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Contraception Flashcards

(53 cards)

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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

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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

Study These Flashcards
A

Buttocks, abdomen, torso or upper arm

24
Q

What are progesterone only contraceptive options

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A

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

25
Mode of action of progesterone only contraceptions
Suppression of ovulation Cervical mucus effect
26
Advantages of POC
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
Disadvantages of the POC
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
Advantages of the DMPA injection
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
Contraindication of POC
Breast cancer Pregnancy must be excluded before starting
30
Disadvantages of the DMPA injection
Duration of effects REgular needling Interaction with emegency contraception Delay in return of fertility Breast cancer and cervical cancer risk
31
Disadvantages of the DMPA injection
Duration of effects REgular needling Interaction with emegency contraception Delay in return of fertility Breast cancer and cervical cancer risk
32
Disadvantages of the DMPA injection
Duration of effects REgular needling Interaction with emegency contraception Delay in return of fertility Breast cancer and cervical cancer risk
33
Side effects of DMPA injection
Reduced bone mineral density Altered bleeding patterns Weight gain Injection site reactions Other side effects
34
Where are the injection sites for the DMPA injection
Dorsogluteal, ventrogluteal, deltoid less favourably, and for SC injections in the abdomen or upper thigh
35
How does the subdermal implant work
ENG absorbed into the circulation Prevention of LH surge, increases viscosity of cervical mucus, and thins the endometrium
36
Benefits of the subdermal implant
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
Risk factors for insertion of the implant
Incorrect insertion - deep, intravascular Injury to nerve or vascular Breakages or migration Wound issues such as fibrosis, scarring, discomfort, bruising, haematoma, skin atrophy
38
Types of intra-uterine devices (IUDs)
Copper IUD LNG-IUS
39
How does the copper IUD work
Prevents fertilisation and is toxic to sperm
40
How does the LNG-IUS work
Hormonal method which prevents implantation, cervical mucus thickening, prevention of fertilisation.
41
Advantages of Cu-IUD
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
Disadvantages of Cu-IUD
Periods may be longer, more painful and heavier Occasional instrumenstural bleeding Bleeding patterns and symptoms can improve after 3-6 months
43
Advantages of LNG-IUS
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
Disadvantages of LNG-IUS
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
Complications of LNG-IUS
Perforation, expulsion, infection and ectopic pregnancy
46
How long can the Cu-IUD stay in for
5-10 years
47
How long can the LNG-IUS stay in for
3 or 5 years
48
How does male sterilisation work
The vas deferens is blocked or clipped off or cut
49
How does female sterilisation work
Fallopian tubes are sealed with clips or rings, or diathermy in second line
50
Early or intra operative complications of male sterilisation
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
Late complications of male sterilisation
Sperm granuloma, chronic post-vasectomy pin, epididymo-orchitis
52
Late complications of female sterilisation
Ectopic pregnancy and effects on menstruation
53
Early complications of female sterilisation
Mortality, damage to bowel, bladder, vascular tree, wound iinfection, abdominal or shoulder pain

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