Contraception Flashcards
(154 cards)
1
Q
What need to know for OSCEs each contraception
A
Options
Suitability - contraindications and risks
Effectivemess
Mechanisms of action
Instruction on use
2
Q
Methods of contraception
A
Family planning
Barrier - condoms
COCP
Progesterone only pills
Coils
Progesterone injection
Progesterone implant
Surgery - sterilisation, vasectomy
Emergency contraception
3
Q
What is UKMEC
A
UK medical eligibility criteria - categorise risks of starting different contraception in different individuals
4
Q
UKMEC levels
A
1 - no restricition in use (minimal risk)
2 - Benefits generally outweigh benefits
3 - Risks generally outweigh benefits
4 - unacceptable risk - contraindicated
5
Q
Which contraceptive methods are user dependent for effectiveness
A
Family planning
Barrier
Pill
6
Q
What contraceptives are not user dependent for effectiveness
A
Implant
Coil
Surgery
7
Q
What does 99% effective contraception mean
A
Used correctly with regular partner for single year, 1% chance of getting pregnant
8
Q
What contraception is >99% effective with perfect and typical use
A
Surgery
coils
Progesterone implant
9
Q
What contraception avoid if high risk breast cancer?
A
Avoid hormonal contracepetion
Copper coil or barrier methdos
10
Q
What avoid if high risk of cervical or endometrail cancer
A
Avoid intrauterine system (mirena coil, copper coil)
11
Q
What contraception avoid in Wilsonds disease
A
Acoid copper coil
12
Q
What risk factors are UKMEC 4 for the COCP?
A
Uncontrolled HPTN esp >160/>100
Migraine with aura
History of VTE
>35 years, >15 cigarettes per day
Major surgery w prolonged immobility
Vascular disease or stroke
Ischaemic heart disease, cardiomyopathy and atrial fibillation
Liver cirrhosis and liver tumours
SLE and antiphospholipid syndrome
13
Q
Is HRT a contraceptive
A
No - additional contraceptive required on top of it
14
Q
What age can the COCP pill be used up to
A
50
15
Q
Why does teh depot injection have to be stopped before 50
A
Risk of osteoporosis
16
Q
When should women a=who are amenorrheic and taking progesterone only contraception stop
A
FSH blood test >35 IU/L on two tests 6 weeks apart - 1 more year continue
>55
17
Q
Why is depot injectio and coils n UKMEC 2 under 20
A
injection- bone mineral density
Coils - higher rate expulsion
18
Q
What is UKMEC 1 for under 20
A
COCP or progesterone pills
Profesterone implant
19
Q
When is contraception required after birth
A
21 days
20
Q
What need to do when starting pills after pregnancy
A
Condoms 7 dyas - COCP
2 days - progesterone
21
Q
How long is lactaitonal amenorrhea considered effective contraception
A
6 months
Fully breastfeeding and amenorrheic
22
Q
What contraceptivs are safe and insage with breastfeeding
A
Porgesterone only pill and implant are safe
COCOP NOT SAFE
23
Q
How long after pregnancy before can start COCP
A
UKMEC 4 before 6 weeks PP
UKMEC 2 after
24
Q
When can copper coil or mirena coil be inserted after birth
A
Within 48 hours or more than 4 weeks after birth - UKMEC 1
If in between UKMEC 3
WHY
25
How effective are condoms typical vs perfect use
98% perfect
82% typical
26
What can make condoms more likely to ttea
Oil based lubricants damage latex condoms
27
How are diaphragms and cervical caps ised
How effective
Fitted before sex - silicone cups sit over cervix
leave in place 6 hours after sex
Used with spermicide gel + perfect = 95% effective
28
Can u use diaphragm or cap and condom
29
What is option for oral sex
Dental dam
30
How effective is the COCP with perfect use or typical use
99% effective - perfect
91% - typical use
31
How does COCP prevent pregnancy
Prevent ovulation - primary
Progesterone thickens cervical mmucus
And inhibits proliferation of endometrium reducing chance successful implantation
32
What effect does oestrogen and progesterone have on other reproductive hormones
Negative feedback -> hypothalamus and ant pituiatry, supress release of GnRH, LH and FSH
Prevent ovulation
33
What is a withdrawal bleed
Endometrial lining maintatined while taking pill - when come off have withdrawal bleed
34
What types of COCP are there
Monophasic pills - same amount hormones each oill
Multiphasic - varying amounts hormones to match cyclical hormonal changes more closely eg vary oestrogen and type progesterone
35
What do everyday formulations monophasic pill packs contain
seven inactive pills - take one everyday dont have to worry youreself
36
Examples of monophasic combined pills
* Microgynon contains ethinylestradiol and levonorgestrel
* Loestrin contains ethinylestradiol and norethisterone
* Cilest contains ethinylestradiol and norgestimate
* Yasmin contains ethinylestradiol and drospirenone
* Marvelon contains ethinylestradiol and desogestrel
37
First line COCP NICE
Levonorgestrel or norethisterone - microgynon or leostrin
Lower risk VTE
38
What type of progesterone in COCP first line fro PMS
Drospirenone eg yasmin
39
Why dropirenone used pMS
Anti-mineralcorticoid and anti-androgen activity
Help with bloating, water retention, modd changes
Continious ise
40
What progesterone type in COCP targets acne and hirsutism and hwy
cyproterone aceteate eg dianette
Anti-androgen effects
41
Why is dianette stopped after 3 months
1.5-2 times higher risk VTE than first line COCP
42
Common regime optinos for COCP
21 days on 7 dyas off
63 days/3 packs on, 7 dyas off
Continious use
43
Side effects and risks of COCP
Unscheduled bleeding common in first 3 months - settles
Breast pain and tenderness
Mood changes and depression
Headahces
HPTN
VTE
Small increased risk breast and cervical cancer, returns to normal 10 years after stopping
Small increased risk MI and stroke
44
Benefits of COCP
Effective
Rapid return to fertility
Improvement in premnestrual sy,ptoms, menorrhageia, dysmenorrhea
Reduced endometrial, ovarian and colon cancer
Reduced risk benign ovarian cysts
45
What is BMI >35 UKMEC for COCP
3
46
What is BMI >35 UKMEC for COCP
3
47
How effective are the pills with perfect vs typical use
Perfect >99%
Typical - 91%
48
How efefctive are depot injection use
Percet - >99%
tYPical 94%
49
How effective is natural family planning perfect vs typical use
95-99.6% effective if perfcet
Typical use - 76%
50
When do you require extra protection and not when strating the pill
Start of dirst day of cycle up to day 5- none extra needed
After day 5 - contraception for first 7 days before protected. Have tom check not already pregnant
51
What do when switch COCPs
Immediately start next pack with no break
52
What do when switch traditional POPs
Switch any time but 7 dyas extra contraception ie condoms jeeded and ensure not pregnant before switching
53
Why no extra protection needed when switching from desogestrol
Stops ovulation = no additional contraceptiona needed
54
When is a pill considered missed
More than 24 hours late, 48 hours since last pill taken
55
What do if miss one pill - less than 72 hours since last pill taken
Take missed pill asap even if take two on same day
No extra protection needed
56
What do if miss more than one pill >72 hours since last pill taken
Take most recent missed pill asap even if take 2 same day
Additional contraception needed untul taken reguarly for 7 days straight
57
What do if days 1-7 missed pills
Emergency contraception if unprotected sex
58
If days 8-14, 15-21
8-14 - and day 1-7 fully complucant, no emergency contraception needed
15-21 - same (8-14 comlicant). Go back to back with next pack pills and skip pill free period
Technically no extra protection needed but recommended
59
How are POPs taken
Continiously
60
How are POPs taken
Continiously
61
What is the only UKMEC 4 for POP
Active breast cancer
62
Types of POP
Trafitional - norgestron, noriday
Desogestrol only pill - cerazette
63
How long after delay is considered a missed pill for the traditional vs desogestrol only pills
>3 hours for POP
>12 hours for desogestrel
64
How do traditional POPs work
Thicken cervical mucus
Alter endometrium, less accepting implant
Reduce ciliary action fallopian tubes
65
How does desogestrel work
Same as traditional POP but ALSO inhibits ovulation
66
How long is additional contraception required for if POP not started in first 5 days of menstrual cycle
48 hours
67
Can POP be started if risk of pregnancy
Yes - not harmful
Woman should do pregancy test 3 weeks after last unprotected intercourse - emergency contraception before pill considered if required
68
Why COCP takes 7 days additional contraception POP only 48 hours
COCP - inhibiting ovulation
POP - thickening cervical mucus
69
Can u switch POPs without extra prtoetciton
Yes
70
When is best to switch from COCP to POP
First seven days of cycle 0 not ectra protection needed
71
When need to switch to POP immeidatiatley how manage
If not had sex since finishing COCP pack can switch straight away, condoms for first 48 hours of POP
If had sex since completing last pack COCPs - 7 consecutive days of COCP before switching, use contraception for 48 hours. If not possible, emergency contraception
72
Main side effect of POP
Unscheduled bleeding
Common in first three monthsOften settles, can persist
73
% women unscheduled bleeding POP
20% amenorrhea
40% regular
40% irregular, prolonged, troublesome bleeding
74
other side effects of POP
Breast tenderness
Headacjes
Acne
75
Increased risk on POP of:
Ovarian cysts
Small risk ectopic pregnancy w traditional POPs - reduced ciliary action tubes
Minimal inctreased risk breast cancer, returns normal 10 years after stopping
76
When is emergency cintraception necessary with missing a pill
Emergency contraception is required if they have had sex since missing the pill or within 48 hours of restarting the regular pills.
77
How are episodes of diarrhoea or vomitting managed
As missed pills and extra contraception needed 48 hours after thye settel
78
What is progesteroene only injection
Depot mdeoxyprogesterone aceteate - DMPA
79
How is DMPA given
12-13 week intercals as SC or IM injection of MA
80
How effectove is DMPA
>99% perfect use
94% typical use - forget to book
81
How long does it take fertility to return after DMPA injection
12 months
82
Two types of injection
Depo-provera - IM
SAyana press - SC, can be self injected
Noristerat - alternative contains norethisterone, works for 8 weeks, used short term interim contraception
83
UKMEC 4 for injection
Active breast cancer
84
UKMEC 4 injection
Ishcaemic HD and stroke
Unexplained vaginal bleeding
Sev liver corrhosis
Liver cancer
85
Age when start to not recommend depot and why
UKMEC 2 over 45
Alternative should have over 50
Cause osteoporosis - contraidicatied if on steroids for asthma or inflammatory conditions
86
How does depot injection work
Inhibit ovulation by inhibiting FSH secretion by pituitary gland, prevents follicle development
THickens cervical mucus
Alters endometrium and makes less accepting of implantation
87
When need extra protection when start injection
If start after day 5 menstrual cycle need seven days extra contraception for seven days before reliable
88
What does FSRH guidelines say about when injection can be given
10 weeks to 14 weeks after last but unlicensed
Dealt past 13 weeks = risk of pregnancy
89
Side effects of depot injection
CHANGES TO BLEEDING - may resolve, common in first 6 months, unpredicatbale
Weigh tgain
Acne
Reduced libido
Mood changes
Headaches
Flushed
Hair loss - alopecia
Skin reactions at injection sites
REDUCED BONE MD
V small increased risk of breast and cervical cancer
90
What hormone helps maintain bone MD in women
Oestrogen
91
What need to do if irregualr bleeding on contraception continues past normal irregular expected
Alternatiev causes rule out
Sexual health screen
Pregnancy test
Cervical screening up to date
92
What can be doone if problematic bleeding occurs with injection
COCP for 3 months in combination
Short course 5 days tranexamic acid to halt
93
Benefits of depot injection
Improves dysmenorrhea
Improves endometriosis related symptoms
Reduces risk of ovarian and endometrial cancer
Reduces severity of sickle cell crisis in patients with sickle cell anaemia
94
Benefits of depot injection
Improves dysmenorrhea
Improves endometriosis related symptoms
Reduces risk of ovarian and endometrial cancer
Reduces severity of sickle cell crisis in patients with sickle cell anaemia
95
How long can you have the progesterone implant for
3 years
96
What is the only UKMEC 4 for progesterone implant
Active breast cacner
97
What is teh implant used in UK and what does it contatin and who is it licesed in
Nexplanon - 68 mg etonegetrel
18-40
98
How does the progesterone onoly implant work
* Inhibiting ovulation
* Thickening cervical mucus
* Altering the endometrium and making it less accepting of implantation
99
When need extra protection with impant
If after day 5 of cycle need to use condoms for 7 dyas
100
Where is it inserted implant
one third uo upper arm on medial side
Lidocaine used prior
Beneath skin adn above SC fat
Should be palpable, press one side other pops upwards against slin
Removal - small incision, pressure or forceps remove
101
Benefits of progesterone implant
Effective and relibal
IMprove dysmenorrhea
Lighter or stop periods
Dont have to remember pills
Doesnt cause weight gain
No effect on bone mineral density
No increase in thrombosis risk
No restriction for use in obese patients
102
Drawbacks of implant
Minor operation to insert and remoce
Can make acne worse
No STI preotect
Problematic bleeding
Can be bent or facutred
Can become impalpable or deeply implanted -> additional management
103
What happens if implant becomes impalpable
Extra contraception
US or X ray to locate
Barium sulphate - radio-opaque so seen on X ryas
Can be in blood vessel and travel to lings - CXR
104
What to do when problematic bleeding occurs with implant
COCP for 3 months
105
Bleeding on the implant
1/3 - in frequent
1/4 - frequent or prolonged
1/5 - no bleeding
Remainder - normal bleeds
106
Types of coil
* Copper coil (Cu-IUD): contains copper and creates a hostile environment for pregnancy
* Levonorgestrel intrauterine system (LNG-IUS): contains progestogen that is slowly released into the uterus
107
When does fertility t=return after removal of IUD/IUS
Immediately
Need to use condoms or abstain for 7 dyas prior or risk of pregnancy
108
Contraindications for IUD/IUS
PID/infection
Immunosupression
Pregnancy
Unexplained bleeding
Pelvic cancer
Uterine cavity distrotion eg fibroids
109
What need to do in women under 25 getting the coil
Screen for chalmydia and gonorrhea - higher risk for STIs
110
What is done before fitting the coil
Bimanual exam - position and size of uterus
BP and HR
Speculum inserted
111
What happens after procedure coils
Temporary crampy period pain - NSAIDs
seen 3-6 weeks after insertion to check threads and taught to check themselves erguarly
112
Risks inserting the coil
bleeding
Vasovagal reactions - dizzy, brady, arrhtyhmias
Pain on insertion
Uterine perforation - 1 in 1000
PID esp in first 20 dys
Expulsion in first 3 months
113
What needs to be excluded if cant feel threads
Expulsion
Pregnancy
Uterine perforation
114
Investgiations if cant feel thread
US
Abdo and pelvic x ray - look for coil or peritoneal cavity after uterine perforation
Hysteroscopy or laparoscopic surgery
115
How long can have copper coil
5-10 years
116
When can the copper coil act as emergency contraception
Inserted up to 5 days after unprotected sex
117
Mechanism copper coil
Toxic to ovum and sperm
Alters endometrium less likely to implant
118
Benefits copper coil
Reliable
Inserted at any time in cycle and immediately effective
No hormones - safe for women at risk VTE/hormone related cancers
Reduce risk of endometrial and cervical cancer
119
Drawbacks of copper coil
Procedure required
Heavy or intermenstrual bleeding - often sttely
Pelvic pain for some
Increases risk ectopic pregnancies
5% fall out
120
the 4 types of IUS
* Mirena
* Levosert
* Kyleen
* Jaydess: effective for 3 years
All effective for 5 years except last
All contain levonorgestrel
121
What can the mirena coil and levosert be used for aswell as contracetpiton
Mirena - menorrhagia, endometrial protection for women on HRT
Levosert - menorrhagia
122
How long is mirena licensed for for HRT
4 years
123
How do IUS work
Thicken cervical mucus
Alter endometrium, less aceepting implant
INhibit ovulation in small number
124
When can an IUS be inserted in a cycle
Up to day 7, no additional contraception needed
After extra protection needed for 7 dyas
125
Benefits of IUS
Periods lighter or stop
improve dysmenorrhea or pelvuc pain related to endometriosis
No effect on bone MD
No increased thrombosis risk
No restrictions in obese patients
126
Drawbacks IUS
Procedure with risks
Can cause spotting and irrgular bleeding - COCP 3 months
Some - pelvic pain
Increased risk ectopic pregnancies
Increased incidence ovarian custs
Cna be systemic abdsoprtion causing acne, headaches, breast tenderness
Can occasionally fall out
127
What can be seen on smear tests in women with the coil
Actinomyces-like orgnaisms
No treatment unless symptomatic - pain, bleeding, then remove device
128
Options for emergnecy contraception
Levonorgestrel - within 72 hours
Ulipristal - 120 hours
Copper coil - 5 days (or 5 days of est ovulatino date)
129
What is the most effective emergnecy contraception
Copper coil (unaffected by BMI, enzyme inducing drugs or malabsorption)
130
What does efficacy of oral emergency contraception depend on
Earlier taken more effective it is
131
When is oral contraception unlikely to be effective
After ovulationn has occured
Can still be offered on any day of the menstrual cycle
132
Can oral emergency contraception be used more than once in a menstrual cycle
Yes
133
What to consider when starting emergency contracwption
Confidentiality
STIs
Future contracpetion plans
Safeguarding, rape, abuse
134
When does ovulation occur
14 days before end of cycle
135
What is recommended by FSRH as first line emergency contraception
Copper coil
136
What consider if copper coil put in and woman at high risk of STIs
Empirical treatment of pelvic infections to prevent PID
137
When can coil be removed after used as emergency contracetption
Kept in til next period then can be removed or can be left as long term contraception
138
How does levonorgestrel work
Progestogen that prevents or delays ovulation
Not known to be harmful if pregnancy then occurs
139
How does levonorgestrel work
Progestogen that prevents or delays ovulation
Not known to be harmful if pregnancy then occurs
140
Dose for levonorgestrel
1.5mg single dose
3mg single dose women > 70kg or BMI >26
141
Side effects of levongorgestrel
N+V
Spotting and changes to next menstrual period
Diarrhoea
Breast tenderness
Dizziness
Depressed mood
142
When should levonorgestrel be re[rescribed after N+V
If N+V within 3 hours
143
Cna you take levonorgestrel when breast feeding
Yes
But avoid for 8 hours to reduce exposure to baby
144
What is ulipristal
Selective progesterone receptor modulaor works by delaying ovulation - ellaone
145
Which oral contraceptive is more effective
Ellaone
146
How soon can you start the combined pill or progesterone only pill after taking ulipristal vs lenorgestrel
5 days - ulipristal + extra cpntraception for 7 dyas COCP, 2 dyas w POP
Straight away with levorgestrel
147
Side effects of ulipristal
* Spotting and changes to the next menstrual period
* Abdominal or pelvic pain
* Back pain
* Mood changes
* Headache
* Dizziness
* Breast tenderness
148
Restrictions with ulipristal
Breastfeeding avoided for 1 week after, milk expressed and discarded
Avoided in patients with severe asthma
WHY
149
Restrictions with ulipristal
Breastfeeding avoided for 1 week after, milk expressed and discarded
Avoided in patients with severe asthma
WHY
150
What does the NHS not provide after sterilisation
Reversal procedures - have to go private and success rate is low - considered permanent
151
What is female sterilisation procedure
Tubal occlusion - GA + laprascopy
Occluded using filshie clips or ties and cut
Elective or during C section
152
Is contraception required after sterilisation
Yes until next menstrual period as ovum may have already reached the uterus to be fertilised
153
What is a vasectomy
cut the vas deferens, prevent sperm tracel to testes to join ejaculated fluid
Stops sperm being released into vagina, preventing pregnnacy
15-20 minutes under local, less invasive than female
154
How ong is alternative contracetpiton required for after vasectomy
2 months
Testing of semen to confirm absence of sperm necessary before can be relied upon, normally 12 weeks after to clear any sperm left in tubes
May require second analysis for confirmation
