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GUM > Contraception > Flashcards

Contraception Flashcards

1
Q

What are the three choices for emergency contraception

A

Copper IUD
UPA (ulipristal acetate)
LNG (levonorgestrel)

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2
Q

When can the copper IUD be used for emegency contraception

A

Within 120 hours of unprotected sex or within 5 days of earliest predicted ovulation

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3
Q

How does the copper IUD work as emegency contraception

A

Prevents fertilisation and implantation

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4
Q

When is the copper IUD safe to use as emergency contraception

A

Safe in breastfeeding
No affected by other medication or weight of patient

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5
Q

When can the UPA be used for emegency contraception

A

Within 120 hours of UPSI

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6
Q

How does the UPA work for emegency contraception

A

Delays ovulation for at least 5 days until sperm are no longer viable

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7
Q

What doseage is the the UPA given in for emegency contrapception

A

Oral pill of 30mg of selective progesterone modulator

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8
Q

When is UPA safe to be used for emegency contraception

A

Very little
Cannot be used in those breastfeeding (breast milk unsafe for week after), induces liver enzymes, and those high in BMI or weight.

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9
Q

When can the UPA not be used in regards to other contraceptive the patient is on

A

Re-starting hormonal contraception is delayed for 5 days following use, and its use is avoided if the patient has used any progesterone in the 7 days before accessing emergency contraception

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10
Q

When can the LNG be used for emegency contraception

A

Up to 72 hours after UPSI

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11
Q

How does LNG work

A

Delayed ovulation is administered before LH surge

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12
Q

When is LNG safe to be used for emegency contraception

A

Breastfeeding
Double dose when high BMI or overweight

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13
Q

When is LNG contraindicated

A

Interacts with liver enzyme inducers

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14
Q

Side effects of emergency contraception

A

Headache, nausea, dysmenorrhoea, vomiting (another dose needed), menstrual disturbances, pregnancy test needed if menses delayed for more than 7 days

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15
Q

Reactions of emegency contraception

A

Porphyria, asthma on glucocorticoids, hepatic impairment, liver enzyme inducers, drugs increasing gastric pH, absorption difficulties, high BMI or weight, active STI, postpartum

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16
Q

What are the options for oestrogen containing contraceptive methods

A

COCP
CTP - transdermal patch
CVR - vaginal ring

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17
Q

Mechanism of action for oestrogen contraceptives

A

Inhibits ovulation
Causes alterations in cervical mucus
Suppresses endometrial growth

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18
Q

What are the three types of combined pills

A

Monophasic, phasic and everyday

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19
Q

How is the transdermal patch used

A

Applied weekly for 3 weeks, then a patch free week

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20
Q

How is the vaginal ring used

A

Placed in the vagina for 3 weeks, followed by ring free week

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21
Q

What are the benefits of CHC

A

Reduced heavy bleeding and pain
Reduction in acne, hirsutism, seborrhoea with maximum benefit of 3-6 months later
PMS improved
Used in management of endometriosis and PCOS
Protective against endometrial, ovarian and cervical cancer

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22
Q

What are the risks of CHC

A

VTE risk - highest in first few months or when restarting after a break of at least one month
Ischaemic stroke or MI
Not used in patients with migraines
Small increase in cervical cancer
Small increase in breast cancer

23
Q

Where can the transdermal patch be applied

A

Buttocks, abdomen, torso or upper arm

24
Q

What are progesterone only contraceptive options

A

Traditional pills including LNG, NET or DGS containing pills.
Injectable PO contraceptions - depot DMPA via IM or SC

25
Q

Mode of action of progesterone only contraceptions

A

Suppression of ovulation
Cervical mucus effect

26
Q

Advantages of POC

A

Can be used in migraine with aura, those with history of VTE, smoker adn aged over 35, BMI over 35, HTN, cardiomyopathies, SLE, and during first 6 weeks of breastfeeding

27
Q

Disadvantages of the POC

A

Needs to be taken within 3 hours every day to maintain effect.
Medication inducing CP450 could reduce efficacy.
Altered bleeding patterns
Mood changes
Reduced libido
May reduce efficacy of UPA
Reduced efficacy from vomiting, diarrhoea, malabsorption, bariatric surgery, incorrect pill taking

28
Q

Advantages of the DMPA injection

A

Long acting - 13 week intervals
Reversible
Unaffected by GI upset
Few interactions
Amenorrhoea or reduced bleeding
Useful in endometriosis
Protective against ovarian and endometrial cancer

29
Q

Contraindication of POC

A

Breast cancer
Pregnancy must be excluded before starting

30
Q

Disadvantages of the DMPA injection

A

Duration of effects
REgular needling
Interaction with emegency contraception
Delay in return of fertility
Breast cancer and cervical cancer risk

31
Q

Disadvantages of the DMPA injection

A

Duration of effects
REgular needling
Interaction with emegency contraception
Delay in return of fertility
Breast cancer and cervical cancer risk

32
Q

Disadvantages of the DMPA injection

A

Duration of effects
REgular needling
Interaction with emegency contraception
Delay in return of fertility
Breast cancer and cervical cancer risk

33
Q

Side effects of DMPA injection

A

Reduced bone mineral density
Altered bleeding patterns
Weight gain
Injection site reactions
Other side effects

34
Q

Where are the injection sites for the DMPA injection

A

Dorsogluteal, ventrogluteal, deltoid less favourably, and for SC injections in the abdomen or upper thigh

35
Q

How does the subdermal implant work

A

ENG absorbed into the circulation
Prevention of LH surge, increases viscosity of cervical mucus, and thins the endometrium

36
Q

Benefits of the subdermal implant

A

Highly effective
Long action
Independent of intercourse
Quickly reversible
No user failure
Oestrogen free
Relief of dysmenorrhoea and ovulatory pain
No risk of VTE, or adverse effects on BMD

37
Q

Risk factors for insertion of the implant

A

Incorrect insertion - deep, intravascular
Injury to nerve or vascular
Breakages or migration
Wound issues such as fibrosis, scarring, discomfort, bruising, haematoma, skin atrophy

38
Q

Types of intra-uterine devices (IUDs)

A

Copper IUD
LNG-IUS

39
Q

How does the copper IUD work

A

Prevents fertilisation and is toxic to sperm

40
Q

How does the LNG-IUS work

A

Hormonal method which prevents implantation, cervical mucus thickening, prevention of fertilisation.

41
Q

Advantages of Cu-IUD

A

Associated with reduced risk of endometrial and cervical cancer.
No interactions, no user faliure, no effect on lactation, does not affect return to fertility and easily reversible, no systemic side effects

42
Q

Disadvantages of Cu-IUD

A

Periods may be longer, more painful and heavier
Occasional instrumenstural bleeding
Bleeding patterns and symptoms can improve after 3-6 months

43
Q

Advantages of LNG-IUS

A

No user error, may reduce dysmnorrhoea, does not interact with other drugs, easily reversible with no effect on fertility, menstrual blood loss reduced, endometrial protection, no risk of increase in VTE risk, may be some protective element against ovarian cancer

44
Q

Disadvantages of LNG-IUS

A

Breast tenderness
Headaches
Acne
Bloating
Mood change
Benign functional overian cyst increased risk
Irregular bleeding and spotting in first 6 months
Not used in breast cancer

45
Q

Complications of LNG-IUS

A

Perforation, expulsion, infection and ectopic pregnancy

46
Q

How long can the Cu-IUD stay in for

A

5-10 years

47
Q

How long can the LNG-IUS stay in for

A

3 or 5 years

48
Q

How does male sterilisation work

A

The vas deferens is blocked or clipped off or cut

49
Q

How does female sterilisation work

A

Fallopian tubes are sealed with clips or rings, or diathermy in second line

50
Q

Early or intra operative complications of male sterilisation

A

Technical difficulties, bleeding, pain, vasovagal episodes, bleeding or blood clot inside scrotum, blood in semen, bruising of scrotum, infection of wound, mild pain or discomfort, swelling

51
Q

Late complications of male sterilisation

A

Sperm granuloma, chronic post-vasectomy pin, epididymo-orchitis

52
Q

Late complications of female sterilisation

A

Ectopic pregnancy and effects on menstruation

53
Q

Early complications of female sterilisation

A

Mortality, damage to bowel, bladder, vascular tree, wound iinfection, abdominal or shoulder pain

GUM (8 decks)

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