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Reproductive System Brian > Contraception > Flashcards

Contraception Flashcards

1
Q

What is the most common form of medical contraception?

A
  1. Sterilised 28%
  2. Combined hormonal contraception (CHC) 25%
  3. Intrauterine methods (coil) 6%
  4. Progesterone only pill and progestogen only implants or injectable both 5%
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2
Q

Describe the characteristics of the ‘ideal’ contraception?

A
  • Reversible
    • All but sterilisation
  • Effective
    • None but vasectomy most then implant
  • Free from side effects
    • None
  • Protective against STIs
    • Condom is best
  • Low maintenance
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3
Q

What is the Pearl index?

A

Number of contraceptive failures per 100 woman years of exposure

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4
Q

What can failure of contraception occur due to?

A
  • Method failure
    • Pregnancy despite correct use of method by user
  • User failure
    • Pregnancy because method not used correctly by user
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5
Q

What does LARC stand for?

A

Long acting reversible contraception

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6
Q

Why does LARC reduce failure rates?

A

Minimises user input

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7
Q

Which form of contraception has the lowest Pearl index?

A

IUS (intra-uterine system)

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8
Q

When is the highest chance of pregnancy curing the ovulation cycle?

A

When sex can cause pregnancy (if 26-32 day cycle and not on hormonal treatment):

  • Likely ovulate day 12-18 (2 weeks before period)
  • Egg survives 24 hours
  • Most sperm survive less than 4 days (5% may survive 7 days)
  • So highest chance of pregnancy occurs on day 8-19
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9
Q

How long can most sperm survive for inside the vagina?

A
  • Most sperm survive less than 4 days (5% may survive 7 days)
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10
Q

What does CHC stand for?

A

Combined hormonal contraception

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11
Q

What are different forms of CHC?

A
  • Pill
    • Taken every day anytime in 24 hours
  • Patch
    • Changed weekly
  • Vaginal ring
    • Changed every 3 weeks
    • Can be taken out for 3 hours out of every 24
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12
Q

How often is the CHC patch changed?

A

Weekly

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13
Q

How often is the CHC vaginal ring changed?

A
  • Changed every 3 weeks
  • Can be taken out for 3 hours out of every 24
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14
Q

What hormones are in CHC?

A

Is a combination of 2 hormones:

  • Ethinyl estradiol (EE) and synthetic progesterone (progestogen)
  • Stops ovulation, also affects cervical mucus and endometrium
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15
Q

What is the effect of CHC?

A
  • Stops ovulation, also affects cervical mucus and endometrium
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16
Q

What is the standard regime of CHC?

A

Standard regime is 21 days with a hormone free week

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17
Q

What are some non-contraceptive benefits of CHC?

A
  • Regulate/reduce bleeding
  • Stop ovulation
    • May help with premenstrual syndrome
  • 50% reduced risk in ovarian and endometrial cancer
  • Improve acne
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18
Q

What are some possible side effects of CHC?

A
  • Breast tenderness
  • Nausea
  • Headache
  • Irregular bleeding first 3 months
  • Serious risks
    • Increased risk venous thrombosis – DVT, PE (3x risk)
      • Avoid if BMI>34, previous VTE, family history
    • Increased risk arterial thrombosis – MI/stroke
      • Avoid in smokers >35, history thrombosis, age > 50
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19
Q

What does POP stand for?

A

Progestogen only pill

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20
Q

What is the administration of POP?

A
  • Same time every day without a pill-free interval
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21
Q

What are the different types of POP?

A
  • Desogestrel pill
    • 12 hour window period
    • Nearly all cycles anovulant (without ovulation), most bleed free
  • Traditional LNG NET pill
    • 3 hour window period
    • 1/3 bleed free, 1/3 irregular, 1/3 regular
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22
Q

What are some contraindications for POP?

A
  • History of breast cancer
  • History of liver tumour
  • NO increased venous or arterial thrombosis
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23
Q

What are some possible side effects of POP?

A
  • Appetite increase
  • Hair loss/gain
  • Mood change
  • Bloating or fluid retention
  • Headache
  • Acne
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24
Q

What is injectable progesterone?

A

Aqueous solution of the progestogen depomedroxyprogesterone acetate Depoprovera

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25
Q

What is injectable progesterone known as?

A

The jag

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26
Q

What is the adminion of injectable progesterone?

A
  • 150mg 1ml deep IM injection into upper outer quadrant of the buttock every 13 weeks
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27
Q

What are the effects of injectable progesterone?

A
  • Prevents ovulation
  • Alters cervical mucus making it hostile to sperm
  • Makes endometrium unsuitable for implantation
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28
Q

Are there any contraindications for injectable progesterone?

A
  • Oestrogen free so few
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29
Q

What are some side effects/problems with injectable progesterone?

A
  • Delay to fertility
    • About 9 months
  • Reversible reduction in bone density
  • Problematic bleeding
  • Weight gain
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30
Q

What is the only contraception with a causal effect on weight gain, delayed return of fertility and bone density?

A

Injectable progesterone

31
Q

What is subdermal progestogen implant Nexplanon known as?

A

The rod

32
Q

What is subdermal progestogen implant Nexplanon made from?

A
  • Core
    • 68mg etonogestrel (ENG)
  • Membrane
    • Ethinyl vinyl acetate (EVA)
33
Q

What are the effects of subdermal progestogen implant Nexplanon?

A
  • Inhibition of ovulation
  • Effect on cervical mucus
34
Q

What are advantages of subdermal progestogen implant Nexplanon?

A
  • Can last 3 years and be removed at any time
  • No user input needed
  • No causal effect on weight
35
Q

What are disadvantages of subdermal progestogen implant Nexplanon?

A
  • 30% have prolonged bleeding
  • May cause mood change more often than other progestogen only methods
36
Q

What is intrauterine contraception known as?

A

The coil

37
Q

What is intrauterine contraception a form of?

A

LARC

38
Q

What are advantages of intrauterine contraception?

A
  • Little user input
  • Can be fitted for any age
  • Effects/side effects immediately reversible when removed
39
Q

What are possible side effects of intrauterine contraception?

A
  • Small risk of infection in first 3 weeks <1:1000
  • Perforation 1:1000
  • Expulsion 5:100
  • If conceives may be ectopic
40
Q

What are contraindications for intrauterine contraception?

A
  • Untreated pelvic infection
  • Distorted endometrial cavity
41
Q

What is the difference between IUD and IUS?

A

Intrauterine device - releases copper which is toxic to sperm

Intrauterine system - releases progesterone

42
Q

What are the effects of copper IUD?

A
  • Toxic to sperm
  • Stop sperm reaching egg
  • May prevent implantation of fertilised egg
43
Q

What are possible side effects of copper IUD?

A
  • May make periods heavier and crampier
44
Q

What are advantages of copper IUD?

A
  • Can last 5-10 years depending on type
  • Hormone free
  • Not a contraindication to MRI
45
Q

What are the effects of levonorgestrel IUS?

A
  • Affect cervical mucus and endometrium, most woman still ovulate
  • Stop fertilisation of egg
46
Q

What are advantages of levonorgestrel IUS?

A
  • Low circulating progestogen levels compared with pill/implant/injection
  • Reduce menstrual bleeding after up to 4 months initial irregular bleeding
47
Q

What are different types of levonorgestrel IUS?

A
  • Mirena
    • 5 years contraception
    • More hormone than other 2
  • Kyleena
    • 5 years contraception
  • Jaydess
    • 3 years contraception
48
Q

Which type of levonorgestrel IUS contains the most hormone levels?

A

Mirena

49
Q

What are different kinds of emergency contraception?

A
  • Copper IUD
    • Most effect option
    • Needs to be fitted before implantation, so within 120 hours of sex
    • 1/100 failure rate
  • Levonorgestrel pill “Levonelle”
    • Take within 72 hours
    • 2-3/100 failure rate
  • Ulipristal pill “Ellaone”
    • Take within 120 hours
    • 1-2/100 failure rate
    • More contraindications, such as breast feeding, enzyme inducing drugs, acid reducing drugs
50
Q

How long after sex must copper IUD, levonorgestrel pill, and ulipristal pill be taken?

A

Copper IUD - 120 hours

Levonorgestrel pill “Levonelle” - 72 hours

Ulipristal pill “Ellaone” - 120 hours

51
Q

Once contraception has been started, during what phases of the ovulation cycle does it work in the beginning?

A
  • Start first 5 days of cycle
    • Immediate cover
  • Other times
    • Need condoms/abstain for next 7 days
52
Q

When can you get pregnant after delivery, miscarriage and abortion?

A

Delivery - 21 days

Miscarriage - 5 days

Abortion - 5 days

53
Q

For how long is breast feeding a contraceptive?

A

Breast feeding is contraceptive for first 6 months:

  • Breast feeding woman can use any kind of contraception
54
Q

What are examples of common drug interactions with contraception?

A
  • Enzyme inducing drugs
    • Such as carbamazepine, topiramate, rifampicin
    • Increases the metabolism of progestogen and oestrogen, reducing effectiveness of combined pill, patch, ring, POP and implant
    • Injectable progestogens and copper or levonorgestrel IUD are not affected
55
Q

What are some barrier methods of contraception?

A
  • Diaphragm
  • Cervical cap
  • Male condom
  • Female condom
56
Q

What is the most common method of female sterilisation?

A

Laparoscopic sterilisation = filshie clips applied across tube to block the lumen

57
Q

What are risks of female sterilisation?

A
  • Irreversible so risks regret
  • Failure rate 1/200
58
Q

What are advantages of female sterilisation?

A
  • No effect on periods/hormones
  • Reduces ovarian cancer risk
59
Q

What happens in a vasectomy?

A

Vas deferens divided and ends cauterised small incision midline scrotum:

  • Under local anaesthetic so most done in primary care
60
Q

What are advantages of vasectomy?

A
  • No effect on testosterone or sexual function
  • No increased risk testicular or prostate cancer
61
Q

What are disadvantages of vasectomy?

A
  • Takes 4-5 months to be effect
  • Failure rate 1/2000
  • Irreversibility
  • 1:100 testicular pain
62
Q

What percentage of UK woman have an abortion?

A

1/3 UK woman will have an abortion:

  • Most common age group is 20-24
  • Numbers falling
  • 90% are under 12 weeks
63
Q

What are the clinicians rights and responsibilities in regards to abortion?

A
  • Right to refuse
  • Ensure woman can access abortion care if they refuse
64
Q

What ligislation directs abortions?

A

Abortion Act 1967

65
Q

What cirriculum must be achieved for an abortion to be allowed under the Abortion Act 1967?

A
  • 2 doctors sign to support woman’s request
    • Continuing pregnancy has grave risk to life of woman, more than if is terminated
    • Necessary to prevent grave injury to physical or mental health of woman
    • Substantial risk that if child was born it would suffer physical or mental abnormalities as to be seriously handicapped
66
Q

What occurs in a clinic consultation about abortion?

A
  • Scan for gestation and viability
  • Medical history
    • Risk VTE, bleeding, contraceptive eligibility
  • Circumstances
    • Reason for considering abortion, check coercion or gender based violence
  • Discuss methods and what to expect
  • Contraception for afterwards
  • Investigations
    • FBC/Rhesus group
    • Vaginal swab for chlamydia and gonorrhoea
    • STI bloods offered
67
Q

What are the different forms of terminating a pregnancy?

A
  • Surgically
    • Can be done from weeks 5-12
    • Complications
      • Perforation 4:1000
      • Infection
  • Medically
    • Can be done weeks 5-24
    • Mifepristone oral antiprogestogen tablet
    • 36-48 hours later misoprostol initiates uterine contraction which opens cervix and expels pregnancy
    • Complications
      • Failure 1:100<8 weeks and 8:100 > 12 weeks, needs surgery to complete
      • Infection
    • Can be done at home
68
Q

During what weeks is a surgical abortion possible?

A

Weeks 5-12

69
Q

What are possible complications of a surgical abortion?

A
  • Perforation 4:1000
  • Infection
70
Q

During what weeks can a medical abortion be done?

A
  • Can be done weeks 5-24
71
Q

What medication is given for a medical abortion?

A
  • Mifepristone oral antiprogestogen tablet
  • 36-48 hours later misoprostol initiates uterine contraction which opens cervix and expels pregnancy
72
Q

What are possible complications of medical abortions?

A
  • Failure 1:100<8 weeks and 8:100 > 12 weeks, needs surgery to complete
  • Infection
73
Q

What are some long term effects of abortion?

A
  • No effect on future fertility
  • No effect on cancer risks
  • Emotional effects

Reproductive System Brian (34 decks)

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