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Reproduction Year 3 > Contraception > Flashcards

Contraception Flashcards

1
Q

Methods of contraception

A
  • Natural family planning
  • Barrier methods (i.e. condoms)
  • Combined contraceptive pills
  • Progesterone only pills
  • Coils (i.e. copper coil or Mirena)
  • Progesterone injection
  • Progesterone implant
  • Surgery (i.e. sterilization/vasectomy)
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2
Q

UK Medical Eligibility Criteria (UKMEC)

A

Categorise the risks of starting different methods of contraception in different individuals. UKMEC 1-4.

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3
Q

UKMEC 1

A

No restriction in use (minimal risk)

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4
Q

UKMEC 2

A

Benefits generally outweigh the risks

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5
Q

UKMEC 3

A

Risks generally outweigh the benefits

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6
Q

UKMEC 4

A

Unacceptable risk (typically this means the method is contraindicated)

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7
Q

Effectiveness of contraceptives can be divided into two categories; what are they?

A

Perfect use

Typical use

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8
Q

What kind of contraception should be used in active breast cancer?

A

avoid any hormonal contraception and go for the copper coil or barrier methods

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9
Q

What methods of contraception should be avoided in active breast cancer?

A

avoid any hormonal contraception and go for the copper coil or barrier methods

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10
Q

Contraindications (UKMEC4) for using the combined oral contraceptive pill

A
  1. Uncontrolled hypertension
  2. Migraine with aura
  3. History of VTE/thrombosis
  4. Aged over 35 smoking more than 15 cigarettes per day
  5. Major surgery with prolonged immobility
  6. Vascular disease or stroke
  7. Ischaemic heart disease, cardiomyopathy or atrial fibrillation
  8. Liver cirrhosis and liver tumours
  9. Systemic lupus erythematosus and antiphospholipid syndrome
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11
Q

What should you consider when prescribing the Combined oral contraceptive pill to older women?

A

Can be used up to age 50 years, and can treat perimenopausal symptoms

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12
Q

What should you consider when prescribing the progesterone injection to older women?

A

Should be stopped before 50 years due to the risk of osteoporosis

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13
Q

How long should contraception be continued in older woman after their last period?

A

After the last period, contraception is required for 2 years in women under 50 and 1 year in women over 50

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14
Q

When should contraception be started after giving birth?

A

After 21 days

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15
Q

When starting the combined contraceptive pill; how long should condoms be used for?

A

7 days

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16
Q

When starting the progesterone only pill; how long should condoms be used for?

A

2 days

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17
Q

Lactational amenorrhea

A

Is over 98% effective as contraception for up to 6 months after birth. Women must be fully breastfeeding and amenorrhoeic (no periods).

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18
Q

What contraceptive methods are safe in breastfeeding?

A

The progestogen-only pill and implant

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19
Q

How long should the combined oral contraceptive pill be avoided in breastfeeding mothers?

A

Should be avoided in breastfeeding for up to 6 weeks post partum.

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20
Q

What is the time criteria for prescribing IUD/IUS after child birth?

A

A copper coil or intrauterine system can be inserted either within 48 hours of birth or more than 4 weeks after birth (UKMEC 1), but not inserted between 48 hours and 4 weeks of birth (UKMEC 3).

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21
Q

What are the barrier methods of contraception?

A

o Condoms
o Diaphragms and Cervical Caps
o Dental Dams

Are the only methods of contraception that protect against STIs

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22
Q

Condoms can be damaged by what?

A

oil-based lubricants

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23
Q

What type of condom should be used if a latex allergy is present?

A

Polyurethane condoms

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24
Q

The combined oral contraceptive pill (COCP)

A

Contains a combination of oestrogen and progesterone.

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25
Q

Mechanism of action of COCPs

A
  1. Preventing ovulation (this is the primary mechanism of action)
  2. Progesterone thickens the cervical mucus
  3. Progesterone inhibits proliferation of the endometrium, reducing the chance of successful implantation
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26
Q

What are the two types of COCP available?

A
  1. Monophasic pills contain the same amount of hormone in each pill
  2. Multiphasic pills contain varying amounts of hormone to match the normal cyclical hormonal changes more closely
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27
Q

Name of different COCPs available

A

Microgynon, Leostrin, Yasmin, Dianette

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28
Q

Withdrawal bleed

A

The lining of the endometrium is maintained in a stable state while taking the combined pill. When the pill is stopped the lining of the uterus breaks down and sheds. This leads to a “withdrawal bleed“.

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29
Q

Name of COCP used in prementrual syndrome

A

Yasmin and other COCPs containing drospirenone

Drospirenone has anti-mineralocorticoid and anti-androgen activity, and may help with symptoms of bloating, water retention and mood changes

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30
Q

Mechanism of action of drospirenone

A

Drospirenone has anti-mineralocorticoid and anti-androgen activity, and may help with symptoms of bloating, water retention and mood changes in PMS

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31
Q

Name of COCP used in acne and hirsutism

A

Dianette and other COCPs containing cyproterone acetate can be considered in the treatment of acne and hirsutism.

Cyproterone acetate has anti-androgen effects, helping to improve acne and hirsutism.

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32
Q

Side effects of COCPs

A
  1. Unscheduled bleeding is common in the first three months and should then settle with time
  2. Breast pain and tenderness
  3. Mood changes and depression
  4. Headaches
  5. Hypertension
  6. Venous thromboembolism
  7. Small increased risk of breast and cervical cancer, returning to normal ten years after stopping
  8. Small increased risk of myocardial infarction and stroke
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33
Q

What are the risks for patients using COCPs

A
  1. Small increased risk of breast and cervical cancer, returning to normal ten years after stopping
  2. Small increased risk of myocardial infarction and stroke
  3. Risk for thrombosis
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34
Q

COCPs reduce the risk of what type of cancers?

A

endometrial, ovarian and colon cancer

35
Q

Benefits of COCPs

A
  1. Effective contraception
  2. Rapid return of fertility after stopping
  3. Improvement in PMS, menorrhagia and dysmenorrhoea
  4. Reduced risk of endometrial, ovarian and colon cancer
  5. Reduced risk of benign ovarian cysts
36
Q

dysmenorrhoea

A

Painful periods

37
Q

What is a UKMEC3 risk for using COCPs

A

BMI above 35

38
Q

What are the considerations for starting the COCPs?

A

Start on the first day of the cycle (first day of the menstrual period). This offers protection straight away. No additional contraception is required

Starting after day 5 of the menstrual cycle requires extra contraception (i.e. condoms) for the first 7 days of consistent pill use before they are protected from pregnancy.

39
Q

Is contraception required if switching from a COCP to desogesterol?

A

When switching from desogestrel, they can switch immediately, and no additional contraception is required. This differs from a traditional POP because desogestrel inhibits ovulation.

40
Q

Why is no additional contraception required when switching from a COCP to desogesterol?

A

When switching from desogestrel, they can switch immediately, and no additional contraception is required. This differs from a traditional POP because desogestrel inhibits ovulation.

41
Q

Why is desogesterol different from other traditional POPs?

A

This differs from a traditional POP because desogestrel inhibits ovulation.

42
Q

What is considered a Missed pill with COCPs?

A

When the pill is more than 24 hours late (48 hours since the last pill was taken).

43
Q

What needs to be done when you miss a COCP and its been less than 72 hours since the last pill was taken?

A

Take the most recent missed pill as soon as possible (even if this means taking two pills on the same day)

Additional contraception is needed until for up to 7 days

  1. If day 1 – 7 of the packets they need emergency contraception
  2. If day 8 – 14 of the pack (and day 1 – 7 was fully compliant) then no emergency contraception is required
  3. If day 15 – 21 of the pack (and day 1 – 14 was fully compliant) then no emergency contraception is needed. They should go back-to-back with their next pack of pills and skip the pill-free period.
44
Q

When is emergency contraception needed with missed COCPs?

A
  1. If day 1 – 7 of the packets they need emergency contraception
  2. If day 8 – 14 of the pack (and day 1 – 7 was fully compliant) then no emergency contraception is required
  3. If day 15 – 21 of the pack (and day 1 – 14 was fully compliant) then no emergency contraception is needed. They should go back-to-back with their next pack of pills and skip the pill-free period.
45
Q

The progestogen-only pill (POP)

A

Is a type of contraceptive pill that only contains progesterone (contains levonorgestrel or norethisterone).

46
Q

What is a contraindication (UKMEC4) for using POPs?

A

Active breast cancer (UKMEC4)

47
Q

What are the 2 types of POPs?

A
  1. Traditional progestogen-only pill (e.g. Norgeston or Noriday)
  2. Desogestrel-only pill (e.g. Cerazette)
48
Q

What is considered a missed pill with traditional POPs?

A

A delay by more than 3 hours. Taking the pill more than 3 hours late is considered a “missed pill”.

49
Q

What is considered a missed pill with desogesterol POPs?

A

Taking the pill more than 12 hours late is considered a “missed pill”.

50
Q

Mechanism of action of POPs

A
  1. Thickening the cervical mucus
  2. Altering the endometrium and making it less accepting of implantation
  3. Reducing ciliary action in the fallopian tubes

Desogestrel has the additional action of inhibiting ovulation

51
Q

What should be considered when starting the POP?

A

Starting the POP on day 1 to 5 of the menstrual cycle means the woman is protected immediately.

It can be started at other times of the cycle provided additional contraception is required for 48 hours.

52
Q

Why do POPs need 48 hours to be effective?

A

It takes 48 hours for the cervical mucus to thicken enough to prevent sperm entering the uterus.

53
Q

Side effects of POPs

A 
o	20% have no bleeding 
o	40% have regular bleeding
o	40% have irregular, prolonged or troublesome bleeding
o	Breast tenderness
o	Headaches
o	Acne
54
Q

When is emergency contraception required with POPs?

A

Emergency contraception is required if they have had sex since missing the pill or within 48 hours of restarting the regular pills.

Episodes of diarrhoea or vomiting are managed as “missed pills”, and extra contraception is required until 48 hours after the diarrhoea and vomiting settle.

55
Q

What is the name given to the Progesterone injection?

A

depot medroxyprogesterone acetate (DMPA)

56
Q

How often is the progesterone injection given?

A

It is given at 12-to-13-week intervals as an intramuscular or subcutaneous injection of medroxyprogesterone acetate

57
Q

How long does it take for fertility to occur after stopping the progesterone injection?

A

It can take 12 months for fertility to return after stopping the injections, making it less suitable for women who may wish to get pregnant in the near term.

58
Q

What are the two progesterone injections available in the UK?

A
  1. Depo-Provera: given by intramuscular injection

2. Sayana Press: a subcutaneous injection device that can be self-injected by the patient

59
Q

What is an example of a UKMEC4 contraindication for the progesterone injection?

A

Active breast cancer (UKMEC4)

60
Q

What are the UKMEC3 contraindications for using the progesterone injection?

A

o Ischaemic heart disease and stroke
o Unexplained vaginal bleeding
o Severe liver cirrhosis
o Liver cancer

61
Q

What is a risk factor of using the progesterone injection?

A

Reduced bone mineral density - osteoporosis & weight gain

62
Q

Mechanism of progesterone injection

A
  1. Inhibit ovulation.
  2. Thickening cervical mucus
  3. Altering the endometrium and making it less accepting of implantation
63
Q

Side effects of the progesterone injection

A 
	Weight gain
	Acne
	Reduced libido
	Mood changes
	Headaches
	Flushes
	Hair loss (alopecia)
	Skin reactions at injection sites
64
Q

The progestogen-only implant

A

Is a small (4cm) flexible plastic rod that is placed in the upper arm, beneath the skin and above the subcutaneous fat. It slowly releases progestogen into the systemic circulation. It lasts for three years and then needs replacing.

65
Q

How often does the progesterone implant need replacing?

A

Lasts 3 years

66
Q

UKMEC4 contraindication for progesterone implant

A

active breast cancer

67
Q

What is the name of the progesterone implant used in the UK?

A

Nexplanon is the implant used in the UK. It contains 68mg of etonogestrel

68
Q

Mechanism of progesterone implant

A
  1. Inhibiting ovulation
  2. Thickening cervical mucus
  3. Altering the endometrium and making it less accepting of implantation
69
Q

Benefits of progesterone implant

A

> 

Effective and reliable contraception
It can improve dysmenorrhoea 
Can make periods lighter/stop all together
No need to remember to take pills 
It does not cause weight gain (unlike the depo injection)
No effect on bone mineral density (unlike the depo injection)
No increase in thrombosis risk (unlike the COCP)
No restrictions for use in obese patients (unlike the COCP)
70
Q

The three types of emergency contraception

A
  1. Levonorgestrel should be taken within 72 hours of UPSI
  2. Ulipristal should be taken within 120 hours of UPSI
  3. Copper coil can be inserted within 5 days of UPSI, or within 5 days of the estimated date of ovulation
71
Q

What is the name of the female sterilization procedure?

A

Tubal Occlusion

Works by preventing the ovum (egg) travelling from the ovary to the uterus along the fallopian tube. This means the ovum and sperm will not meet, and pregnancy cannot occur.

72
Q

What is the name of the male sterilization procedure?

A

Vasectomy

This involves cutting the vas deferens, preventing sperm travelling from the testes to join the ejaculated fluid. This prevents sperm from being released into the vagina, preventing pregnancy

73
Q

Gillick competence

A

Children under the age of 16 can consent to their own treatment if they’re believed to have enough intelligence, competence and understanding to fully appreciate what’s involved in their treatment.

74
Q

What are coils?

A

Coils are devices inserted into the uterus that provide contraception. They are a form of long-acting reversible contraception. Once fitted, they work for a long time. Removing the device restores fertility.

75
Q

What are the two types of IUD?

A
  1. Copper coil (Cu-IUD): contains copper and creates a hostile environment for pregnancy
  2. Levonorgestrel intrauterine system (LNG-IUS): contains progestogen that is slowly released into the uterus
76
Q

Describe the copper coil

A

contains copper and creates a hostile environment for pregnancy

77
Q

Describe the Levonorgestrel intrauterine system (LNG-IUS) (mirena coil)

A

contains progestogen that is slowly released into the uterus

78
Q

Contraindications for using IUDs as a form of contraception.

A
  1. PID or infection
  2. Immunosuppression
  3. Pregnancy, Unexplained bleeding, Pelvic cancer
  4. Uterine cavity distortion (e.g fibroids)
79
Q

What screening has to be done before insertion of IUDs?

A

STI screening

80
Q

Risks of copper coil insertion

A

> 

Bleeding, Pain on insertion
Vasovagal reactions (dizziness, bradycardia and arrhythmias)
Uterine perforation 
Pelvic inflammatory disease 
Expulsion highest in the first 3 months
81
Q

What is an abortion

A

Termination of pregnancy - abortion is legal up to 24 weeks

82
Q

What are the options for a medical abortion?

A
  1. Mifepristone (anti-progestogen)

2. Misoprostol (prostaglandins) 1 – 2 day later

83
Q

Mifepristone

A

Is an anti-progestogen medication that blocks the action of progesterone, halting the pregnancy and relaxing the cervix.

84
Q

Misoprostol

A

A prostaglandin analogue, meaning it binds to prostaglandin receptors and activates them. Prostaglandins soften the cervix and stimulate uterine contractions.

Reproduction Year 3 (17 decks)

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