Contraception Flashcards
(224 cards)
1
Q
What is contraception?
A
The intentional prevention of pregnancy as a consequence of sexual intercourse
2
Q
When are women most fertile during a 28 day cycle?
A
10-17 days
3
Q
What is the combined oral contraceptive pill?
A
A pill containing a combination of oestrogen and progesterone
4
Q
How effective is the combined oral contraceptive pill with perfect use and typical use?
A
Perfect Use - 99%
Typical Use - 91%
5
Q
In what three ways does the combined oral contraceptive pill prevent conception?
A
Ovulation prevention
Cervical mucus thickening
Endometrium thinning
6
Q
What is the primary mechanism in which the combined oral contraceptive pill prevents conception?
A
Ovulation prevention
7
Q
How does the combined oral contraceptive pill prevent ovulation?
A
This is due to the fact that oestrogen and progesterone have a negative feedback effect on the hypothalamus and anterior pituitary and therefore they suppress the release of GnRH, LH and FSH
When LH and FSH are absent, ovulation doesn’t occur
8
Q
How does cervical mucus thickening prevent conception?
A
This prevents sperm from reaching and thus fertilising the egg
9
Q
How does a thinned endometrium prevent conception?
A
This reduces the chance of successful implantation of a fertilised egg
10
Q
What are the two types of combined oral contraceptive pills?
A
Monophasic
Multiphasic
11
Q
What are monophasic combined oral contraceptive pills?
A
They contain the same amount of hormone in each pill
12
Q
What are multiphasic combined oral contraceptive pills?
A
They contain varying amounts of the hormones to match the normal cyclical hormonal changes more closely
13
Q
What are the two dosing regimes for the combined oral contraceptive pill?
A
Standard
Continuous dosing
14
Q
What is the standard combined oral contraceptive pill regimen?
A
It involves individuals taking the combined pill for 21 days with a hormone free week
15
Q
Describe the mechanism behind the standard combined oral contraceptive pill regimen
A
The lining of the endometrium is maintained in a stable state while taking the contraceptive pill
When the pill is stopped the lining of the uterus breaks down and sheds
This leads to a withdrawal bleed
This is not classed as a menstrual period as it is not part of the natural menstrual cycle
16
Q
What is the continuous dosing combined oral contraceptive pill regimen?
A
It involves individuals taking the combined pill for 63 days (three packs) with a hormone free week
17
Q
What are the two advantages of the continuous dosing combined oral contraceptive pill regimen?
A
This avoids the inconvenient withdrawal bleed
It avoids individuals forgetting to restart their pill after the break
18
Q
Is it safe for individuals to have sexual intercourse during the hormone free week of the combined oral contraceptive pill?
A
Yes - as long as they remember to start their new packet
19
Q
What two investigations should be conducted prior to individuals starting the combined contraceptive pill?
A
Blood pressure
BMI
20
Q
When do individuals start the combined oral contraceptive pill?
A
First day of the menstrual cycle
21
Q
How long does the combined oral contraceptive pill take to offer protection?
A
7 days
22
Q
When would additional contraception be required when starting the combined oral contraceptive pill? How long for?
A
If it is started after day five of the menstrual cycle
Individuals will need to take extra contraception for the first seven days of consistent pill use before they are protected from pregnancy
23
Q
What advice is given to individuals when they are switching between different types of the combined oral contraceptive pill?
A
We advise them to finish one pack then immediately start the new pack without the pill-free period
24
Q
What advice is given to individuals when switching from the progesterone only pill to the combined oral contraceptive pill?
A
They can switch at any time, but seven days of extra contraception is required
25
How often should individuals take the combined oral contraceptive pill?
Daily, with 24 hours ideally between each dose
26
What is regarded as a missed combined oral contraceptive pill dose?
If an individual takes the pill more than 24 hours late, which therefore means that it has been 48 hours since the last pill was taken
27
What advice do we give if an individual has a missed the combined oral contraceptive pill by less than 72 hours?
They should take the missed pill as soon as possible even if this means taking two pills on the same day
They are not required to use extra contraception protection if other pills before and after are taken correctly
28
What advice do we give if an individual has a missed the combined oral contraceptive pill by more than 72 hours?
They should take the most recent missed pill as soon as possible even if this means taking two pills on the same day
They are required to use extra contraception protection until they have taken the pill regularly for seven days straight
29
What advice do we give if an individual has a missed the combined oral contraceptive pill by more than 72 hours (during day one to seven of the packet)?
They are required to take emergency contraception if they have had unprotected sex
30
What advice do we give if an individual has a missed the combined oral contraceptive pill by more than 72 hours (during day eight to fourteen of the packet)?
They are not required to take emergency contraception if they have had unprotected sex
31
What advice do we give if an individual has a missed the combined oral contraceptive pill by more than 72 hours (during day fifteen to twenty one of the packet)?
They are required to take emergency contraception if they have had unprotected sex
These individuals should also miss their pill-free period
32
What are the five non-contraceptive benefits of the combined oral contraceptive pill?
Dysmenorrhea Relief
Premenstrual Syndrome Relief
Menorrhagia Relief
Decreased Risk of Ovarian Cysts & Cancers
Acne Treatment
33
Which three cancers does the combined oral contraceptive pill decrease the risk of?
Ovarian
Endometrial
Colon
34
What are the seven side effects of combined oral contraceptive pill?
Irregular Bleeding
Breast Tenderness
Cholestasis
Headaches
Nausea
Hypertension
Depression & Mood Changes
35
How long does irregular bleeding persist with the combined oral contraceptive pill? What makes this side effect more common?
The first three months
Continuous dosing or extended cycle pills
36
What are the five risk factors associated with the combined oral contraceptive pill?
Venous Thrombosis (DVT & PE)
Arterial Thrombosis (MI & ischaemic stroke)
Breast & Cervical Cancer
Liver Disorders
Gallbladder Disease
37
Due to the risk of VTE, what advice is given to patients in regards to the combined oral contraceptive pill and upcoming surgery?
They should stop the pill 4 weeks before surgery
They should restart it 2 weeks after surgery
38
How long after stopping the combined oral contraceptive pill does the risk of breast and cervical cancer return to normal?
10 years
39
What are the seven relative contraindications associated with the combined oral contraceptive pill?
Controlled Hypertension
Smoking, in individuals who are > 35 years old and smoke less than 15 cigarettes/day
BMI > 35
Thromboembolic Disease FH History, which involves first degree relatives < 45 years old
Prolonged Immobility, which is normally due to a major surgery or disability
Breast Cancer History, which can be a personal history or family history associated with the BRCA gene
Current Gallbladder Disease
40
What are the seven absolute contraindications associated with the combined oral contraceptive pill?
Uncontrolled Hypertension
Smoker, in individuals > 35 years old and more than 15 cigarettes/day
Migraine With Aura
Thromboembolic Disease History
Ischaemic Disease History
Breast Feeding < 6 Weeks Postpartum
Current Breast Cancer
Major Surgery, with prolonged immobilisation
Positive Antiphospholipid Antibodies (SLE)
41
What are the two other forms of combined oral contraception, apart from the pill?
Patch
Vaginal ring
42
What combined contraceptive patch is usually prescribed? How often is this changed?
EVRA
Weekly
43
How long does the contraceptive patch take to offer protection?
7 days
44
What advice should be given if patients delay in changing their patch at the end of week one or two (within 48 hours)?
It should be changed immediately, with no further precautions
45
What advice should be given if patients delay in changing their patch at the end of week one or two (greater than 48 hours)?
It should be changed immediately and a barrier method of contraception should be used for the next 7 days
In cases where the patient has had sexual intercourse in the last 5 days, then emergency contraception should be considered
46
What advice should be given if patients delay in changing their patch at the end of week three?
It should be removed as soon as possible and the new patch should be applied on the usual cycle start day for the next cycle
No additional contraception is needed
47
What advice should be given if patients delay in changing their patch at the end of a patch free week?
A barrier contraception method should be used for 7 days following any delay at the start of a new patch cycle
48
What combined vaginal ring is usually prescribed? How often is this changed?
NuvaRing
Every three weeks
49
How long does the combined vaginal ring take to offer protection?
7 days
50
Can individuals take the vaginal ring out during sexual intercourse?
The ring can be taken out for three hours every twenty-four hours for sex
51
What is the progesterone only pill?
A type of contraceptive pill that only contains the hormone progesteron
52
How effective is the progesterone only pill with perfect use and typical use?
Perfect Use - 99%
Typical Use - 91%
53
What are the two types of progesterone only pills?
Traditional Progesterone-Only Pill
Desogesterol-Only Pills
54
When is the traditional progesterone only pill classified as missed?
If it is delayed by more than three hours
55
When is the traditional desogesterol only pill classified as missed?
If it is delayed by more than twelve hours
56
What are the four mechanisms in which the traditional progesterone only pill prevents conception?
Cervical Mucus Thickening
Endometrium Thinning
Ciliary Action Reduction
Ovulation Inhibition
57
What is the primary mechanism in which the progestogen-only pill (excluding desogestrel) prevents conception?
Cervical Mucus Thickening
58
What are the three mechanisms in which the traditional desogesterol only pill prevents conception?
Endometrium Thinning
Ciliary Action Reduction
Ovulation Inhibition
59
How does reduced ciliary action prevent conception?
It prevents movement of the egg through the fallopian tube
60
How is the progesterone only pill taken?
It is taken continuously, unlike the cyclical combined pills
It is therefore taken at the same time every day without a pill-free interval
61
How is the progesterone only pill started?
It is started between the first and fifth day of the menstrual cycle
62
How long does the progesterone only pill take to offer protection?
2 days
63
Can the progesterone only pill be started at other times of the menstrual cycle?
Yes
However, in this instance, additional contraception is required for 48 hours
64
What advice is given if individuals miss a progesterone only pill?
Patients are advised to take a pill as soon as possible and continue with the next pill at the usual time even if this means taking two in 24 hours
These patients are also advised to use extra contraception for the next 48 hours of regular use
Emergency contraception is required if they have had sex since missing the pill or within 48 hours of restarting the regular pills
65
What happens if individuals experience episodes of vomiting or diarrhoea whilst on the progesterone only pill?
These patients are advised to treat this as a missed pill.
These patients are also advised to use extra contraception until 48 hours after the vomiting and diarrhoea settle
66
What are the six side effects of the progesterone only pill?
Irregular Bleeding
Decreased Libido
Mood Changes
Headache
Breast Tenderness
Acne
67
How long does irregular bleeding persist with the progesterone only pill?
Three months
68
What are the three risk factors associated with the progesterone only pill?
Breast Cancer
Ovarian Cysts
Ectopic Pregnancy
69
How long after stopping the progesterone only pill does the risk of breast cancer return to normal?
10 years
70
Why does the progesterone only pill increase the risk of an ectopic pregnancy?
It reduces ciliary action in the fallopian tubes
71
What is the advantage of the progesterone only pill compared to the combined oral contraceptive pill?
There are fewer contraindications
72
What are the three contraindications of the progesterone only pill?
Breast Cancer, however, this does not include a family history just personal history.
Liver Cancer
Enzyme Inducing Drugs, such as carbamazepine, topiramate and rifampicin increase the metabolism of progesterone and oestrogen. They therefore reduce the effectiveness of the combined oral contraceptive pill.
73
Do antibiotics have an effect on the progesterone only pill?
No
74
What is another name for the progesterone-only injection?
Depot medroxyprogesterone acetate (DMPA)
75
What is the dosage of the progesterone-only injection?
It is given at three-month (13 weeks) intervals
76
What are the two forms in which the progesterone-only injection can be given?
Intramuscular
Subcutaneous
77
What is contained in the progesterone-only injection?
Medroxyprogesterone acetate – which is a form of progesterone
78
How effective is the progesterone-only injection with perfect use and typical use?
Perfect Use - 99%
Typical Use - 94%
79
What is the typical use of the progesterone-only injection?
Women may forget to book in for an injection every three months
80
What are the three ways in which the progesterone-only injection prevents conception?
Ovulation Prevention
Cervical Mucus Thickening
Endometrium Thinning
81
What is the primary mechanism in which the progesterone-only injection prevents conception?
It inhibits ovulation + thickens cervical mucus
82
What are the two types of the progesterone-only injection?
Depo-Provera Injection
Sayana-Press Injection
83
How is the depo-provera injection given?
Intramuscular into the upper outer quadrant of the buttock
84
What dose of the depo-injection is given?
1ml
85
How is the sayana-press injection given?
Subcutaneous into the abdomen or thigh
These patients are able to administer themselves this injection at home
86
What dose of the sayana-pressinjection is given?
1ml
87
How is the progesterone only injection started?
It is started between the first and fifth day of the menstrual cycle
88
How long does the progesterone only injection take to offer protection?
7 days
89
Can the progesterone only injection be started after day five of the menstrual cycle?
Yes
However, in this instance, additional contraception is required for 7 days
90
What are the four non-contraceptive benefits of the progesterone only injection?
Dysmenorrhea Relief
Endometriosis Symptom Relief
Decreased Risk of Ovarian & Endometrial Cancers
Decreased Sickle Cell Crisis Severity
91
What are the eight side effects of the progesterone only injection?
Irregular Bleeding
Fertility Effects
Osteoporosis
Weight Gain
Decreased Libido
Mood Changes
Skin Reactions
Acne
92
What type of irregular bleeding is experienced with the progesterone only injection?
These patients often experience more irregular, heavier, and longer lasting periods
This is usually temporary and after a year of regular use, most women experience amenorrhoea
93
How do we try to help control irregular bleeding experienced by those on the progesterone-only injection?
We prescribe the combined oral contraceptive pill in addition to the injection for three months to help settle the bleeding
94
Which contraception method is proven to be associated with weight gain?
Depo Provera injection
95
Why does the progesterone only injection affect fertility?
This is due to the fact that it can take 12 months before individuals begin ovulating again
This makes it less suitable for women who may wish to get pregnant in the near term
96
Why is osteoporosis an effect of the progesterone only injection?
This is due to the fact that oestrogen maintains bone mineral density in women and is mainly produced by the follicles in the ovaries.
The progesterone-only injection suppresses the development of follicles and therefore reduces the amount of oestrogen produced
97
What are the two unique side effects of the progesterone only injection?
Osteoporosis
Weight gain
98
How much weight can individuals gain with the progesterone only injection?
2-3kg
99
What are the three contraindications of the progesterone only injection? Due to the side effect of osteoporosis what else should we consider?
Breast Cancer, however only in those who have active cancer
Ischaemic Heart Disease & Stroke
Liver Disorders, such as liver cirrhosis and liver cancer
We should also be cautious about prescribing it to women over 50 and those on steroids
100
What is the progesterone only implant?
A small flexible plastic rod that is placed in the upper arm
It slowly releases progesterone into the systemic circulation
101
How deep in the upper arm do we place the progesterone only implant?
It is placed beneath the skin and above the subcutaneous fat
102
How long is the implant? How wide is the implant?
4cm long
2mm wide
103
How often is the implant changed?
Three years
104
How effective is the implant with perfect use and typical use?
It is 99% effective with perfect and typical use
Once in place, there is no room for user error
105
What is the most effective form of contraception (excluding abstinence)?
Progesterone implant
106
What brand of the implant is most commonly given?
Nexplanon
107
What is contained in the Nexplanon implant?
68mg of progesterone etonigestrel in its core
The rod is then covered in a rate controlling membrane made from ethinyl vinyl acetate
108
What are the three mechanisms in which the implant prevents conception?
Ovulation Prevention
Cervical Mucus Thickening
Endometrium Thinning
109
What is the primary mechanism in which the implant prevents conception?
It inhibits ovulation + thickens cervical mucus
110
How is the implant inserted?
It is inserted between the first and fifth day of the menstrual cycle
111
How long does the implant take to offer protection?
7 days
112
Can the implant be started after day five of the menstrual cycle?
Yes
However, additional contraception is required for 7 days.
113
Where in the arm is the implant inserted?
It is placed a third the way up the upper arm and on the medial side
114
What type of anaesthetic is used when inserting the implant?
Local
Lidocaine
115
What are the two non-contraceptive benefits of the implant?
Dysmenorrhea Relief
Menorrhagia Relief
116
What are the five side effects of the implant?
Irregular Bleeding
Mood Changes
Decreased Libido
Headaches
Breast Tenderness
117
How do we control irregular bleeding with the implant?
We prescribe the combined oral contraceptive pill in addition to the implant for three months to help settle the bleeding
118
What side effect is more common with the implant compared to other progesterone only methods?
Mood changes
119
Should the implant be palpable after insertion? What should be done if this is not the case?
Yes
Extra contraception is required until it is located
120
Which two scans can be used to locate the implant?
US
X-ray
121
What is added to Nexplanon to make is radio-opaque on x-rays?
Barium sulphate
122
What is a rare complication of the implant?
There are reports of devices entering blood vessels and migrating through the body, including to the lungs
If the implant cannot be located even after an ultrasound scan, a chest x-ray may be considered to identify an implant in a pulmonary artery
123
What is the one contraindication of the implant?
Enzyme Inducing Drugs, such as carbamazepine, topiramate and rifampicin increase the metabolism of progesterone and oestrogen. They therefore reduce the effectiveness of the combined oral contraceptive pill.
124
What are coils?
They are devices inserted into the uterus that provide contraception
125
How often do coils need to be changed?
Every 5 to 10 years
126
How effective are coils?
99%
127
What are the two types of coils?
Copper Intrauterine Device (IUD)
Levonorgestrel Intrauterine System (IUS)
128
What is the IUD composed of?
Copper
129
What is the IUS composed of?
Progesterone
130
What is another name for the IUS?
Mirena coil
131
Why is the levonorgestrel considered as a system?
It contains hormones
132
When do we conduct extra tests before inserting the coil?
When patients are at an increased risk of sexually transmitted infections
We screen for chlamydia and gonorrhoea
133
What tests do we conduct in all patients before insertion of the coil?
A bimanual examination is performed to check the position and size of the uterus
The blood pressure and heart rate measurements are recorded before and after insertion
134
What two tools are used to insert the coil?
Speculum
Forceps
135
What do we prescribe patients after insertion of the coil? Why?
NSAIDs
Individuals may experience temporary crampy, period-like pain
136
How long after insertion of the coil do we check it again?
These patients then have their threads checked around three to six weeks after insertion
After this they should be taught to feel the strings after each period to ensure the coil remains in place
137
How long should women abstain from sex or use condoms before the coil is removed? Why?
7 days
There is a risk of pregnancy
138
When can the IUD be used as an emergency contraception method?
When inserted up to five days after an episode of unprotected intercourse
When inserted by day 19 of a 28 day cycle
139
How long does the IUS take to offer protection?
7 days
140
How long does the IUD take to offer protection?
Immediately
141
When can the IUD be inserted?
At any time during the menstrual cycle
142
In what two ways does the IUD prevent conception?
The copper within the coil is toxic to the ovum and sperm.
It can also alter the endometrium and makes it less accepting of implantation of a fertilised egg
143
What is the primary mechanism in which the copper coil prevents conception?
It decreases sperm motility and survival
144
What are the three side effects of IUD's?
Irregular Bleeding
Pelvic Pain
Ectopic Pregnancies
145
When is the IUD contraindicated?
Wilson’s disease
This is a condition where there is excessive accumulation of copper in the body and tissues
146
In breast ccancer patients, which form of contraception is recommended?
IUD
147
When should the IUS be inserted?
It is inserted up to day seven of the menstrual cycle without a need for additional contraception
148
Can the IUS be started after the seventh day of the menstrual cycle?
Yes
However, in this instance, additional contraception is required for 7 day
149
What are the four types of IUS's?
Mirena
Levosert
Kyleena
Jaydess
150
How long is the Mirena coil effective for?
5 years
151
What two conditions can the Mirena coil also be prescribed for?
Menorrhagia
HRT
152
What is the most commonly prescribed IUS type?
Mirena
153
How long is the Levosert coil effective for?
5 years
154
What condition can the Levosert coil also be prescribed for?
Menorrhagia
155
How long is the Kyleena coil effective for?
5 years
156
What is the advantage of the Kyleena coil?
It contains less progesterone than the Mirena and Levosert, thus preventing the chance of side effects.
157
How long is the Jaydess coil effective for?
3 years
158
What is the advantage of the Jaydess coil?
It contains less progesterone than the Mirena and Levosert, thus preventing the chance of side effects
159
What are the two mechanisms in which the IUS prevents conception?
Cervical Mucus Thickening
Endometrium Thinning
160
What is the primary mechanism in which IUS prevents conception?
It prevents thickening of the endometrium
161
What are the three side effects of the IUS?
Irregular Bleeding
Pelvic Inflammatory Disease
Ectopic Pregnancies
162
How long does irregular bleeding with the IUS coil persist for?
Six months
163
How do we control irregular bleeding with the IUS?
We prescribe the combined oral contraceptive pill in addition to the coil for three months to help settle the bleeding.
164
Which patients are at a high risk of pelvic inflammatory disease with the IUS coil? How do we manage this?
Those who are at a high risk of STIs
In these cases we can consider empirical treatment of pelvic infections.
165
How effective are barrier methods?
88%
166
What are the four types of barrier contraception methods?
Male condoms
Female condoms
Diaphragms
Cervical caps
167
What only contraceptive method is effective in protecting against STI transmission? What three types of sex does this apply to?
Condoms
This applies to vaginal sex, oral sex and anal sex
168
How effective are condoms with perfect use and typical use?
Perfect Use - 98%
Typical Use - 82%
169
What is a male condom?
A thin sheath placed over the erect penis
170
What is the main material which male condoms are made from?
Latex
171
What advice is given to individuals using male condoms made from latex?
If individuals use oil-based lubricants, they can damage the latex and make it more likely that they will tear
172
What condoms are used in males allergic to latex?
Polyurethane condoms
173
What is a female condom?
A soft, loose-fitting pouch with a ring on each end
On insertion, one ring is placed into the vagina, to hold the condom in place, and the ring at the open end remains outside the vagina.
The outer ring helps keep the condom in place and is also used for removal
174
What two types of sex can female condoms be used for?
Vaginal
Anal
175
What are diaphragms and cervical caps?
They are silicone cups that fit over the cervix
176
When do women insert diaphragms and cervical caps?
They fit them before having sex and leaves them in place for at least six hours after intercourse
177
What should women use with diaphragms and cervical caps with to reduce the risk of pregnancy further?
Spermicide gel
178
How effective are diaphragms and cervical caps with spermicide gel?
95%
179
When should emergency contraception be used?
After episodes of unprotected sexual intercourse
This includes situations where the contraceptive method is not protective, such as damaged condoms or multiple missed pills
180
What are the three types of emergency contraceptions?
Levonorgestrel Pill
Ulipristal Pill
Copper Coil
181
What is contained in the levonorgestrel pill?
Progesterone
182
When is levonorgestrel pill used for emergency contraception?
It can be used up to 72 hours post intercourse
183
What dosage of levonorgestrel is given?
1.5mg one dose
However 3mg in those that have a BMI greater than 25
184
What are the two side effects of the levonorgestrel pill?
Nausea
Vomiting
185
What advice is given if women vomit within three hours of taking the levonorgestrel pill?
The dose should be repeated
186
What advice is given to those breastfeeding with the levonorgestrel pill?
The pill is not known to be harmful breastfeeding
However, it is advised that breastfeeding is avoided for eight hours after taking the dose to reduce the exposure to the infant
187
What is contained in the ulipristal pill?
A selective progesterone receptor modulator
188
When can ulipristal pill be used an an emergency contraceptive?
It can be used up to five days post intercourse
189
What is the most common brand of the ulipristal pill? What dose is usually prescribed?
EllaOne
30mg
190
What is the most effective emergency contraceptive pill? How effective are they?
Ulipristal
60-80%
191
What are the two side effects of the ulipristal pill?
Nausea
Vomiting
192
What advice is given to individuals who vomit within three hours of taking the ulipristal pill?
The dose should be repeated
193
What are the three contraindications of the ulipristal pill?
Breastfeeding
Severe Asthma
Enzyme Inducing Drugs
194
What is the most effective emergency contraceptive? How effective are they?
Copper coil
99%
195
What makes the copper coil the most effective emergency contraceptive?
This is due to the fact that it is not affected by BMI, enzyme inducing drugs or malabsorption – which can significantly reduce the effectiveness of oral methods
196
How long should the copper coil be kept in for emergency contraception?
Until the next period, after which it can be removed
If individuals wish it can be left in long term as contraception
197
What advice is given when the levonorgestrel pill has been used as an emergency contraceptive within the same menstrual cycle? (ulipristal pill)
It is advised that patients are not prescribed ulipristal within the next seven days
198
What advice is given when the ulipristal pill has been used as an emergency contraceptive within the same menstrual cycle? (levonorgestrel pill)
It is advised that patients are not prescribed levonorgestrel within the next five days
199
How long after taking the levonorgestrel pill can we prescribe hormonal contraception methods? Why?
Immediately
This is due to the fact that the levonorgestrel pill contains progesterone
200
How long after taking the ulipristal pill can we prescribe hormonal contraception methods? Why?
It needs to be delayed for five days
This is due to the fact that the ulipristal pill contains progesterone receptor modulator
201
At what age does a competence assessment need to be conducted before contraception can be prescribed?
Under 16
202
What competence assessment test is used for prescribing contraception to under 16 year olds?
Fraser
203
What guidelines are used to spot signs of child sexual exploitation?
Brook/BASHH guidelines
204
At what age does sexual activity always result in a child protection referral?
13
205
At what age does sexual activity with a partner of a two year age gap raise additional concerns?
16
206
What after sterilisation procedures?
They are permanent surgical interventions to prevent concepti
207
What is the female sterilisation procedure?
Tubal occlusion
208
Describe tubal occlusion procedure
This is typically performed by laparoscopy under a general anaesthetic, with occlusion of the tubes using Filshie clips
In some cases, the fallopian tubes can be tied and cut, or removed altogether
This can be done as an elective procedure, or during a c-section
209
How does tubal occlusion prevent conception?
The procedure works by preventing the ovum travelling from the ovary to the uterus along the fallopian tube
This means the ovum and sperm will not meet and pregnancy cannot occur
210
Does tubal occlusion effect periods?
There is no effect
This is because the endometrium will still break down every month due to normal hormone production
211
What is the male sterilisation procedure?
Vasectomy
212
Describe the vasectomy procedure
This procedure involves cutting the vas deferens via a small incision midline of the scrotum
The procedure is performed under local anaesthetic, mostly in a primary care setting
213
How does the vasectomy procedure prevent conception?
It prevents sperm travelling from the testes to join the ejaculated fluid
214
Why is vasectomy preferred to tubal occlusion?
It is a less invasive procedure than female sterilisation
The failure rate is lower in males
215
How long after vasectomy is alternative contraception required?
Two months
216
How do confirm the success of a vasectomy procedure?
We then test the patient’s semen sample after 12 weeks to confirm the absence of sperm
The use of two sperm samples is usually recommended
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Do vasectomy procedures have an effect on sexual function? Why?
No
Due to normal hormone production of testosterone
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How long after childbirth can individuals become pregnant?
21 days
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How long after an abortion or miscarriage can individuals become pregnant?
5 days
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What is the lactational amenorrhea method (LAM)?
This is when breastfeeding delays the return of periods, therefore acting as a contraceptive
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How long can breastfeeding act as a contraceptive?
The first six months
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How often do individuals need to breastfeed for it to act as a contraceptive?
They nurse at least every 4 hours during the day and every 6 hours at night
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Does breastfeeding affect contraception use?
Breastfeeding patients can use any form of contraception
However, they must wait six weeks to use combined hormonal contraception
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What is the primary mechanism in which the copper coil prevents conception?
It decreases sperm motility and survival
