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Contraception Flashcards

(72 cards)

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1
Q

what does the natural family planning method take in to account to work as contraception

A

1) Basal body temperature
2) Cervical mucous
3) Cervical position
4) “Standard” days
5) Breast feeding

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2
Q

what does the cervical mucous tell you about ovulation

A

Thick and sticky post ovulation

3 days after thinner, watery, stretchy mucous

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3
Q

what does the cervical position tell you about ovulation

A

when fertile, cervix is high, soft and open

when less fertile, cervix is low in vagina, firm and closed

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4
Q

what days tend to be most fertile in a 28 day cycle

A

day 8 to 18

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5
Q

what criteria is needed to know that breast feeding is working as contraceptive

A

1) exclusively breast feeding
2) less than 6/12 post natal
3) amenorrhoeic

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6
Q

what does the pearl index represent

A

no. of contraceptive failures per 100 women users/year

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7
Q

what is LARC and examples

A

long acting reversible contraception

Depo Provera IM ( medroxyprogesterone acetate)
Sayana press (SC version)
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8
Q

what are VLARC and examples

A

very long acting reversible contraception

IUD
IUS
Implant

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9
Q

how does the Depo provera/ Sayana press [LARC] work

A

inhibits ovulation

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10
Q

when is Depo provera/ Sayana press [LARC] given

A

every 13 weeks

lasts 14 weeks

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11
Q

what else does Depo provera/ Sayana press [LARC] have an effect on

A

thickens cervical mucus

endometrium

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12
Q

what are side effects of Depo provera/ Sayana press [LARC]

A

irregular bleeding

weight gain

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13
Q

what hormones are present in Depo provera/ Sayana press [LARC]

A

progesterone only

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14
Q

what needs to be done before first prescription of Depo provera/ Sayana press [LARC]

A

BP
BMI
risk factors for osteoporosis

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15
Q

what are risk factors for osteoporosis

A 
Underweight
Anorexia
Prolonged steroid use
XS alcohol intake
Immobility
Family history
Smoking
Low trauma fracture
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16
Q

when do you start Depo

A

can be started up to and including Day 5 of the cycle without the need for any additional contraception

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17
Q

when do you start Depo after day 5

A

any other time provided she is ‘reasonably certain’ she is not pregnant and needs to use condoms/abstain for 7 days

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18
Q

what criteria is there to be reasonably certain a women is not pregnant

A

No sex since last period

Consistently using reliable contraception

< 7 days since last normal period

< 4 wks post partum (not breast feeding)

Fully breastfeeding, amenorrhoeic and < 6m post partum

Negative preg test AND > 3 wks since UPSI

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19
Q

side effects of Depo

A

weight gain
delay in return of fertility
irregular bleeding
risk of osteoporosis

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20
Q

what is different about the IUD compared to other devices

A

it is non-hormonal

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21
Q

how does IUD’s work

A

prevent fertilisation

decreases sperm motility and survival

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22
Q

what are side effects of IUD

A

Periods may be heavier, longer and more painful

Small chancer of getting infection in first 20 days
perforation 1-2/1000
Expulsion 1/20, most in first 3/12

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23
Q

when can an IUD be started

A

up to 5 days after UPSI
[it is immediately protective]

Up to 5 days after predicted date of ovulation (I.e. day 19 of 28 day cycle)

Either within 48 hrs or > 4 weeks post partum

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24
Q

what hormones do IUS contain

A

progesterone only

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25
how does IUS work
Prevents endometrial proliferation (implantation) | Also thickens cervical mucus
26
what is side effects of IUS
Irregular bleeding/lighter+less frequency bleeding and spotting in first 6 months Can get infection in first 20 days
27
when can an IUS be started
Within first 7 days of period If after first 7 days use additional contraception Either with in 48 hrs or > 4 weeks post partum
28
what are contraindications to IUD and IUS
``` Current pelvic infection Abnormal uterine anatomy Pregnancy Sensitivity to any of the constituents Gestational trophoblastic disease when BHCG levels are abnormal/persistently elevated Endometrial ca Cervical ca awaiting treatment ```
29
what should be checked before fitting IUD/IUS
PV to check uterine size/position | BP and pulse if you think necessary
30
what is the implant
single, non biodegradable, subnormal rod
31
how does the implant work
inhibition of ovulation
32
when can the implant be fitted
Within first 5 days of cycle Up to day 5 post first/second trimester abortion On or before day 21 postpartum
33
what hormone does the implant release
progesterone only
34
how long does the implant last for
3 years
35
S.E of implant
irregular bleeding weight gain acne nerve damage/vascular injury on insertion
36
what are the types of short acting contraception
Combined Hormonal Contraception (CHC) Progestogen Only Pill (POP) Emergency Hormonal Contraception (EHC)
37
what does the COC contain
estrogen and progesterone
38
how does the COC work
inhibits ovulation thickens cervical mucous makes endometrium unfavourable for implantation
39
COC packet contains 21 pills - how does the system work
first 7 pills inhibit ovulation remaining 14 maintain anovulation
40
side effects of COC
Increases risk of venous thromboembolism Increases risk of breast and cervical cancer Small risk of increase in BP > systemic hypertension
41
what should a person be advised to do if they miss 1 pill
Over 24 hours and less than 48 hours Take the missed pill as soon as it is remembered Remaining pills are taken at the normal time EC is not required
42
what should a person be advised to do if they miss 2 or more pills
More than 48 hrs without pills Take the most recent missed pill Take the remaining pills at the correct time Use condoms or abstain until 7 pills have been taken consecutively
43
through what mechanism does COC stop ovulation
action on hypothalmic-pituitary-ovarian axis to reduce LH and FSH
44
how does CTP work - contraceptive patch
One patch is applied and worn for 1 week to suppress ovulation. The patch is reapplied weekly for a further 2 weeks The 4th week is patch-free to allow a withdrawal bleed New patch is applied after 7 patch-free days
45
how does CVR work - vaginal ring
A ring is placed into the vagina and left continuously for 21 days. After a ring-free interval of 7 days to induce a withdrawal bleed, a new ring should be inserted
46
what factors require consideration when prescribing COC
absorption - impaired in GI conditions metabolism - increased in liver enzyme induction, drug interaction metabolic effects forgetting
47
what is Cyproterone acetate
works as COC | used in the Tx of acne and hirsutism
48
when is COC contraindicated
patient suffers migraine ith aura
49
why is migraine with aura a contraindication of COC
Migraine with aura increases the risk of ischaemic stroke | CHC further increases thi risk
50
what is 'aura' with migraine
A ‘change’ occurring 5 – 20 minutes before the onset of headache May be visual, typical scotoma Altered sensation Smell or taste Hemiparesis
51
what is COC protective against
ovarian and endometrial cancers beneficial effect on acne can decrease bleeding
52
side effects of COC
Unscheduled bleeding - usually settles with time, don't change before 3 months Mood changes WEight gain
53
side effects of CTP - the patch
more breast pain, nausea, painful periods than COC/CVR
54
side effects of CVR - vaginal ring
less bleeding problems, acne, irritability/mood changes
55
why is CHC useful along side emergency contraception [EC]
as a quick start and can be used as riding if the new contraception that patient wants has a delayed started
56
what types of progesterone only pills [POP] are there
Older POP - levonorgestrel, norethisterone Newer POP – etonorgestrel
57
how does POP work
primary = Thickening of cervical mucous secondary = Suppression of ovulation, decreased endometrial receptivity to blastocyst, reduction in cilia activity in fallopian tube
58
what does POP interact with
Liver enzyme inducers - Cytochrome P450
59
how are POP taken
older pills - Daily at same time - No break - Within 24 - 27 hours of last dose newer pills - Daily at same time within 24 – 36 hours of last dose No break
60
what happens is a patient is on POP and has = One missed dose plus UPSI
emergency contraception plus 2 days extra protection
61
what are complications of vasectomy
Anaesthetic complications Pain Infection Bleeding /haematoma Failure Post-op testicular, scrotal, penile, lower abdominal pain
62
how soon are people protected on the POP
Protected immediately if started on day 1-5 of period If taken after day 5 then must wait 2 days until protected
63
in terms of legality, when can an abortion happen
only if two registered medical practitioners are of the opinion, formed in good faith, that an abortion is justified within the terms of the Act
64
what is the types of methods of abortion that can be done and what time frame can they be done in
Surgical termination up to 12 weeks | Medical termination up to 18 weeks and 6 days
65
for medical termination, what are the 3 time frames that affect the treatment
``` early = up to 9 weeks late = 9-12 weeks mid-trimester = 12-24 weeks ```
66
what are the 2 steps in the process of medical TOP
1) Oral MIFEPRISTONE 200mg | 2) 24-48 hours later – Vaginal (or oral) prostagladin e.g. misoprostol, gemeprost
67
what are the methods of surgical treatment and what time frames are they in
Vacuum aspiration = 6-12 weeks Dilatation and evacuation = 13-24 weeks
68
what is required before surgical TOP
Cervical ‘priming’ – vaginal prostaglandin
69
what are the risks of TOP surgically
``` Pain, Haemorrhage Infection Incomplete/failed procedure Uterine perforation Cervical trauma Anaesthetic complications Ongoing pregnancy Uterine rupture ```
70
what is the follow up of a TOP
Urine Pregnancy Test at 2-3 weeks
71
what are the methods of emergency contraception and in what time frame can they be used
Oral = Levonelle – up to 72hrs post UPSI ellaOne – up to 120hrs post UPSI Intrauterine = Copper IUD - up to 120hrs post UPSI
72
what follow should be done after emergency contraception
urine pregnancy test after 3 weeks

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