Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

GP > Contraception > Flashcards

Contraception Flashcards

(67 cards)

Start Studying
1
Q

What are some methods of contraception?

A

Natural family planning (“rhythm method”)
Barrier methods (i.e. condoms)
Combined contraceptive pills
Progestogen-only pills
Coils (i.e. copper coil or Mirena)
Progestogen injection
Progestogen implant
Surgery (i.e. sterilisation or vasectomy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the UKMEC?

A

UK Medical Eligibility Criteria

to categorise the risks of starting different methods of contraception in different individuals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the levels of UKMEC?

A

UKMEC 1: No restriction in use (minimal risk)
UKMEC 2: Benefits generally outweigh the risks
UKMEC 3: Risks generally outweigh the benefits
UKMEC 4: Unacceptable risk (typically this means the method is contraindicated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What contraception should be avoided if there’s a risk factor of breast cancer?

A

Hormonal contraceptives

Copper coil or barrier methods should be used instead

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What contraception should be avoided if cervical or endometrial cancer is a risk factor?

A

Intrauterine system e.g. Mirena coil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What contraception should be avoided if patient has Wilson’s disease?

A

Copper coil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some specific risk factors that makes you avoid combined contraceptive pill?

A

-Uncontrolled hypertension (particularly ≥160 / ≥100)
-Migraine with aura
-History of VTE
-Aged over 35 smoking more than 15 cigarettes per day
-Major surgery with prolonged immobility
-Vascular disease or stroke
-Ischaemic heart disease, cardiomyopathy or atrial fibrillation
-Liver cirrhosis and liver tumours
-Systemic lupus erythematosus and antiphospholipid syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How long is contraception still required after a woman’s last period due to menopause?

A

2yrs if under 50
1yr over 50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What contraception advice should be given to perimenopausal women starting HRT

A

HRT does not prevent pregnancy

Added contraception is required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What age should the progesterone injection be stopped and why?

A

Before 50yrs due to osteoporosis risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What contraceptive can be used to treat perimenopausal symptoms?

A

Combined contraceptive pill

Up to 50yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When does fertility return after childbirth?

A

21days after

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is lactational amenorrhea?

A

Women who are fully breastfeeding become amenorrhoeic
Effective contraception for up to 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What contraceptions are safe and what should be avoided in breastfeeding?

A

Progesterone only pill and implant are safe

Combined contraceptive pill should be avoided

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the mechanism of action for the combined oral contraceptive pill?

A

-Preventing ovulation (this is the primary mechanism of action)
-Progesterone thickens the cervical mucus
-Progesterone inhibits proliferation of the endometrium, reducing the chance of successful implantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What hormones does the COCP contain?

A

Oestrogen
Progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does the COCP prevent ovulation?

A

Oestrogen and progesterone have a negative feedback effect on the hypothalamus and anterior pituitary, suppressing the release of GnRH, LH and FSH.

Without the effects of LH and FSH, ovulation does not occur. Pregnancy cannot happen without ovulation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the two types of COCP?

A

Monophasic pills contain the same amount of hormone in each pill

Multiphasic pills contain varying amounts of hormone to match the normal cyclical hormonal changes more closely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are some examples on monophasic COCP?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are some side effects of COCP?

A

-Unscheduled bleeding is common in the first three months and should then settle with time
-Breast pain and tenderness
-Mood changes and depression
-Headaches
-Hypertension
-Venous thromboembolism (the risk is much lower for the pill than pregnancy)
-Small increased risk of breast and cervical cancer, returning to normal ten years after stopping
-Small increased risk of myocardial infarction and stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the benefits of COCP?

A

-Effective contraception
-Rapid return of fertility after stopping
-Improvement in premenstrual symptoms, menorrhagia (heavy periods) and dysmenorrhoea (painful periods)
-Reduced risk of endometrial, ovarian and colon cancer
-Reduced risk of benign ovarian cysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the missed pill rules for COCP?

A

Missing one pill (less than 72 hours since the last pill was taken):

-Take the missed pill as soon as possible (even if this means taking two pills on the same day)
-No extra protection is required provided other pills before and after are taken correctly

Missing more than one pill (more than 72 hours since the last pill was taken):

-Take the most recent missed pill as soon as possible (even if this means taking two pills on the same day)
-Additional contraception (i.e. condoms) is needed until they have taken the pill regularly for 7 days straight
-If day 1 – 7 of the packet they need emergency contraception if they have had unprotected sex
-If day 8 – 14 of the pack (and day 1 – 7 was fully compliant) then no emergency contraception is required
-If day 15 – 21 of the pack (and day 1 – 14 was fully compliant) then no emergency contraception is needed. They should go back-to-back with their next pack of pills and skip the pill-free period.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the mechanism of action for the traditional progesterone only pill?

A

-Thickening the cervical mucus
-Altering the endometrium and making it less accepting of implantation
-Reducing ciliary action in the fallopian tubes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What’s the mechanism of action for the Desogestrel only pill?

A

-Inhibiting ovulation
-Thickening the cervical mucus
-Altering the endometrium
-Reducing ciliary action in the fallopian tubes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are some side effects of the POP?
Changes to bleeding schedule: -20% have no bleeding (amenorrhoea) -40% have regular bleeding -40% have irregular, prolonged or troublesome bleeding Breast tenderness Headaches Acne
26
What is there an increased risk of when taking POP?
-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
27
What are the missed pill rules for POP?
-take a pill as soon as possible -continue with the next pill at the usual time (even if this means taking two in 24 hours) -use extra contraception for the next 48 hours of regular use
28
What is the progesterone only injection also known as?
depot medroxyprogesterone acetate (DMPA)
29
What’s a contraindication for starting POP?
Breast cancer
30
How is the progesterone only injection given, and how frequently?
intramuscular or subcutaneous injection 12-13wk intervals
31
What are the two versions of the progesterone only injection given in UK?
Depo-Provera: given by intramuscular injection Sayana Press: a subcutaneous injection device that can be self-injected by the patient
32
What are some contraindications for progesterone only injection?
Active breast cancer Ischaemic heart disease and stroke Unexplained vaginal bleeding Severe liver cirrhosis Liver cancer
33
Whats the mechanism of the progesterone only injection?
-inhibit ovulation by inhibiting FSH secretion -Thickening cervical mucus -Altering the endometrium and making it less accepting of implantation
34
What are some side effects of the progesterone only injection?
-Changes in bleeding schedule -Weight gain -Acne -Reduced libido -Mood changes -Headaches -Flushes -Hair loss (alopecia) -Skin reactions at injection sites -Osteoporosis -Small increased risk of breast and cervical cancer
35
What can be done to help problematic bleeding when taking the progesterone only injection?
taking the combined oral contraceptive pill (COCP) in addition to the injection for three months OR short course (5 days) of mefenamic acid to halt the bleeding.
36
What are some benefits of the progesterone only injection?
-Improves dysmenorrhoea (painful periods) -Improves endometriosis-related symptoms -Reduces the risk of ovarian and endometrial cancer -Reduces the severity of sickle cell crisis in patients with sickle cell anaemia
37
When should progesterone only injection be started?
Day 1-5 of cycle gives immediate protection After day 5, 7 days of extra contraception required
38
When should POP be started?
Day 1-5 of cycle gives immediate protection. If started at other time, 48hrs of additional contraception required
39
What is the progesterone only implant?
a small (4cm) flexible plastic rod that is placed in the upper arm, beneath the skin and above the subcutaneous fat. It slowly releases progestogen into the systemic circulation
40
How long does the progesterone only implant last for before it needs replacing?
3 years
41
What’s a contraindication of the progesterone only implant?
Active breast cancer
42
What does the progesterone only implant contain?
Nexplanon is the implant used in the UK. It contains 68mg of etonogestrel
43
Whats the mechanism of the progesterone only implant?
-Inhibiting ovulation -Thickening cervical mucus -Altering the endometrium and making it less accepting of implantation
44
What are the benefits of the progesterone only implant?
Effective and reliable contraception It can improve dysmenorrhoea (painful menstruation) It can make periods lighter or stop all together No need to remember to take pills (just remember to change the device every three years) It does not cause weight gain (unlike the depo injection) No effect on bone mineral density (unlike the depo injection) No increase in thrombosis risk (unlike the COCP) No restrictions for use in obese patients (unlike the COCP)
45
What are some drawbacks of the progesterone only implant?
requires a minor operation with a local anaesthetic to insert and remove the device It can lead to worsening of acne There is no protection against sexually transmitted infections It can cause problematic bleeding Implants can be bent or fractured Implants can become impalpable or deeply implanted, leading to investigations and additional management
46
What can happen to the patients bleeding pattern once receiving the progesterone only implant?
1/3 have infrequent bleeding 1/4 have frequent or prolonged bleeding 1/5 have no bleeding The remainder have normal regular bleeds
47
What are the two types of coils?
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
48
What are some contraindications for receiving the coil?
Pelvic inflammatory disease or infection Immunosuppression Pregnancy Unexplained bleeding Pelvic cancer Uterine cavity distortion (e.g. by fibroids)
49
What are some risks relating to the insertion of the coil?
Bleeding Pain on insertion Vasovagal reactions (dizziness, bradycardia and arrhythmias) Uterine perforation (1 in 1000, higher in breastfeeding women) Pelvic inflammatory disease (particularly in the first 20 days) The expulsion rate is highest in the first three months
50
What must be ruled out if threads from a coil are no longer visible?
Expulsion Pregnancy Uterine perforation
51
What is the mechanism of the copper coil?
Copper is toxic to the ovum and sperm. It also alters the endometrium and makes it less accepting of implantation
52
What disease makes the copper coil contraindicated?
Wilson’s disease
53
What are some benefits of the copper coil?
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 Can be used as emergency contraception if inserted up to 5 days after unprotected intercourse
54
What are some negatives of the copper coil?
A procedure is required to insert and remove the coil, with associated risks It can cause heavy or intermenstrual bleeding (this often settles) Some women experience pelvic pain It does not protect against sexually transmitted infections Increased risk of ectopic pregnancies Intrauterine devices can occasionally fall out (around 5%)
55
What hormone is in IUS and give some examples
Levonorgestrel Mirena: effective for 5 years for contraception, and also licensed for menorrhagia and HRT (4yrs) (most common) -Levosert: effective for 5 years, and also licensed for menorrhagia -Kyleena: effective for 5 years -Jaydess: effective for 3 years
56
Whats the mechanism of LNG-IUS?
releasing levonorgestrel (progestogen) into the local area Thickening cervical mucus Altering the endometrium and making it less accepting of implantation Inhibiting ovulation in a small number of women
57
When can LNG-IUS be inserted
inserted up to day 7 of the menstrual cycle without any need for additional contraception inserted after day 7, pregnancy needs to be reasonably excluded, and extra protection (i.e. condoms) is required for 7 days.
58
What are some benefits of LNG-IUS?
It can make periods lighter or stop altogether It may improve dysmenorrhoea or pelvic pain related to endometriosis No effect on bone mineral density (unlike the depo injection) No increase in thrombosis risk (unlike the COCP) No restrictions for use in obese patients (unlike the COCP) The Mirena has additional uses (i.e. HRT and menorrhagia
59
What are some downsides to the LNG-IUS?
A procedure is required to insert and remove the coil, with associated risks It can cause spotting or irregular bleeding Some women experience pelvic pain It does not protect against sexually transmitted infections Increased risk of ectopic pregnancies Increased incidence of ovarian cysts There can be systemic absorption causing side effects of acne, headaches, or breast tenderness Intrauterine devices can occasionally fall out (around 5%)
60
What are the options for emergency contraception?
Levonorgestrel should be taken within 72 hours of UPSI Ulipristal should be taken within 120 hours of UPSI Copper coil can be inserted within 5 days of UPSI, or within 5 days of the estimated date of ovulation - Most effective
61
What can affected the effectiveness of oral emergency contraception?
BMI, enzyme-inducing drugs or malabsorption
62
What are some side effects of using levonorgestrel as emergency contraception?
Nausea and vomiting - retake pill if vomit within 3 hours Spotting and changes to the next menstrual period Diarrhoea Breast tenderness Dizziness Depressed mood
63
What are some side effects of taking Ulipristal as emergency contraception?
Nausea and vomiting- If vomiting occurs within 3 hours of taking the pill, the dose should be repeated Spotting and changes to the next menstrual period Abdominal or pelvic pain Back pain Mood changes Headache Dizziness Breast tenderness
64
What are some restrictions on Ulipristal?
Breastfeeding should be avoided for 1 week after taking ulipristal (milk should be expressed and discarded) Ulipristal should be avoided in patients with severe asthma
65
What is the female sterilisation option?
tubal occlusion occlusion of the tubes using “Filshie clips”. Alternatively, the fallopian types can be tied and cut, or removed altogether
66
How does female sterilisation work?
preventing the ovum (egg) travelling from the ovary to the uterus along the fallopian tube. This means the ovum and sperm will not meet, and pregnancy cannot occur
67
Whats the male option for sterilisation?
Vasectomy vas deferens, preventing sperm travelling from the testes to join the ejaculated fluid. This prevents sperm from being released into the vagina

GP (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions