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Year 4 - Obs&Gynae > Contraception > Flashcards

Contraception Flashcards

1
Q

Name an example of a Combined oral contraceptive pill (COCP)

A

Microgynon (Ethinylestradiol + Levonorgestrel)

Yasmin (Ethinylestradiol + Drospirenone)

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2
Q

Name an example of a Progesterone only pill (POP)

A

Cerazette (Desogestrel) &laquo_space;12 Hour pill

Norethisterone also used (3 hour pill though???)

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3
Q

Name an example of a contraceptive patch used in the UK

A

Evra

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4
Q

Name a contraceptive vaginal ring

A

Nuva ring

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5
Q

How do Combined hormonal contraceptives work?

A

Negative feedback to the pituitary = prevents release of LH + FSH = Inhibits ovulation

Effects on endometrium = Prevents implantation

Effects on cervical mucus = Prevents sperm penetration

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6
Q

What are the 4 types of regimens for Combined hormonal contraceptives?

A

Extended use (3 pill packs taken back to back / 3 months on pill followed by 7 day break)

Shortened pill-free interval (3 weeks of CHC use then 4 days taken between pill pack)

Extended use with shortened pill-free interval (use for >=21 days; CHC-free period omitted until breakthrough bleeding occurs then 4 day break)

Extended use with regular pill-free interval (use for >=21 days; CHC-free period omitted until breakthrough bleeding occurs then 7 day break)

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7
Q

When is patch CHC preferred to oral CHC?

A

Patch preferred when PMHx of VTE

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8
Q

What are the benefits of Combined Hormonal Contraceptive use?

A

Reduces:
- Menstrual bleeding
- Menstrual pain
- Ovarian cancer risk
- Endometrial cancer risk
- Colorectal cancer risk

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9
Q

What are the risks associated with Combined Hormonal Contraceptive use?

A

Breast cancer (risk increased)
Cervical cancer (risk increased)
VTE (DVT/PE)
Cardiovascular disease + Stroke

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10
Q

What is the name of the criteria for CHC contraindications

A

UK MEC Criteria

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11
Q

Outline the UK MEC Criteria

A

Age >35 + Smoking >15/day
Hypertension (sBP >=160; dBP >=95)
VTE (current or previous)
Migraine with aura
Current breast cancer
CHD/IHD/Stroke

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12
Q

Name 2 drugs which effect the efficacy of COCP

A

Anti-epileptic (eg Phenytoin)
Rifampicin
Certain HIV drugs

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13
Q

What are the side effects of POP?

A

Headaches,
Breast pain,
Acne,
Nausea,
Changes in libido

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14
Q

When are POP contraindicated?

A

DO NOT USE IN CURRENT BREAST CANCER

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15
Q

What drug is used in the POP injectable? (eg in Depo provera)

A

Medroxyprogesterone acetate

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16
Q

What are the risks associated with POP injectables (Depo provera)

A

Osteoporosis,
Weight gain,
Delayed return of fertility

17
Q

What is a contraindication for the Depo provera?

A

Current breast cancer

18
Q

What are the benefits of the subdermal progesterone only implant? (eg Nexplanon)

A

LARC (less likely to fail due to user reasons)

No adverse effects on BP, risk of VTE or CV disease

BMD – no effect

Rapid return of ovulation&raquo_space; fertility following removal

19
Q

What are the risks associated with the subdermal progesterone only implant (eg Nexplanon)

A

Procedure-related» Infection. Bleeding/Bruising. Scarring.

First 3 months&raquo_space; Irregular bleeding is common.
Long term:
- 2 in 10 = Amenorrhoea
- 3 in 10 = Infrequent bleeding
- 2 in 10 = Prolonged bleeding

20
Q

What is a contraindication for the subdermal progesterone only implant (eg Nexplanon)

A

COMPLETE CONTRAINDICATION = CURRENT BREAST CANCER

21
Q

What are the side effects associated with intra-uterine contraceptive device insertion? (IUS/IUCD)

A

Pain/Discomfort at insertion.
Infection/PID.
Bleeding.
Perforation (of the uterus – 5/1000).
Expulsion (use threads to check or Speculum examination – 1/1000).
Failure + Ectopic pregnancy.

Note: the IUCD can be fitted at the time of caesarean section - if not fitted at the time then have to wait 6 weeks until insertion

22
Q

What are the specific side effects associated with IUCD usage?

A

Dysmenorrhoea and/or HMB

22
Q

What are the specific side effects associated with IUS usage?

A

Hormonal side effects: (less than systemic progesterones)
- Breast tenderness
- Acne
- Headaches

Irregular bleeding

23
Q

Give 3 UKMEC Category 4 criteria for IUD/IUS insertion

A

Initiation of intrauterine methods:
o Pregnancy.
o Current PID or Symptomatic CT or NG
o Pelvic tuberculosis
o Postpartum sepsis
o Immediate post-septic abortion

Initiation of the method in women with unexplained vaginal bleeding:
o Malignant Gestational Trophoblastic Disease
o Cervical cancer
o Endometrial cancer

24
Q

What is a contraindication for IUS insertion (eg Mirena)?

A

Breast cancer

25
Q

Name 3 emergency contraceptives

A

Levonorgestrel
Ulipristal acetate (EllaOne)
Copper intrauterine device (IUD)

26
Q

How long is Levonorgestrel licensed for emergency contraceptive use?

A

Licensed for use up to 72 hours after unprotected sexual intercourse or contraceptive failure

27
Q

How long is Ulipristal acetate (EllaOne) licensed for emergency contraceptive use?

A

Licensed for use up to 120 hours after unprotected sexual intercourse or contraceptive failure

28
Q

How long is the IUD licensed for emergency contraceptive use?

A

Can be used up to 5 days following first unprotected sexual intercourse anywhere in cycle.

OR

Within 5 days from the earliest estimated day of Ovulation.

29
Q

What patient information is provided following Levonorgestrel use?

A

o Emergency contraception can fail.
o Pregnancy test in 3 weeks if abnormal period
o Nausea, Headaches, Breast tenderness or Abdominal pain
o If patient vomits within 2 hours  Repeat dose
o Continue or quick start regular contraception + use condoms
o Repeated use of emergency contraception within same cycle is OK

30
Q

What patient information is provided following Ulipristal acetate (ellaOne) use?

A

o CHC or POP may interfere with action of ellaOne&raquo_space; commence CHC/POP 5 days after administration
o Breast feeding NOT recommended for 7 days after intake
o Repeated use of emergency contraception within same cycle is OK

31
Q

When is Ulipristal acetate (ellaOne) especially more effective than Levonorgestrel?

A

Ulipristal acetate may be more effective than Levonorgestrel in those with BMI >26 or Weight >70kg
* First line (for BMI >26 or BW >70kg) = Cu-IUD (but patients may prefer second line drugs)
* Second line = Ulipristal acetate (or 3mg Levonorgestrel)

Year 4 - Obs&Gynae (27 decks)

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