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Contraception Flashcards

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1
Q

% unintended pregnancy - female sterilisation

A

0.5%

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2
Q

% unintended pregnancy - vasectomy

A

0.1%

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3
Q

% unintended pregnancy - progesterone only implant

A

0.05%

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4
Q

% unintended pregnancy - mirena

A

0.2%

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5
Q

% unintended pregnancy - Copper coil

A

0.8-0.6%

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6
Q

% unintended pregnancy - Depo injection

A

0.2 - 6%

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7
Q

% unintended pregnancy - COCP and POP

A

0.3- 9%

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8
Q

% unintended pregnancy - male condom

A

18 - 2%

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9
Q

% unintended pregnancy - female diaphragm

A

12 - 6%

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10
Q

UKMEC category 1

A

no restriction

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11
Q

UKMEC category 2

A

advantages outweigh theoretical risk

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12
Q

UKMEC category 3

A

theoretical or proven risks outweigh advantage

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13
Q

UKMEC category 4

A

unacceptable health risk

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14
Q

Which conditions contraindicate the use of certain contraceptives postpartum/breastfeeding (UKMEC 4)?

A

postpartum sepsis contraindicates the use of intrauterine devices
1-3 week postpartum + VTE risk - no cocp

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15
Q

Which contraceptives can be safely used postpartum and breastfeeding?

A

Progesterone only pill/depo/implant

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16
Q

When should cocp be avoided (UKMEC 3) postpartum/breastfeeding?

A

0-3 weeks post partum without VTE risk factors

3-6 weeks with risk factor of VTE

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17
Q

When should IUDs be avoided postpartum/breast feeding (UKMEC 3)

A

48-4weeks post partum (can be inserted in first 48 hours)

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18
Q

Regarding BMI, when should COCP be avoided?

A

BMI >/= 35

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19
Q

Which contraceptions are UKMEC 2 for organ transplant?

A

If uncomplicated - all are
If complicated it is not advisable to start IUD or COCP but progesterone only is UKMEC 2 and IUD can be continued if already present

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20
Q

Which contraceptives should be avoided (UKMEC 3) in patient with multiple cardiac risk factors?

A

Depo injection and COCP

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21
Q

Which contraception is contraindicated with impaired cardiac function?

A

COCP, the rest are fine to use

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22
Q

Which contraception is contraindicated in AF?

A

COCP, the rest are fine to use

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23
Q

Which contraceptions are best avoided in long QT and why?

A

Advisable not to start an IUD, risk of vasovagal due to cervical excitation leading to bradycardia and risk of cardiac event

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24
Q

Which contraceptions are UKMEC 3/4 with gestational trophoblastic disease?

A

All fine if BHCG levels not detectable
IUDs should be avoided if BHCG levels present and falling
IUDS contraindicated if BHCG levels elevated or there is malignant disease

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25
Which contraceptions are UKMEC 3/4 with cervical cancer?
``` Awaiting treatment UKMEC 4 - do not start IUD Radical cervicectomy (Trachelectomy) - UKMEC 3 IUD ```
26
In active breast cancer, which contraceptions are contraindicated?
Everything except copper coil
27
In past breast cancer, which contraceptives are UKMEC 3?
everything except the copper coil
28
Regarding breast conditions, when should COCP be avoided?
starting in an undiagnosed breast lump/mass/symptoms | BRCA1/BRCA2 carriers
29
What is the UKMEC guidance on contraception in ovarian cancer?
All contraceptions safe to use
30
Which contraceptions are contraindicated with certain STIs?
UKMEC 4 IUD insertion of IUD in a symptomatic chlamydia or active gonorrhoea or in cervicitis or active PID, UKMEC 3 for insertion of IUD in asymptomatic chlamydia
31
When should you not insert an IUD in a HIV positive patient?
If CD4 count <200
32
Which contraceptive is UKMEC 3 in diabetes?
COCP if associated cardiovascular disease or diabetic retinopathy
33
In viral hepatitis, which contraceptive should be avoided?
Don't start COCP in an acute flare
34
What dose difference between the progesterone IUD that lasts for 3 years and theIUD that lasts for 5 years?
3 years - 13.5mg | 5 years - 58mg
35
What is the risk of having an IUD at <20 years?
Increased risk of expulsion
36
What are highest risk factors for IUD expulsion?
lactation and insertion within 36 weeks of birth
37
Decompensated liver disease - IUD
copper coil safe | mirena should be avoided as liver will find it difficult to metabolise progesterone
38
What dose is the progesterone only implant?
68mg
39
When should an IUD be avoided in liver disease?
copper coil safe | UKMEC3 for mirena in decompensated liver disease, hepatocellular adenoma and carcinoma
40
What dose of progesterone is in the POP?
350micrograms norehisterone | 75micograms desogestrel
41
progesterone only contraception and bone mineral density
depo has slight increased risk of reduced bone mineral density, in women under 18 other methods should be considered first
42
Progesterone only contraception post abortion/breastfeeding/postpartum
All safe to use straight away | Although, non-breastfeeding women don't require contraception until 21 days
43
Progesterone only contraception in smokers and high BMI
safe to use
44
Vascular disease (CHD/TIA/PVD/angina) which progesterone only contraception should be avoided?
DEpo injection, otherwise all fine to use in patients with uncomplicated hypertension
45
Which contraception is safe to use in ischaemic heart disease and stroke?
Copper coil
46
Which contraceptions should be avoided in IHD/stroke?
avoid continuing mirena/POP/implant if stroke or IHD develops avoid depo UKMEC 4 with stroke/IHD
47
Which progesterone only contraception is UKMEC3 with unexplained vaginal bleeding?
implant and depo | POP = UKMEC 2
48
Active or past breast cancer - progesterone only contraceptives
Active - UKMEC 4 for all including mirena | Past- UKMEC 3 for all including mirena
49
STIs- progesterone only contraceptives
safe to use except mirena
50
HIV - progesterone only contraceptives
safe to use except mirena if CD4 count <200
51
Liver disease- progesterone only contraceptives
avoid (UKMEC3) if decompensated liver disease or hepatocellular adenoma or carcinoma (including mirena)
52
Cervical/endometrial/ovarian cancer - progesterone only contraceptives
safe to use whilst awaiting treatment mirena is ukmec 4 for starting in endometrial cancer and ukmec 2 for continuing Do not start mirena whilst awaiting cervical treatment theoretical risk of POC with cervical cancer and prognosis
53
Oestrogen in COCP
Ethinylestradiol
54
When is COCP contraindicated postpartum?
0-6 weeks breastfeeding 0- <3 weeks with VTE risk factors Should be avoided if additional VTE risk factors 0-6 weeks postpartum (UKMEC 3) Safe to use after 6 weeks
55
COCP post abortion
safe to use
56
smoking and COCP
ukmec 4 - >35 years and smoking >15/d | ukmec 3 - >35 years and smoking <15/d or quit within the last year
57
BMI and COCP
>35 = UKMEC 3
58
Complicated organ transplant + COCP
UKMEC 3
59
Multiple risk factors for CVD + COCP
UKMEC 3 (also depo - other POP incl. mirena = UKMEC 2)
60
HTN + COCP
UKMEC 3 | Except BP >160/>100 or vascular disease = UKMEC 4
61
IHD or Stroke + COCP
UKMEC 4!
62
History of vte or current vte + COCP
UKMEC 4
63
First degree relative <45 years had VTE + COCP
UKMEC 3
64
Major surgery + prolonged immobilisation + COCP
UKMEC 4
65
Immobility + COCP
UKMEC 3
66
Thrombogenic mutations + COCP
UKMEC 4
67
complicated heart disease/impaired cardiac function/AF + COCP
UKMEC 4
68
Migraine + COCP
``` with aura (at any age) = UKMEC 4 5 years ago with aura = UKMEC 3 Migraine without aura starts whilst on COCP = UKMEC 3 to continue ```
69
Breast cancer + COCP
Active = UKMEC 4 Past = UKMEC 3 BRCA1/BRAC 2= UKMEC 3 Undiagnosed breast lump - can continue UKMEC 2 but shouldnt start UKMEC3
70
STIs + COCP
Safe
71
HIV + COCP
safe
72
Diabetes + COCP
UKMEC 3 if diabetic retinopathy or other cvd risk factors
73
Gallbladder disease + COCP
UKMEC 3 if medically treated or current symptomatic disease
74
Viral hepatitis + COCP
UKMEC 3 for starting COCP if active infection
75
Liver disease + COCP
UKMEC 4 for hepatocellular adenoma and carcinoma and for decompensated liver disease
76
SLE + COCP
UKMEC 4 if anti-phospholipid antibodies present
77
When can copper IUD be used for emergency contraception?
0-120hours | Or within 5 days of ovulation
78
When can oral emergency contraception be used?
Ullipristal acetate within 120 hours | Levenorgesterel within 72 hours 1.5mg

Gynaecology (10 decks)

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