks
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2
Q

COCP indications

A 
Contraception
Menorrhagia 
Dysmenorrhea 
PMS
Acne
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3
Q

COCP contraindications

A 
35 + yrs old 
Migraine
DVT 
HTN
DM with complications 
Breast cancer or primary liver CA
< 6 weeks post partum
BMI < 35 
Breastfeeding 
Smoking over 35 yo
FHx of VTE 
Prolonged immobility or surgery
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4
Q

COCP side effects

A 
Initial temporary:
o	Nausea 
o	Headache 
o	Breast tenderness 
o	Menstrual irregularities
  • No STI protection
  • MI, stroke, VTE and HTN
  • Risk of breast cancer
  • Mood changes – depression
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5
Q

Missed COCP or POP dose

A

Take the missed pill immediately and the next pill as usual (2 pills in 1 day)

• If 2+ pills are missed, abstain from intercourse until finishing 7 days of pill or extra contraception should be used

  • Vomits 3hrs after taking pill, take another
  • If illness occurs during last 7 days, omit pill free interval
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6
Q

Which contraception, when stopped, returns fertility immediately

A 
COCP
POP
Progesterone implant 
IUS
IUD
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7
Q

Progesterone only pill mechanism and use

A 
Progesterone only 
o	Prevents ovulation
o	Thick, acidic cervical mucus 
o	Prevents implantation 
o	Reduces cilia activity
  • Taken with no break at the same time each day
  • Start on day 1 -5
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8
Q

Indications for POP

A
  • Contraception

* Dysmenorrhea

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9
Q

POP contraindications

A
  • Breast cancer
  • Liver cirrhosis or tumours
  • Lower efficacy in women over 70kg
  • Stroke or CHD
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10
Q

POP side effects

A 
Menstrual irregularities 
Breast tenderness 
Ovarian cysts 
Ectopic pregnancy 
Increased risk of breast cancer
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11
Q

COCP patch use and indications

A 
Use: 
• Only 1 patch worn at one time 
• Applied to clean dry arm  
• Change weekly for 3 weeks 
• Patch free interval on week 4

Indication:
COntraception

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12
Q

If COCP patch detached for 48+ hrs

A
  • Abstain for 7 days

* Barrier contraception

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13
Q

Vaginal ring mechanism, use and indication

A

Mechanism:
Oestrogen and progesterone:
• Inhibits FSH and LH
• Inhibits ovulation

Use:
• 21 days, new ring inserted after 7 days
• Insert day 1 – 5 of menstruation cycle

Indication:
• Contraception

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14
Q

When does fertility return after using patch

A

May have a delay of few months

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15
Q

Side effects of vaginal ring

A 
Initial temporary:
o Higher chance of headache 
o Vaginal discharge 
o Breast tenderness 
o Menstrual irregularities
  • No STI protection
  • MI, stroke, higher risk of VTE and HTN
  • Risk of breast cancer
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16
Q

If 8 days since last removal of vaginal ring

A

Abstain or use barrier contraception
Emergency pill
Insert ring as soon as possible

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17
Q

When does fertility return after using vaginal ring

A

May have a delay of few months

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18
Q

Progesterone Implant mechanism and use

A 
Increased progesterone:
• Inhibits ovulation 
• Thickens cervical mucus 
• Thinning of endometrium preventing implantation 
• Works for 3 years

Indication: contraception

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19
Q

Side effects of progesterone implant

A
  • Irregular menstruation
  • Increased risk of breast cancer
  • Can bend or break in situ
  • Acne
  • Pain and bruising when inserted
20
Q

Progesterone Injection

A 
Increased progesterone 
• Inhibits ovulation 
• Thickens cervical mucus 
• Prevents implantation by thinning endometrium 
• Lasts 3 months

Indication: contraception

21
Q

Contraindications and side effects of progesterone injection

A 
Contraindications:
• Breast cancer 
• Pregnancy 
• PMHx of arterial disease or RF 
• DM with complication 
Side effects:
• Irregular menstruation 
• Weight gain 
• Increased risk of breast cancer
• Loss of bone density
22
Q

If longer than 3 months before getting next progesterone injection

A

If longer than the time specified for next injection use:
• emergency contraception
• bridging methods e.g. POP
• Avoid intercourse for 7 days

23
Q

When does fertility return after not taking progesterone injection

A

Delay of up to 1 year

Menstruation can take several months to return to normal

24
Q

Intrauterine system mechanism

A

5 years

  • Progesterone that inhibits implantation due to thickened cervical mucus and endometrial thinning
  • Can still ovulate
  • Inserted day 1 – 7 of the menstrual cycle
  • Use barrier contraception for first 7 days
25
Q

IUS indication

A

Contraception
Menorrhagia
Dysmenorrhea

26
Q

IUS contraindications

A

Internal pelvic examination is needed to check suitability

  • Pregnancy or 4 wks post partum
  • Distorted uterine anatomy
  • Unexplained vaginal bleeding
  • Pelvic infection or STI
27
Q

IUS sie effects

A
  • Acne and headaches
  • Irregular bleeding in first 6 months
  • Perforation of uterine walls (rare)
  • Expulsion
  • Ectopic pregnancy
  • Ovarian cyst
  • Hypersensitivity
  • Depression
  • Weight gain
  • Decreased libido
28
Q

Intrauterine device mechanism

A
  • Copper – spermicide
  • 5 – 10 years
  • Internal pelvic examination is required
29
Q

IUD indication

A

Contraception

Emergency contraception – within 5 days

30
Q

IUD contraindications

A 
Pregnancy or 4 wks post partum
Distorted uterine anatomy 
Unexplained vaginal bleeding 
Pelvic infection 
Wilson’s disease 
Allergy to copper 
STI 
Uterine fibroids 
PID
31
Q

IUD side effects

A

Copper can make periods heavier and painful
• Uterine perforation
• PID
• Expulsion
• Ectopic pregnancy
• Unscheduled bleeding – common during 3 – 6 months

32
Q

Methods of sterilisation

A

• Vasectomy (male):
- Prevent sperm entering semen by blocking vas deferens
• Tubal occlusion (women)
- clip inserted to block fallopian tubes

33
Q

Emergency contraception

A

Levonorgestrel
Ulipristal Acetate
Copper IUD

34
Q

Levonorgestrel

A

Synthetic progesterone inhibits ovulation for 5 – 7 days

Efficacy may be reduced with diseases of malabsorption e.g. Crohn’s and enzyme inducing drugs e.g. rifampicin

35
Q

Ulipristal Acetate

A

Selective progesterone receptor modulator:
• Inhibition of ovulation for 5 days
• If given before ovulation – prevents follicular development
• If LH surge started, delays follicular rupture

36
Q

Contraindications for ulipristal acetate

A
  • Crohn’s
  • Hypersensitivity
  • Severe hepatic dysfunction
  • Rifampicin and other enzyme inducing drugs
  • Breast feeding
  • Asthma that is not controlled by corticosteroids
  • Drugs increasing gastric pH – omeprazole, ranitidine
  • Avoid breastfeeding for 1 week after taking
37
Q

Contracepetive assessment

A

UKMEC - ensure no contraindications

  • comorbidities
  • DHx
    -Age
    STI risk
  • Competency
  • Measure BMI and BP
38
Q

Fraser guidlines

A

If a girl younger than 16 requests emergency contraception without parental consent:

  • Reassure consultation is confidential
  • Emotional and physical implications of intercourse
  • risks of pregnancy and STI
  • Assess competence
39
Q

Fraser criteria

A 
Understands advice
Cannot be persuaded to inform parents 
Likely to begin or continue intercourse 
Physical and mental health will suffer if doesn't receive contraception 
Autonomy
40
Q

Learning disability capacity

A

Understand information
Retains information
Use info to weigh up options
Communicate decision

41
Q

Gillick competency

A

Person under the age of 16 wishes to receive treatment without their parents’ or carers’ consent

42
Q

Gillick competency criteria

A
  • child’s age, maturity and mental capacity
  • understanding of the issue and what it involves - including advantages, disadvantages and potential long-term impact
  • understanding of the risks, implications and consequences
  • how well they understand any advice or information they have been given
  • understanding of any alternative options, if available
  • ability to explain a rationale around their reasoning and decision making.
43
Q

When should ulipristal acetate be given?

A

Within 120 hours (5 days) of unprotected sex

44
Q

How long do you have to take the POP for before it becomes effective?

A

After 48 hours

Provides immediate effective contraception if started on the first to the fifth day of menstruation.

If started at any other point in the cycle, or if the patient is unsure, then additional contraceptive measures, such as condoms or abstinence, should be utilised for the first 48 hours.

45
Q

Time until effective if not taken within first 5 days of period

A

Instant - IUD
2 days - POP
7 days - COCP, injection, implant, IUS

Year 3 GP (20 decks)

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