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Year 3 GP > Contraception > Flashcards

Contraception Flashcards

(45 cards)

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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

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

Progesterone Injection

Study These Flashcards
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

Study These Flashcards
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

Study These Flashcards
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

Study These Flashcards
A

Delay of up to 1 year

Menstruation can take several months to return to normal

24
Q

Intrauterine system mechanism

Study These Flashcards
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
IUS indication
Contraception Menorrhagia Dysmenorrhea
26
IUS contraindications
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
IUS sie effects
* 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
Intrauterine device mechanism
* Copper – spermicide * 5 – 10 years * Internal pelvic examination is required
29
IUD indication
Contraception | Emergency contraception – within 5 days
30
IUD contraindications
``` 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
IUD side effects
Copper can make periods heavier and painful • Uterine perforation • PID • Expulsion • Ectopic pregnancy • Unscheduled bleeding – common during 3 – 6 months
32
Methods of sterilisation
• Vasectomy (male): - Prevent sperm entering semen by blocking vas deferens • Tubal occlusion (women) - clip inserted to block fallopian tubes
33
Emergency contraception
Levonorgestrel Ulipristal Acetate Copper IUD
34
Levonorgestrel
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
Ulipristal Acetate
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
Contraindications for ulipristal acetate
* 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
Contracepetive assessment
UKMEC - ensure no contraindications - comorbidities - DHx -Age STI risk - Competency - Measure BMI and BP
38
Fraser guidlines
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
Fraser criteria
``` 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
Learning disability capacity
Understand information Retains information Use info to weigh up options Communicate decision
41
Gillick competency
Person under the age of 16 wishes to receive treatment without their parents' or carers' consent
42
Gillick competency criteria
- 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
When should ulipristal acetate be given?
Within 120 hours (5 days) of unprotected sex
44
How long do you have to take the POP for before it becomes effective?
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
Time until effective if not taken within first 5 days of period
Instant - IUD 2 days - POP 7 days - COCP, injection, implant, IUS

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