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GYNAECOLOGY > CONTRACEPTION > Flashcards

CONTRACEPTION Flashcards

1
Q

What ways can combined hormonal contraception be given?

A

Pill
Transdermal patch
Vaginal ring

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2
Q

What ways can progesterone-only contraception be given?

A

Pill
Implant
Injectable

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3
Q

What are the 2 options for intrauterine contraception?

A

Copper IUD
Levonorgestrel IUS “mirena”

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4
Q

Sterilisation options?

A

Vasectomy for men
Tubal occlusion for women

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5
Q

What is long-acting reversible contraception and what are the options?

A

Contraception methods that require administration less than once per cycle or once a month

Progestogen-only injectable
Progestogen only implant
Copper IUD
LNG-IUS

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6
Q

What is emergency contraception?
What are the options?

A

An intervention aimed at preventing unintended pregnancy after unprotected sexual interior use or contraceptive failure

Oral levonorgestrel “levonelle”
Oral ullipristal acetate “ellaOne”
Copper IUD

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7
Q

What can be used as “bridging contraception”?

A

CHC - except co-cyprindiol
POP
Progestogen-only implant
Progestogen-only injectable - only considered if other options are not available or unsuitable

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8
Q

Most effective contraception methods?

A

Progestogen-only implant
Male sterilisation
LNG-IUS
Female sterilisation
CU-IUD

(In order from most to least but all >99% effective)

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9
Q

What is UKMEC?

A

UK Medical Eligibility Criteria for Contraceptive Use

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10
Q

How should I assess a woman requesting contraception?

A

Exclude pregnancy
Identify any factors that may affect contraception choice e.g. comorbidities, allergies, lifestyle factors, reproductive history, drug treatment, age
Check UKMEC if relevant
Assess risk of STIs
Carry out a risk assessment for sexual abuse, rape and non-consensual sex

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11
Q

Fraser criteria?

A

In England and Wales, it is lawful to provide contraceptive advice and treatment to young people without parental consent, provided that the practitioner is satisfied that the Fraser criteria for competence are met. The criteria are that:
- The young person understands the practitioner’s advice.
- The young person cannot be persuaded to inform their parents, or will not allow the practitioner to inform the parents, that contraceptive advice has been sought.
- The young person is likely to begin or to continue having intercourse with or without contraceptive treatment.
- Unless he or she receives contraceptive advice or treatment, the young person’s physical or mental health are likely to suffer.
- The young person’s best interest requires the practitioner to give contraceptive advice or treatment without parental consent.

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12
Q

Which contraception should not be started in women with abnormal vaginal bleeding?

A

Consider additional investigation for IUC insertion

Dont use progestogen-only implant and progestogen-only injectable

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13
Q

What contraception type should not be used with fibroids and known distortion of the uterine cavity?

A

Intrauterine coils should not be used

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14
Q

What contraception methods should not be started in a woman with PID?

A

Intrauterine methods - although if already inserted then its ok to leave them

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15
Q

What methods of contraception should not be used in women with chlamydia or gonorrhoea infection?

A

Intrauterine devices - note its ok to leave it if already implanted at time of infection

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16
Q

What contraception should not be used in women with DM and nephropathy, retinopathy, neuropathy or any other vascular disease?

A

CHC

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17
Q

What contraception is contraindicated in migraines with aura?
Why?

A

CHC - small increased risk of stroke

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18
Q

What contraception should not be used in women with multiple risk factors for CVD?

A

CHC
Progestogen-only injectables

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19
Q

What contraception should be avoided in women with a BMI of 35 or more?

A

CHC

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20
Q

What contraception should you avoid for women with hypertensin?

A

CHC
Progestogen-only injection IF vascular disease too

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21
Q

What methods of contraception should you avoid in women with a history of VTE?

A

CHC - even if FHx or any immobility

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22
Q

What methods of contraception should not be used in women of any age who smoke?

A

CHC if 15 cigs or more, or any amount and over 35

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23
Q

When can intrauterine contraception be started in the postpartum period?

A

<48 hrs postpartum
Or over 4 weeks postpartum

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24
Q

When can combined hormonal contraception be started in the postpartum period?

A

From 3 weeks if not breastfeeding and no additional risk factors for VTE
From 6 weeks if breastfeeding

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25
Q

Contraception in patients who have had a gastric sleeve, bypass or duodenal switch?

A

Can never have oral contraception again, including emergency contraception due to lack of efficayc

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26
Q

Outline the UKMEC levels

A

UKMEC1 - no restriction in use
UKMEC2 - benefits generally outweigh the risks
UKMEC3 - risks generally outweigh the benefits
UKMEC4 - unacceptable risk i.e. contraindicated

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27
Q

What method of contraception is 100% effective?

A

Complete abstinence

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28
Q

Effectiveness of combined oral contraceptive pill?

A

With perfect use of>99%
But with average use 91%

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29
Q

Best hormonal contraception itions for women with breast cancer

A

Copper coil and barrier methods

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30
Q

Which contraception should you avoid in cervical or endometrial cancer?

A

IUS

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31
Q

Risk factors for CCH?

A

Examples of UKMEC 3 conditions include:
>35 years old and smoking <15 cigarettes/day
BMI >35 kg/m^2*
FHx of thromboembolic disease in first degree relatives < 45 years
controlled hypertension
immobility e.g. wheel chair use
carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
current gallbladder disease
Diabetes mellitus diagnosed >20 years ago

Examples of UKMEC 4 conditions include:
>35 years old and smoking >15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
PMHx of stroke or IHD
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)

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32
Q

How does the combined oral contraceptive pill work?

A

Inhibits ovulation as they suppress the release of LH and FSH

Some secondary actions:
Progesterone thickens cervical mucus
Progesterone inhibits endometrial proliferation, reducing the chance of successful implantation

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33
Q

Why are intrauterine coils UKMEC2 in women under 20?

A

They may have a higher rate of expulsion

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34
Q

Effectiveness of condoms?

A

98% effective with perfect use
82% effective with typical use

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35
Q

What condoms can be used in a latex allergy?

A

Polyurethane condoms

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36
Q

How do diaphragms and cervical caps work?

A

silicone cups that fit over the cervix and prevent semen from entering the uterus. The woman fits them before having sex, and leaves them in place for at least 6 hours after sex. They should be used with spermicide gel the further reduce the risk of pregnancy

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37
Q

What are dental dams?

A

Latex or polyurethane sheets used between the mouth and vagina/anus during oral sex

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38
Q

Benefits of COCP?

A

Usually makes period sregular, lighter and less painful
Reduces risk of ovarian and endometrial cancer and these effects may last for several decades after cessation
Reduced risk of colorectal cancer
May protect against PID
May reduce ovarian cysts, benign breast disease and acne vulgaris

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39
Q

Risks of COCP?

A

Forgetting to take it
No protection against STIs
Increased risk of VTE
Increased risk of breast and cervical cancer
Increased risk of stroke and IHD

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40
Q

Possible SE of COCP?

A

Headache
Nausea
Breast tenderness
Some users report weight gain but Cochrane review did not support this

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41
Q

COCP and concurrent antibiotic use?

A

Recent change to no need to use extra protection
Precautions should still be taken with enzyme-inducing antibiotics e.g. rifampicin

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42
Q

When do you require additional contraception when starting COCP?

A

If you start at any point in the cycle other than the first 5 days then you require additional contraception for the first 7 days

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43
Q

How should the COCP be taken?

A

Take at the same time every day
Conventionally taken for 21 days and then stopped for 7 days but it was realised there was no medical benefit from having a withdrawal bleed
Options include never having a pill-free interval or ‘tricycling’ - taking 3 x 21 day packs back to back before having a 4-7 day break

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44
Q

Situations where efficacy of the COCP may be reduced?

A

If vomiting within 2 hours of taking COCP
Medication that induces diarrhoea or vomiting e.g. orlistat
If taking lover enzyme-inducing drugs

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45
Q

What should you advise a woman to do if 1 COCP is missed at any time in the cycle?

A

Take the last pill even if it means taking 2 pills in 1 days and then continue taking 1 pill a day
No additional contraception protection is required

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46
Q

What should you advise a woman to do if 2 or more COCPs are missed at any time in the cycle?

A

Take the last pill even if it means taking 2 pills in 1 day, leave any earlier missed pills, and then continue taking 1 pill a day
Use condoms or abstain from sex until she has taken pills for 7 days in a row

If pills are missed in week 1 - emergency contraception if had intercourse
In week 2 - ok after 7 consecutive days of taking COCP
Week 3 - finish current pack and start new pack the next day i.e. skip pill-free interval

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47
Q

What does microgynon contain?

A

Ethinylestradiol and levonorgestrel

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48
Q

What does loestrin contain?

A

Ethinylestradiol and norethisterone

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49
Q

What does cilest COCP contain?

A

Ethinylestradiol and norgestimate

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50
Q

What does Yasmin COCP contain?

A

Ethinylestradiol and drospirenone

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51
Q

What does marvelon COCP contain?

A

Ethinylestradiol and desogestrel

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52
Q

First line COCP choice? And why?

A

A pill containing levonorgestrel or norethisterone e.g. microphone or leostrin
This is because they have a lower risk of VTE

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53
Q

Which COCP is considered first line for premenstrual syndrome? Why?

A

Yasmin as it contains drospirenone
Drospirenone has anti-mineralocorticoid and anti-androgen activity and may help with symptoms of bloating, water retention and mood changes
(May be more effective if used continually rather than cyclically)

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54
Q

Which COCP is good for treatment of acne and hirsutism e.g. in PCOS?
Why?
How long is it used for and why?

A

COCPs containing cyproterone acetate (“co-cyprindiol) e.g. dianette

Cyproterone acetate has anti-androgen effects

Usually only used for 3 months after acne is controlled as it has nearly 2x risk of VTE than other COCP

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55
Q

Side efefcts of COCP?

A

Unscheduled bleeding - common for first 3 months
Breast pain and tenderness
Mood changes and depression
Headaches

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56
Q

When should you stop COCP before surgery?

A

4 weeks before any major operation or any aperation that requires lower limb to be immobilised
To reduce thrombosis risk

A progestogen-only contraceptive may be offered as an alternative and the oestrogen-containing contraceptive restarted after mobilisation.

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57
Q

What is the only UKMEC4 for the POP?

A

Active breast cancer

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58
Q

What are the 2 types of progesterone-only pills?
Why is this relevant

A

Traditional POP e.g. norgeston or noriday
Desogestrel-only pill e.g. cerazette

Traditional POP cannot be called by more than 3 hours or it is considered a missed pill
Deogestrel-only pill can be taken up to 12 hours late and still be effective!

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59
Q

How do traditional POPs work?

A

They thicken the cervical mucus, alter the endometrium to make it less accepting of implantation and reduce ciliary action in the fallopian tubes

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60
Q

How does desogestrel-only pill work?

A

Inhibits ovulation
Thickens cervical mucus
Alters the endometrium
Reduces ciliary action in fallopian tubes

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61
Q

When starting the POP do you need additional contraception?

A

If you start it day 1-5 of menstrual cycle woman is immediately protected
If started any other time then additional contraception is required for 48 hours to allow cervical mucus to thicken enough to prevent sperm enterin the uterus

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62
Q

Switching between POPs

A

Can be switched immediately without need for any extra contraception

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63
Q

Switching from COCP to POP?

A

Immediately without additional contraception if they have taken the COCP consistently for >7 days or are on days 1-2 of the hormone-free period following a full pack of COCP

Otherwise it depends on whether they have had unprotected sex. If they have not since day 3 of the hormone-free period then they can start POP but require additional contraception for the first 48 hours. If they have had protected sex since day 3 of hormone-free period they should take COCP until they have taken 7 days consecutively and then they can switch over without any additional requimrent

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64
Q

Why is the woman not protected from pregnancy if she has unprotected sex on day 3 or later of the hormone-free period after taking COCP and then starts POP?

A

The POP does not reliably prevent ovulation and works mainly by thickening the cervical mucous. Sperm can live for 5 days in the uterus.
This means sperm can enter the uterus and live there for 5 days (until the 8th day after finishing the COCP). Taking the POP during this time will make no difference to the sperm already in the uterus, as they are already past the cervix. Then, if the woman ovulates on the 8th day after finishing the COCP, those sperm are there waiting to fertilise the egg.

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65
Q

Side effects of POP?

A

Unscheduled bleeding. Common for first 3 months - if longer then look for another cause
Breast tenderness
Headaches
Acne

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66
Q

How does POP typically affect periods?

A

20% have amenorrhoea
40% have regular bleeding
40% have irregular, prolonged or troublesome bleeding

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67
Q

What does POP increase the risk of?

A

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

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68
Q

What should you do after missing POP?

A

Take pill ASAP and continue with the next pill at the usual time
Then use extra contraception for the next 48 hours
If they have had sex since missing the pill or within 48 hours of restarting regular pills then emergency contraception is required

Episodes of d&v are managed as missed pills so extra contraception is required until 48 hours after D+V settle

69
Q

What is the progestogen-only injection called?

A

Depot medroxyprogesterone acetate (DMPA)

70
Q

How often is progestogen-only injection given?

A

Every 12 weeks
It can be given up to 14 weeks after last dose without need for extra precautions. BNF gives different advice and advises a pregnancy test if interval is >12 weeks and 5 days (not commonly adhered to)

71
Q

How does the progestogen-only injection work?

A

It inhibits ovulation by inhibiting FSH secretion by the pituitary, preventing follicular development in the ovaries

Secondary effects: cervical mucus thickening and endometrial thinning

72
Q

What are the 2 types of progestogen-only injection?

A

Depo-Provera: given by IM
Sayana Press: a subcutaneous injection device that can be self-injected by the patient

73
Q

Why is DMPA 99% effective with perfect use but 94% effective with typical use?

A

Because women forget to book in for an injection every 12-13 weeks

74
Q

Why is DMPA not a suitable contraception option for women who may wish to get pregnant in the near term?

A

It can take 12 months for fertility to return after stopping the injections
It’s not reversible once given

75
Q

What is an alternative progestogen-only injectable to DMPA?

A

Noristerat - contains norethisterone and works for 8 weeks
Rarely used in clinical practcie

76
Q

Contraindications to progestogen-only injectable?

A

UKMEC4:
Active breast cancer

UKMEC3:
IHD and stroke
Unexplained vaginal bleeding
Severe liver cirrhosis
Liver cancer

Women should generally switch to an alternative by age 50 due to the risk of osteoporosis

77
Q

Timing the progesterone injection?

A

Starting on day 1-5 of the menstrual cycle = immediate protection and no extra contraception required
Starting after day 5 = 7 days of extra contraception

78
Q

Side effects of the progesterone-only injection?

A

Irregular menstrual bleeding
Weight gain
Headache
Acne
Hair loss
Decreased libido
Mood swings
Skin reactions at injection site

79
Q

Risks of progesterone-only injection?

A

Osteoporosis
Small increased risk of breast and cervical cancer
Small risk of infection at injection site or allergy

80
Q

Why is the progesterone-only injectable associated with osteoporosis?

A

Suppressing the development of follicles = reduces amount of oestrogen produced = increased osteoclasts and enhanced bone resoprtion

81
Q

What could you take alongside the porgestogen-only injectable if there is problematic bleeding?

A

COCP for 3 months to help settle the bleeding
Another option is a short/5 day course of mefanamic acid to halt the bleeding

82
Q

Potential benefits of the progesterone-only injection?

A

Improved dysmenorrhea and premenstrual Sx
Improves endometriosis-related pain
Reduces risk of ovarian and endometrial cancer
Reduces severity of sickle cell crises in pt with SCA
Pt does not have to think about contraception for 12 weeks with DMPA

83
Q

Name of the implantable contraceptive available?

A

Nexplanon
(This replaced Implanon to try to prevent deep insertions and the new one is now radiopaque and is therefore easier to locate if implapable)

84
Q

What does the nexplanon implant release?

A

68mg Etonogestrel (a progestogen hormone)

85
Q

Where are the nexplanon implants inserted?

A

In the proximal non-dominant arm, just overlying the tricep under the skin but a live the subcutaneous fat

86
Q

How long do nexplanon implants last?

A

3 years

87
Q

Mechanism of action of nexplanon implant?

A

Prevents ovulation

Also works to thicken cervical mucus and alters the endometrium to make it less accepting of implantation

88
Q

Failure rate of nexplanon implant?

A

0.7/100 - most effective form of contraception

89
Q

Disadvantages of nexplanon implant

A

Need for trained professional to insert and remove the device
Additional contraceptive methods are needed for the first 7 days if not inserted on day 1-5 of the woman’s menstrual cycle
Can lead to worsening of acne
No protection against STIs
Can cause problematic bleeding
Implants can be bent or fractured
Implants can become implapable or deeply implanted - may need investigation and additional management

Most expensive contraception annually

90
Q

Advantages of nexplanon implant?

A

Effective and reliable
Can improve dysmenorrhea
Can make periods lighter or stop them altogether
No weight gain, effect on bone mineral density, increase i thrombosis risk or restrictions for use in obese pt

91
Q

Adverse effects of nexplanon implant?

A

Irregular or heavy bleeding can occur (usually in 1/3rd infrequent bleeding, 1/4 worse bleeding and 1/5 no bleeding - rest normal)
Headache, nausea, breast pain

92
Q

How can we help manage problematic bleeding as an adverse effect of nexplanon implant?

A

Using COCP for 3 months alongside it to help settle the bleeding (same as with injection)

93
Q

What drugs may the nexplanon implant interact with?

A

Enzyme-inducing drugs e.g. certain antiepileptics and rifampicin - may reduce the efficacy of nexplanon
The advise is to switch method or use additional contraception until 28 days after stopping tx

94
Q

Contraindications to nexplanon implant?

A

UKMEC4 - current breast cancer
UKMEC3: IHD and stroke, unexplained vaginal bleeding, past breast cancer, severe liver cirrhosis or liver cancer

95
Q

What happens if the nexplanon implant becomes implapable?

A

Extra contraception is required until it is located
An USS or XR may be required to locate it. (It contains barium sulphate to make it radio-opaque)
In very very rare cases there are reports of devices entering blood vessels and migrating through the body, including to the lungs so you may consider a CXR if you cannot identify it

96
Q

Which intrauterine device can be used for contraception, managing menorrhagia and HRT?

A

IUS
(Specifically mirena)

97
Q

Mode of action of the IUD?

A

Prevents fertilisation by decreasing sperm motility and survival - copper ions are a hostile environment

98
Q

How does the IUS work?

A

Contains levonorgestrel which prevents endometrial proliferation and causes cervical mucous thickening

99
Q

When does fertility return after removal of an intrauterine device?

A

Immediately

100
Q

Contraindications of intrauterine contraception?

A

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

101
Q

What is done before inserting an intrauterine coil?

A

Screening for chlamydia and gonorrhoea if woman is deemed high risk e.g. under 25
Bimanual exam to check position and size of uterus
Blood pressure and HR recorded before and after

102
Q

How are the intrauterine coils inserted?

A

A speculum is inserted and forceps used to stabilise the cervix while the device is inserted

103
Q

When can the IUD be relied on after insertion?

A

Immediately!

104
Q

When can the IUS be relied on after insertion?

A

After 7 days

105
Q

How long is the IUD effective for?

A

5 years
Some have copper on the stem and arms of the device and this may be effective for up to 10 years

106
Q

How long is the IUS effective for?

A

Mirena is most common - 5 years

if used as endometrial protection for women taking oestrogen-only hormone replacement therapy they are only licensed for 4 years

107
Q

Risks relating to intrauterine coil insertion?

A

Temporary crampy period-type pain after insertion
Bleeding
Vasovagal reactions
Uterine perforation 2 in 1000 (higher in breastfeeding women
Proportion of pregnancies being ectopic are increased but absolute number of ectopic pregnancies is reduced compared to a woman not using conyrsaception
PID (only in the first 20 days)
Expulsion rate (most likely to occur in the first 3 months)

108
Q

How do IUDs tend to impact periods?

A

They make them heavier, longer and more painful

109
Q

How do IUSs tend to impact periods?

A

Initial frequently uterine bleeding and spotting
Later women typically have intermittent light menses with less dysmenorrhea
Some women become amenorrhoeic

110
Q

What follow up is needed after insertion of an intrauterine device?

A

3-6 weeks later they need to be seen to check the threads
They will be taught how to feel the strings to ensure the coil remains in place

111
Q

Risk of pregnancy before intrauterine coil removal?

A

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

112
Q

What 3 things need to be excluded when the coil threads cannot be seen or palpated?

A

Expulsion
Pregnancy
Uterine perforation

113
Q

Managing non-visible or palpable coil threads?

A

Extra contraception until coil is located
USS
Abdominal/pelvic XR may be done to look for coil in abdomen or peritoneal cavity after a uterine perforation
Hysteroscopy or laparoscopic surgery may be required depending on location of coil

114
Q

Benefits of copper coil?

A

Reliable contraception
It can be inserted at any time in the menstrual cycle and is effective immediately
It contains no hormones, so it is safe for women at risk of VTE or with a history of hormone-related cancers
It may reduce the risk of endometrial and cervical cancer

115
Q

Contraindication specific to copper coil?

A

Wilsons disease

116
Q

What are the 2 new IUS systems?

A

Jaydess
Kyleena

117
Q

Features of the new Jaydess IUS?

A

Licensed for 3 years
Has a smaller frame, narrower inserted tube
Contains less levonorgestrel than mirena coil (13.5mg compared to 52mg)

118
Q

Features of the new Kyleena IUS?

A

Has less levonorgestrel than mirena (19.5mg compared to 52mg)
Smaller than mirena
Licensed for 5 years
Rate of amenorrhoea is less compared to mirena

119
Q

How often do intrauterine devices typically fall out?

A

5% of cases

120
Q

Management of problematic bleeding on LNG-IUS?

A

Often settles with time. Worst in first 6 months
May need to exclude other causes - sexual health screen, pregnancy test, cervical screening

COCP can be taken for 3 months alongside to help settle the bleeding

121
Q

What is often discovered incidentally during smear tests in women with the IUD?

A

Actinomyces-like organisms - dont need treatment unless symptomatic and then removal of IUD may be considered

122
Q

What are the 3 options for emergency hormonal contraception?

A

Levonorgestrel
Ulipristal
Copper IUD

123
Q

What is ulipristal?

A

A progesterone receptor modulator
“EllaOne”
It inhibits ovulation

124
Q

How does levonorgestrel work as emergency contraception?

A

mode of action not fully understood - acts both to stop ovulation and inhibit implantation

125
Q

When does levonorgestrel have to be taken to work as emergency contraception?

A

Must be taken within 72 hours of unprotected sexual intercourse but it should be taken as soon as possible as efficacy decreases with time
Best within 12 hours

126
Q

Dose of levonorgestrel as emergency contraception

A

1.5mg
Higher doses should be considered for patients with body weight >70kg or BMI >26

127
Q

How effective is levnorgestrel as emergency contraception?

A

84% effective if used within 72 hours of unprotected sexual inter course

128
Q

Side effects of levonorgestrel for emergency contraception

A

GI discomfort - vomiting, nausea, diarrhoea common - if vomiting within 3 hours of taking then dose should be repeated
Next menstrual cycle irregularities e.g. spotting - common
Dizziness
Depressed mood

129
Q

Trade name for levonorgestrel for emergency contraception

A

Levonelle

130
Q

When can hormonal contraception be started after levonelle for emergency contraception?

A

Immediately

131
Q

When should ulipristal (EllaOne) be taken for emergency contraception?

A

No later than 120 hours after intercourse

132
Q

When can hormonal contraception be started after EllaOne emergency contraception?

A

5 days - reduces the effectiveness of hormonal contraception (use barrier methods in this time)

133
Q

Common side effects of EllaOne?

A

Nausea and vomiting - common + if vomiting occurs within 3 hours of taking pill, dose should be repeated

Next menstrual cycle irregularities
Abdominal or pelvic pain
Back pain
Mood changes
Headache
Dizziness
Breast tenderness

134
Q

Contraindications of ullipristal (EllaOne)

A

Severe asthma
Breastfeeding - avoid for 1 week after administration

Any gynae cancer or undiagnosed vaginal bleeding

135
Q

Can you use more than 1 dose of ulipristal in the same menstrual cycle?

A

Previously it was not recommended however now this guidance has changes and it can be used > once

136
Q

What is the most effective method of emergency contraception?

A

Copper IUD

137
Q

When does the copper IUD have to be inserted if using for emergency contraception?

A

Within 5 days of UPSI or if later than it can be fitter up to 5 days after the likely ovulation date in the menstrual cycle

138
Q

How does the copper IUD work for emergency contraception?

A

It may inhibit fertilisation or implantation
Copper is toxic to the ovum and sperm

139
Q

First line emergency contraception?
How effective is it?

A

Copper IUD - >99% regardless of where it is used in the cycle

140
Q

Why may antibiotics be considered when inserting a copper IUD?

A

Insertion may lead to PID, especially in women at high risk of STIs

141
Q

How long should the copper IUD be in for if used as emergency contraception?

A

At least until the next period, after which it can be removed
Or it can be left in long term as contraception

142
Q

Is male or female sterilisation more effective as contraception ?

A

Male

143
Q

What is a vasectomy?

A

Male sterilisation
Cutting the vas deferens which prevents sperm travelling from the testes to join the ejaculated fluid which prevents sperm being released into the vagina

Performed under LA and is 15-20 mins and most men go home within a couple of hours

144
Q

Follow up following a vasectomy?

A

Semen analysis needs to be performed twice following the vasectomy before a man can have unprotected sex. This is usually from 12 weeks post-procedure

145
Q

Complications of vasectomy?

A

Bruising
Haematoma
Infection
Sperm granuloma
Chronic testicular pain - 5-30% of men

146
Q

Success of vasectomy reversal and where can it be done?

A

Up to 55% if done within 10 years and 25% if after 10 years post procedure
Not on NHS so must be private

147
Q

What is the procedure for female sterilisation?

A

Tubal occlusion

148
Q

How is a tubal occlusion done?

A

This is typically performed by laparoscopy under general anaesthesia, with occlusion of the tubes using “Filshie clips”. Alternatively, the fallopian types can be tied and cut, or removed altogether. This can be done as an elective procedure, or during a caesarean section.
This prevents the ovum travelling from the ovary to the uterus along the fallopian tube

149
Q

When do you need to use alternative contraception after female sterilisation procedure?

A

It’s required until the next menstrual period as an ovum may have already reaches the uterus during that cycle

150
Q

What is gillick competence?

A

This refers to a judgement about whether the understanding and intelligence of the child is sufficient to consent to treatment. Gillick competence needs to be assessed on a decision by decision basis, checking whether the child understands the implications of the treatment.

Consent needs to be given voluntarily. When prescribing contraception to children under 16 years, it is essential to assess for coercion or pressure which may raise safegaurding concerns.

151
Q

What are the Fraser guidelines?

A

Specific guidelines for providing contraception to patients under the age of 16 without parental input and consent

all the following requirements should be fulfilled:
the young person understands the professional’s advice
the young person cannot be persuaded to inform their parents
the young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment
unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer
the young person’s best interests require them to receive contraceptive advice or treatment with or without parental consent

152
Q

Intercourse in a child under 13 years old?

A

All intercourse in children under 13 years should be escalated as a safeguarding concern to a senior or designated child protection doctor.

153
Q

What is FSRH?

A

Faculty of Sexual and Reproductive Healthcare

154
Q

what % of couples globally use contraception?

A

64%

155
Q

Globally what is the most popular method of contraception?

A

Female sterilisation

156
Q

Average age of IUS user?

A

38

157
Q

In which women might the newer IUS e.g. Jaydess or Kyleena be beneficial?

A

If they are having hormonal SE with the mirena
If they would prefer to menstruate but the Cu_IUD makes periods too heavy
If they have a narrow cervix which makes it difficult to insert the mirena

158
Q

Advantages of the Sayana Press over Depo-Provera?

A

Patients dont need to attend GP 3 monthly = better for travel and lifestyle
Overweight patients - needle doesnt need to reach muscle as its a subcutaneous injection
Patients with a bleeding disorder or taking anticoagulants it can be used unlike depo-provera

159
Q

Advantages of extended pill taking?

A

Improves adherence and efficiency
Cost saving on sanitary wear
Decreased absence from work and school

160
Q

Why is the contraceptive pill better at treating acne than transdermal patch or ring would be?

A

As it has the first pass effect through the liver which increases sex hormone binding globulin, lowering androgen availability

161
Q

Can hormonal contraception be commenced in women with unexplained vaginal bleeding?

A

Oral methods can
All other methods are contraindicated, pending investigations

162
Q

Which contraception methods are contraindicated in ovarian cancer sufferers?

A

No methods contraindicated

163
Q

Which contraception methods are contraindicated in uterine cancer sufferers?

A

Only intrauterine methods are contraindicated

164
Q

What is the Evra patch?

A

The combined contraceptive patch - only one licensed for use in the UK

165
Q

How long does the patch cycle last for the Evra patch?
Outline this cycle?

A

4 weeks
For the first 3 weeks the patch is worn everyday and needs to be changed weekly
During the 4th week the patch is not worn = withdrawal bleed

166
Q

What should the woman do if she delayed changing her combined contraception patch at the end of week 1 or 2?

A

If the delay in changing the patch is <48 hours then it should be changed immediately and no further precautions are needed

If delay is >48 hours then change patch immediately and use barrier method contraception for the next 7 days

If the woman has had sexual intercouse during this extrended patch-free interval or if it has occurred in the last 5 days = consider emergency contraception

167
Q

What should the woman do if she delayed changing her combined contraception patch at the end of week 3?

A

Remove patch as soon as possible and the new patch wont be applied until the usual cycle start day for the net cycle, even if withdrawal bleeding is occurred
No additional contraception is needed

168
Q

What should the woman do if she delayed changing her combined contraception patch at the end of the patch-free week?

A

Additional barrier contraception for 7 days following any delay at the start of a new patch cycle

GYNAECOLOGY (9 decks)

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