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Contraception Flashcards

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1
Q

What are some absolute contraindications of the COCP?

A

Smoker ages 35+, <6 weeks post-partum, breast feeding, hypertension, current/past VTE history, migraine with aura, CVD, current breast cancer, liver cirrhosis

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2
Q

What are some relative contraindications of the COCP?

A

Adequately controlled hypertension, migraine and 35+, BMI over 35, enzyme-inducing medications

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3
Q

How does the COCP work?

A
  • Stops ovulation
  • Increases cervical mucus
  • Thins endometrium
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4
Q

How is the COCP taken?

A

Once daily-> 3 weeks on + 1 week off

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5
Q

What are the risks and side effects of the COCP?

A
  • Hormonal-> weight gain, acne, mood changes, headache
  • Blood clots
  • Increases breast + cervical cancer risk
  • Lighter periods
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6
Q

What are some positives about the COCP?

A
  • Can control periods, bleeding and pain

- Reduces risk of endometrial + cervical cancer

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7
Q

What should someone do if they miss one pill (COCP)?

A
  • Take ASAP even if means two at same time

- If next pill on time then should be fine

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8
Q

What should someone do if they miss two pills (COCP)?

A
  • Take 1 pill immediately
  • Use condoms for 7 days
  • Further management depends on week
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9
Q

What should someone do if they miss two pills (COCP) in the first week of their packet?

A

If had sex in pill-free interval or 1st week of packet-> will need emergency contraception

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10
Q

What should someone do if they miss two pills (COCP) in the second week of their packet?

A
  • Take 1 pill immediately
  • Use condoms for 7 days
  • No further action
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11
Q

What should someone do if they miss two pills (COCP) in the third week of their packet?

A
  • Take 1 pill immediately
  • Use condoms for 7 days
  • Omit the pill-free week
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12
Q

When should someone on the COCP use condoms for 7 days?

A
  • D+V
  • Enzyme inducing drugs
  • Usually when missed 2 or more pills
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13
Q

What are some absolute contraindications of the combined contraceptive patch?

A

Same as COCP-> smoker ages 35+, <6 weeks post-partum, breast feeding, hypertension, current/past VTE history, migraine with aura, CVD, current breast cancer, liver cirrhosis

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14
Q

What are some absolute contraindications of the combined contraceptive vaginal ring?

A

Same as COCP-> smoker ages 35+, <6 weeks post-partum, breast feeding, hypertension, current/past VTE history, migraine with aura, CVD, current breast cancer, liver cirrhosis

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15
Q

What are some relative contraindications of the combined contraceptive patch?

A

Same as COCP-> Adequately controlled hypertension, migraine and 35+, BMI over 35, enzyme-inducing medications

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16
Q

What are some relative contraindications of the combined contraceptive vaginal ring?

A

Same as COCP-> Adequately controlled hypertension, migraine and 35+, BMI over 35, enzyme-inducing medications

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17
Q

How does the combined contraceptive patch work?

A
  • Stops ovulation
  • Increases cervical mucus
  • Thins endometrium
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18
Q

How does the combined contraceptive vaginal ring work?

A
  • Stops ovulation
  • Increases cervical mucus
  • Thins endometrium
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19
Q

How is the combined contraceptive patch administered?

A

Change weekly with 1 patch-free week per month

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20
Q

What are some of the risks and side effects of the combined contraceptive patch?

A
  • Hormonal-> weight gain, acne, mood changes, headache
  • Blood clots
  • Increases breast + cervical cancer risk
  • Lighter periods
  • Local irritation
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21
Q

What are some positives about the combined contraceptive patch?

A
  • Can control periods, bleeding and pain
  • Reduced risk of endometrial + ovarian cancer
  • Don’t need to remember to take a pill every day
  • Effective when D+V etc
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22
Q

How is the combined contraceptive vaginal ring administered?

A

Leave in for 3 weeks then 1 ring-free week

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23
Q

What are some of the risks and side effects of the combined contraceptive vaginal ring?

A
  • Hormonal-> weight gain, acne, mood changes, headache
  • Blood clots
  • Increases breast + cervical cancer risk
  • Lighter periods
  • Pain from ring during intercourse-> can remove but only for 3 hours max
  • Can come out on its own
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24
Q

What are some of the positives of the combined contraceptive vaginal ring?

A
  • Can control periods, bleeding and pain
  • Reduced risk of endometrial + ovarian cancer
  • Don’t need to remember to take a pill every day
  • Effective when D+V etc
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25
How effective if the COCP?
- When used correctly-> 99% | - Typically-> 92%
26
How effective is the combined contraceptive patch?
- When used correctly-> 99% | - Typically-> 92%
27
How effective is the combined contraceptive vaginal ring?
- When used correctly-> 99% | - Typically-> 91%
28
How effective is the progesterone-only pill?
- When used correctly-> 99% | - Typically-> 92%
29
What are the contraindications of the progesterone-only pill?
Forgetfulness, breast cancer, undiagnosed PV bleeding, liver disease
30
How does the progesterone-only pill work?
- Increases cervical mucus | - Thins endothelium
31
How is the progesterone-only pill administered?
Once daily without a pill-free break
32
What are some risks and side effects of the progesterone-only pill?
- Hormonal-> weight gain, acne, mood changes, headache - Periods-> can stop or be irregular, lighter or more frequent - Must take at same time each day-> window of effectiveness much narrower
33
What are the positives of the progesterone-only pill?
- Not as many side effects as COCP | - Very effective when taken properly
34
What should be done if someone misses one dose of the progesterone-only pill (within 3 hours)?
Take as soon as remember + no action needed
35
What should be done if someone misses one dose of the progesterone-only pill (3 hours late or 12 hours late for Cerazette?)
- Use condoms for 2 days | - Consider emergency contraception-> if had sex in 2-3 days before or since missed pill
36
How effective is the copper coil (IUD)?
Over 99%
37
What are the contraindications of the copper coil (IUD)?
Pelvic infection, PID <3 months ago, gynae cancer, small uterine cavity, undiagnosed PV bleeding, copper allergy
38
How does the copper coil (IUD) work?
Acts as spermicide + causes intra-uterine inflammation
39
How long does the copper coil (IUD) last?
-Usually 5 years
40
What are the risks and side effects of the copper coil (IUD)?
- Infection in 1st 3 weeks - Bleeding after procedure - Perforation (1/1000) - Expulsion (1/20) - Vasovagal (1/10) - Heavier periods
41
What advice should be given to people getting the copper coil (IUD)?
- Check strings monthly - STI check before insertion - If >40 can stay in place until menopause
42
When can the copper coil (IUD) be fitted?
- As emergency contraception (within 5 days of sex) - Any time if not had sex since period - Ideally within first 5 days of period - Should be effective immediately
43
How effective is the intra-uterine coil (IUS)?
Most effective-> over 99%
44
What are the contraindications of the intra-uterine coil (IUS)?
Pelvic infection, PID <3 months ago, gynae cancer, small uterine cavity, undiagnosed PV bleeding
45
How does the intra-uterine coil (IUS) work?
- Stops ovulation - Increases cervical mucus - Thins endometrium
46
How long does the intra-uterine coil (IUS) last?
- Usually 5 years | - Jaydess-> 3 years
47
What are the risks and side effects of the intra-uterine coil (IUS)?
- Infection in 1st 3 weeks - Bleeding after procedure - Perforation (1/1000) - Expulsion (1/20) - Vasovagal (1/10) - Some hormonal-> mood swings, breast tenderness, acne - Spotting for 6 months then light/absent periods
48
What are the positives of the intra-uterine coil (IUS)?
- Can forget about it | - Reduced dysmenorrhoea + menorrhagia
49
What additional advice should be given to people getting the intra-uterine coil (IUS)?
- Check strings monthly - STI check before insertion - If >45 can stay in place until menopause
50
When should the intra-uterine coil (IUS) be fitted?
- Ideally within first 7 days of period | - If not-> should use barrier contraception for 7 days after fitting
51
What are the contraindications of the implant?
Liver/genital/breast cancer, liver disease, undiagnosed PV bleeds, on enzyme inducing medications
52
How does the implant work?
- Contains progesterone - Stops ovulation - Increases cervical mucus - Thins endometrium
53
How long does the implant last?
3 years
54
What are some of the side effects of the implant?
- Some hormonal side effects-> weight gain, acne etc - Periods can stop, become irregular or get longer - Insertion risks-> bruising, infection, scarring, expulsion
55
How is the implant inserted?
- Under the skin of upper arm under local anaesthetic | - Can feel it
56
When should the implant be inserted?
- Ideally within first 7 days of period | - If not-> should use barrier contraception for 7 days after fitting
57
How effective is the implant?
Over 99%
58
How effective is the Depo injection?
97%
59
What are the contraindications of the depo injection?
Liver/genital/breast cancer, liver disease, undiagnosed PV bleeds, on enzyme inducing medications
60
How does the depo injection work?
- Contains progesterone - Stops ovulation - Increases cervical mucus - Thins endometrium
61
How long does the depo injection last?
3 months (13 weeks)
62
What are the side effects of the Depo injection?
- Some hormonal side effects-> weight gain, acne etc - Periods-> can stop, become irregular or longer - Takes time for fertility to return - Osteoporosis-> should consider stopping at 2 years and definitely at 5 years - Side effects can last 3 months as irreversible
63
How effective are condoms?
- When used properly-> 98% | - Typical use-> 85%
64
What are the contraindications to condoms?
Latex allergy-> can get ones without
65
How do condoms work?
Physical barrier to sperm
66
What are the risks of condoms?
- Small allergy risk - May slip off or break - Interrupts sex
67
What are the benefits of condoms?
Only contraception with STI protection
68
How effective is the diaphragm?
Around 84%
69
How is the diaphragm used?
- Inserted into vagina before sex to cover cervix - Needs spermicide - Leave in for 6 hours after
70
What are the positives of using a diaphragm?
- No hormonal side effects | - Reuseable after cleaning
71
What are the risks of using a diaphragm?
- Insertion can be difficult - Cystitis - Doesn't protect from STIs - Don't use during periods-> TSS risk
72
How effective is tubal ligation?
- Failure rate of 1/200 | - So over 99% effective
73
How is tubal ligation done?
Fallopian tubes clipped laproscopically under GA
74
What are the risks of tubal ligation?
- Failure-> 1 in 200 - Anaesthetic risks - Bleeding, bruising, infection - Irreversible
75
How effective is vasectomy?
-Very-> failure rate only 1 in 2000
76
How is a vasectomy perfored?
- Vas deference cut + tied with forceps through skin or scrotum - Local anaesthetic - Takes 20 minutes
77
What are the risks of vasectomy?
- Failure rate-> 1 in 2000 - Bleeding, bruising, infection - Swollen scrotum for few days - Sperm granulomas if leaks - Chronic testicular pain
78
What follow up and advice should be given after a vasectomy?
- Can take 3 months for remaining sperm to be used up - Take sperm sample at 8 weeks then 2-4 weeks later-> both need to be negative - Can have sex with a condom whenever feel ready
79
How effective is the fertility awareness method?
Around 73%
80
How does the fertility awareness method work?
- Monitor and record fertility signals during cycle-> temperature, cervical fluids - Use to work out when likely to get pregnant
81
What are the benefits of the fertility awareness method?
- No side effects | - Normal fertility instantly if decide to plan pregnancy
82
What are the risks of the fertility awareness method?
- Least effective method - Can be a lot of effort - Measurements can be affected by stress or illness

Obs & Gynae (5 decks)

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