contraception Flashcards

Question

what type of hormonal contraception should yo be cautious with asthmatics

Answer 1

breastfeeding should be delayed for one week after taking ulipristal.

Answer 2

copper IUD

Answer 3

must be inserted within 5 days of UPSI, or if a woman presents after more than 5 days then an IUD may be fitted up to 5 days after the likely ovulation date

Answer 4

ones that contain levonorgestrel or norethisterone e.g. Microgynon or Leostrin least risk of VTE

Answer 5

drospirenone Drospirenone has anti-mineralocorticoid and anti-androgen activity, and may help with symptoms of bloating, water retention and mood changes. Continuous use of the pill, as opposed to cyclical use, may be more effective for premenstrual syndrome.

Answer 6

COCPs containing cyproterone acetate (i.e. co-cyprindiol) can be considered in the treatment of acne and hirsutism. Cyproterone acetate has anti-androgen effects, helping to improve acne and hirsutism. The oestrogenic effects mean that co-cyprindiol has a 1.5 – 2 times greater risk of venous thromboembolism compared to the first-line combined pills (e.g. Microgynon). It is usually stopped three months after acne is controlled, due to the higher risk of VTE.

Answer 7

Small increased risk of breast and cervical cancer, returning to normal ten years after stopping. Protective against endometrial and ovarian cancers

Answer 8

if the COC is started within the first 5 days of the cycle then there is no need for additional contraception. If it is started at any other point in the cycle then alternative contraception should be used (e.g. condoms) for the first 7 days

Answer 9

take the last pill even if it means taking two pills in one day and then continue taking pills daily, one each day no additional contraceptive protection needed

Answer 10

take the last pill even if it means taking two pills in one day, leave any earlier missed pills and then continue taking pills daily, one each day Use condoms or abstain from sex until she has taken pills for 7 days in a row. Emergency contraception? if pills are missed in week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1 if pills are missed in week 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception* if pills are missed in week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval

Answer 11

precautions should still be taken with enzyme inducing antibiotics such as rifampicin

Answer 12

- >35 years old and smoker of > 15 cigarettes per day - migraine with aura - Personal history of deep vein thrombosis or pulmonary embolism - Personal history of stroke or ischaemic heart disease - Uncontrolled hypertension - Breast cancer - Recent major surgery with prolonged immobilisation - Breast feeding and < 6 weeks postpartum - positive antiphospholipid antibodies (e.g. in SLE)

Answer 13

- > 35 years old and smoker of < 15 cigarettes per day - BMI > 35 - Migraine with no aura - Family history of deep vein thrombosis or pulmonary embolism in first degree relative < 45 years old - Controlled hypertension - Immobility e.g. Wheelchair use - Breast feeding and 6 weeks to 6 months postpartum

Answer 14

inhibit ovulation

Answer 15

thickens cervical mucous

Answer 16

primary: inhibit ovulation also: thickens cervical mucous

Answer 17

Primary: Inhibits ovulation Also: thickens cervical mucus

Answer 18

Primary: Inhibits ovulation Also: thickens cervical mucus

Answer 19

Decreases sperm motility and survival

Answer 20

Primary: Prevents endometrial proliferation Also: Thickens cervical mucus

Answer 21

active breast cancer

Answer 22

Traditional progestogen-only pill (e.g. Norgeston or Noriday) Cannot be delayed by more than 3 hours. Taking the pill more than 3 hours late is considered a “missed pill”.

Answer 23

12 hours late

Answer 24

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 pregnancy can be excluded. Additional contraception is required for 48 hours. It takes 48 hours for the cervical mucus to thicken enough to prevent sperm entering the uterus.

Answer 25

POPs can be switched immediately without any need for extra contraception.

Answer 26

When switching from a COCP to a POP, the directions depend on what point they are in the COCP pill packet. The best time to change is on day 1 to 7 of the hormone-free period after finishing the COCP pack, in which case no additional contraception is required. Sometimes it is essential to switch immediately, for example, if they develop migraines with aura. If they have not had sex since finishing the COCP pack, they can switch straight away but need to use extra contraception (i.e. condoms) for the first 48 hours of the POP. If they have had sex since completing the last pack of combined pills, they need to have completed at least seven consecutive days of the combined pill before switching, then use extra contraception for 48 hours. If this is not possible, emergency contraception may need to be considered.

Answer 27

20% have no bleeding (amenorrhoea) 40% have regular bleeding 40% have irregular, prolonged or troublesome bleeding may take 3 months to fully find out which you will be so worth persisting

Answer 28

Breast tenderness Headaches Acne

Answer 29

Ovarian cysts Small risk of ectopic pregnancy with traditional POPs (not desogestrel) due to reduce ciliary action in the tubes Minimal increased risk of breast cancer, returning to normal ten years after stopping

Answer 30

More than 3 hours late for a traditional POP (more than 26 hours after the last pill) More than 12 hours late for the desogestrel-POP (more than 36 hours after the last pill) The instructions are to take a pill as soon as possible, continue with the next pill at the usual time (even if this means taking two in 24 hours) and 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.

Answer 31

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

Answer 32

every 12-13 weeks

Answer 33

UK MEC 4 Active breast cancer UK MEC 3 Ischaemic heart disease and stroke Unexplained vaginal bleeding Severe liver cirrhosis Liver cancer

Answer 34

Starting on day 1 to 5 of the menstrual cycle offers immediate protection, and no extra contraception is required. Starting after day 5 of the menstrual cycle requires seven days of extra contraception (e.g. condoms) before the injection becomes reliably effective.

Answer 35

irregular bleeding weight gain osteoporosis acne

Answer 36

There are several possible benefits of the injection, with evidence that it: Improves dysmenorrhoea (painful periods) Improves endometriosis-related symptoms Reduces the risk of ovarian and endometrial cancer Reduces the severity of sickle cell crisis in patients with sickle cell anaemia

Answer 37

Inserting the implant on day 1 to 5 of the menstrual cycle provides immediate protection. Insertion after day 5 of the menstrual cycle requires seven days of extra contraception (e.g. condoms), similar to the injection.

Answer 38

1/3 have infrequent bleeding 1/4 have frequent or prolonged bleeding 1/5 have no bleeding The remainder have normal regular bleeds The FSRH guidelines suggest the combined oral contraceptive pill (COCP) in addition to the implant for three months when problematic bleeding occurs, to help settle the bleeding (provided there are no contraindications).

Answer 39

Pelvic inflammatory disease or infection Immunosuppression Pregnancy Unexplained bleeding Pelvic cancer Uterine cavity distortion (e.g. by fibroids)

Answer 40

Bleeding Pain on insertion Vasovagal reactions (dizziness, bradycardia and arrhythmias) Uterine perforation (1 in 1000, higher in breastfeeding women) Pelvic inflammatory disease (particularly in the first 20 days) The expulsion rate is highest in the first three months

Answer 41

Before the coil is removed, women need to abstain from sex or use condoms for 7 days, or there is a risk of pregnancy.

Answer 42

increased risk of ectopic pregnancy

Answer 43

Copper is toxic to the ovum and sperm. It also alters the endometrium and makes it less accepting of implantation.

Answer 44

Mirena: effective for 5 years for contraception, and also licensed for menorrhagia and HRT Levosert: effective for 5 years, and also licensed for menorrhagia Kyleena: effective for 5 years Jaydess: effective for 3 years

Answer 45

The LNG-IUS can be inserted up to day 7 of the menstrual cycle without any need for additional contraception. If it is inserted after day 7, pregnancy needs to be reasonably excluded, and extra protection (i.e. condoms) is required for 7 days.

Answer 46

Alternative contraception is required until the next menstrual period, as an ovum may have already reached the uterus during that cycle, ready for fertilisation.

Answer 47

Alternative contraception is required for two months after the procedure. Testing of the semen to confirm the absence of sperm is necessary before it can be relied upon for contraception. Semen testing is usually carried out around 12 weeks after the procedure, as it takes time for sperm that are still in the tubes to be cleared. A second semen analysis may be required for confirmation.

Answer 48

- Any progesterone only contraception - copper coil

Answer 49

Evra patch is the only combined contraceptive patch licensed for use in the UK. The patch cycle lasts 4 weeks. For the first 3 weeks, the patch is worn everyday and needs to be changed each week. During the 4th week, the patch is not worn and during this time there will be a withdrawal bleed.

Answer 50

If the patch change is delayed at the end of week 1 or week 2: If the delay in changing the patch is less than 48 hours, it should be changed immediately and no further precautions are needed. If the delay is greater than 48 hours, the patch should be changed immediately and a barrier method of contraception used for the next 7 days.

Answer 51

Micronor, Noriday, Nogeston, Femulen

Answer 52

the implant

Answer 53

instant: IUD 2 days: POP 7 days: COC, injection, implant, IUS

Answer 54

Oestrogen-containing contraceptives should preferably be discontinued 4 weeks before major elective surgery and all surgery to the legs or surgery which involves prolonged immobilisation of a lower limb.

Answer 55

the dose should be doubled for those with a BMI >26 or weight over 70kg