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Gynae > Contraception > Flashcards

Contraception Flashcards

1
Q

What are the 3 main types of emergency contraception and the time-frame in
which they need to be used? Which is most effective?

A

Levonogesterol (Levonelle) - 72 hours
Ulipristal (ellaOne) - 120 hours
Copper IUD - 120 hours (works immediately) - most effective

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2
Q

What is the MOA of levonorgesterol as an emergency contraception?

A

Stops ovulation and inhibits implantation

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3
Q

What is the stat dose of levonorgesterol?

A

1.5mg (double dose if >70kg or BMI >26 BMI)

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4
Q

When should the dose of levongorgesterol be repeated?

A

If vomiting within 2 hours of dose

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5
Q

How many times can levongorgesterol be used in one cycle

A

More than once per cycle

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6
Q

What is the MOA of ullipristal acetate?

A

elective progesterone receptor inhibitor –> inhibits ovulation

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7
Q

What is the stat dose of ellaOne?

A

30mg

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8
Q

Recall important contraindications of ellaOne

A

Severe asthma
Not to be used with levonorgesterol

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9
Q

What advice about hormonal contraception would you give to someone taking ellaOne?

A

If already on pill, restart 5 days after the morning-after pill (use barrier for 5 days)

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10
Q

When should the dose of ullipristal acetate be repeated?

A

If vomiting within 3 hours

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11
Q

How many times can EllaOne be used per cycle

A

Can be used more than once per cycle

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12
Q

What are the indications for the copper coil?

A

<5 days of last UPSI, or up to 5 days after the likely ovulation date
Only method effective after ovulation

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13
Q

Mechanism of IUD

A

Spermicide and prevents implantation
Can’t be inserted with a current STI

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14
Q

What is the pearl index?

A

Describes the chance of becoming pregnant on contraception - number of pregnancies occuring per 100 woman-years
ie. Pearl of 2 = 2 pregnancies per year in 100 women

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15
Q

What should women be advised to do if their next period is more than 7 days late

A

STI test
Pregnancy test

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16
Q

Side effects of emergency contraception (not IUD)

A

Nausea & Vomiting
Headache
Breast tenderness
abnormal menstrual bleeding

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17
Q

Long acting vs short acting

A

Long - stays in place
IUD/IUS
Injection implant

Short - remember to take
Pills POP vs COCP
Patches
Rings

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18
Q

LARC time until effective

A

IUD - instant
POP - 2 days
COCP, IUS, injection, implant - 7 days

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19
Q

How often does a transdermal patch need to be used to make it effective contraception?

A

Every week

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20
Q

How often does a vaginal ring need to be used to make it effective as contraception?

A

3-weekly

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21
Q

COCP brand

A

Microgynon 30

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22
Q

COCP hormone

A

Ethinyl oestriadiol + progestin

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23
Q

What is the MOA of the COCP?

A

Prevention of ovulation

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24
Q

How quickly does the COCP connvey contraceptive protection?

A

If started on first 5 days of the cycle = immediate
If started at any other time, us additional measures for first 7 days

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25
Q

What precaution should be taken if on the COCP and undergoing surgery?

A

Stop taking 4w before, restart 2w after

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26
Q

How to take COCP

A

1 tablet per day for 3 weeks with –>
1 week off (withdrawal bleed)

Tricycle OD 9 weeks, 1 week off

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27
Q

Benefits of COCP

A

> 99% effect if taken properly
Reversible on stopping
Less pain, regular, lighter periods
Reduced risk of ovarian, endometrial, bowel cancer

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28
Q

Disadvantages of COCP

A

Forgetting to take it
No protection STIs
Increased risk of VTE, Breast cancer, cervical cancer, stroke, IHD

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29
Q

COCP side effects

A

Headache
N&V
breast tenderness

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30
Q

Recall some absolute contraindications to any long term contraception that contains oestrogen - UKMEC 4

A

CV: Ischaemic/ valvular HD, VTE history, HTN severe 160/100, TIA/ stroke history
Diabetes with complications
Migraine with aura
Liver tumour/ severe cirrhois
Current breast Ca
>35 smoke >15 a day
SLE positive APL antibodies
<6 week pp and breastfeeding

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31
Q

UKMEC 3

A

more than 35 years old and smoking less than 15 cigarettes/day
BMI > 35 kg/m^2
family history 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

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32
Q

Recall the missed dose procedure for the COCP

A

1 pill missed: take last pill and current pill (even if 2 in one day)
2 pills missed: same as above, PLUS:
If in week one: consider emergency contraception
If in week two: no need for emergency contraception
If in week 3: finish current pack, start new pack without pill free break

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33
Q

POP hormone

A

Progestin –> desogestrel/cerazette, norethsterone, levonorgestrel

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34
Q

Recall the MOA of the POP

A

Thickens cervical mucus and primarily stops ovulation (desogestrel)

35
Q

How should the POP be taken? protection times

A

OD at the same time every day - no pill-free break

within first 5 days of cycle immediate protection
If other 2 days of protection needed
COCP-POP immediate

36
Q

Benefits of POP

A

No COCP risks

37
Q

Disadvantage POP

A

Forget to take
take at same time everyday
Irregular bleeding
Ovarian cysts

38
Q

What is the most common complaint with the POP?

A

Initial irregular bleeding

39
Q

What disorders does the POP increase the risk of?

A

Osteoporosis/ ovarian cyst

40
Q

POP side effects

A

Irregular bleeding
Acne
Constipation
Irritability
Breast tenderness
Mood changes
Headache

41
Q

Recall the missed dose protocol for the POP

A

If <3 hours late, continue as normal
If 3+ hours late, take missed pill asap and take extra precautions until the pill has been re-established for 48 hours
With Cerazette (desogesterel) - can continue as normal if <12 hours late

42
Q

Patch hormone

A

Norelgestromin + ethinyl oestradiol

43
Q

Patch brand

A

Evra patch

44
Q

What is the MOA of the transdermal patch?

A

Thickens cervical mucus and prevents ovulation

45
Q

How to take patch

A

Apply for 3 weeks -replace at end of 3 weeks then 1 week off

tricycle

46
Q

Benefits of patch

A

Hard to forget
No clot risk

47
Q

Disadvantage of patch

A

Skin sensitivity
COCP contraindications
Adherence sometimes

48
Q

Patch missed dose

A

Delayed change < 48 hours: change immediately with no further precautions
Delayed change > 48 hours in week 1 or 2: change immediately and use barrier
contraception for 7 days (if UPSI within previous 5 days or during extended patch-free
period, consider emergency contraception)
Delayed removal > 48 hours in week 3: remove immediately and apply next patch on
the usual start date of the next cycle (no additional contraception is needed)
Delayed at the end of the patch-free week: use barrier contraception for 7 days

49
Q

Combined hormonal ring (Nova ring) hormones + MOA

A

ethinyl oestradiol + norelgestromin

thickens cervical mucous + prevents ovulation

50
Q

Ring how to use

A

apply for 3 weeks 1 week off

51
Q

IUS hormone and brand

A

Levonorgestrel
Mirena
Jaydess - not for heavy periods

52
Q

What is contained within Mirena?

A

Progesterone (levonorgesterol)

53
Q

MOA mirena

A

Prevents endometrial thickening
Thickens mucous

54
Q

For how long can mirena be left in?

A

3-5 years

55
Q

For how long after insertion is extra contraception needed for mirena?

A

7 days

56
Q

What are some risks of mirena?

A

Expulsion, infection, perforation

57
Q

IUS/D CI

A

Pregnancy
PID
Malignancy
Unknown bleeding

58
Q

Mirena SE

A

Irregular bleeding
Acne
Constipation
Irritability
Breast tenderness
Mood changes
Headache

59
Q

How long does the copper coil last?

A

5-10 years

60
Q

MOA IUD

A

decrease sperm motility and survival
sterile inflammation –> no implantation

61
Q

When can an IUD be inserted pp

A

<48 hours
after 4 weeks

62
Q

IUD SE

A

Heavy painful periods
Expulsion
Infection
perforation
ectopic

63
Q

Recall one important contraindication of the copper coil

A

Menorrhagia

64
Q

What is contained within the implant? Nexaplanon

A

Progesterone (etonogestrel)

65
Q

How long does the implant last?

A

3 years

66
Q

Implant MOA

A

Prevents ovulation
Thickens mucous
thins endometrium

67
Q

Implant how to take

A

Small rod inserted sub-dermally into non-dominant arm

additional contra needed for 7 days if not <5 days of new cycle

68
Q

Implant benefit

A

fertility restored immediately after removal

69
Q

Recall a contraindication of the implant

A

IHD + progesterone SEs

70
Q

What is in the contraceptive injection? Depo-povera

A

Progesterone - medroxyprogesterone acetate

71
Q

Injection MOA

A

Prevents ovulation
Thickens mucous

72
Q

How long does the contraceptive injection work for?

A

12-14 weeks
injected into arm or buttock

73
Q

How long does it take for fertility to return after last contraceptive injection?

A

6-12 months

74
Q

Recall two significant risk associations with the contraceptive injection

A

Weight gain and ectopic pregnancy

75
Q

Who to avoid injection in

A

risk factors for osteoporosis as can thin bone

76
Q

What are some important elements of the history to ascertain when counselling
about contraception?

A

Previous FHx of VTE, migraine, Ca, stroke and HTN

77
Q

POP PP

A

anytime

78
Q

lacatational

A

<6 months post partum if fully breastfeeding amenorrhoeic

79
Q

When around childbirth is the COCP contraindicated?

A

<6 weeks post-partum + breastfeeding

80
Q

When around childbirth is the POP contraindicated?

A

You can start any time, but if >21 days post-partum, use barrier for 2 days

81
Q

Which forms of contraception can be continued past 50 years old?

A

Implant, POP, IUS

82
Q

Stopping contra women <50

A

Non-hormonal (condoms) - >2 years amenorrhoea
COCP - continue to 50
Injection - continue to 50
Implant, POP, IUS continue beyond

83
Q

Stopping contra women >50

A

Non-hormonal (condoms) - >1 years amenorrhoea
COCP - switch to non-hormonal or POP
Injection -switch to non-hormonal or POP / stop at >2 amenorrhoea
Implant, POP, IUS continue beyond

Gynae (4 decks)

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