Contraception Flashcards by Jane Keery

NATURAL FAMILY PLANNING

How long do sperm live in the female genital tract?

How long will an ovum survive in the female genital tract?

What is the significance of this?

5 days

17-24 hours

There is only a fairly small amount of time where the two actually overlap

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NATURAL FAMILY PLANNING

When should basal body temperature be taken?

A basal body temperature of what suggests a female is ovulating?

In the morning before rising

If there is an increase in > 0.2 degrees sustained for 3 days after at least 6 days of a lower temperature

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NATURAL FAMILY PLANNING

Describe the cervical mucus during ovulation?

What happens to the cervical mucus after ovulation?

Thinner, watery and stretchy

Thick and sticky

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NATURAL FAMILY PLANNING

Describe the position of the cervix when fertile?

Describe the position of the cervix when less fertile?

High in the vagina, soft and open

Low in the vagina, firm and closed

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NATURAL FAMILY PLANNING

In a 28 day cycle, which days is a person most fertile?

Days 8-18

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NATURAL FAMILY PLANNING

Lactational amenorrhoea acts as a natural contraceptive (98% effective) if what 3 criteria are met?

Exclusively breastfeeding

Less than 6 months post-natal

Amenorrhoeic

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TYPES OF CONTRACEPTION

What types of combined hormonal contraception are available?

Pills

Patches

Ring

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TYPES OF CONTRACEPTION

What types of progestogen only methods of contraception are available?

Pills

Implant

Depot injection

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TYPES OF CONTRACEPTION

What are the 3 types of IUS available?

Mirena

Jaydess

Kyleena

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FAILURE RATES

What is the name of the method used to calculate failure rates of contraceptives?

What does this represent?

Pearl index

Represents the number of contraceptive failures per 100 women users per year

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FAILURE RATES

How is the Pearl index worked out?

(Number of accidental pregnancies x 1200) / Total number of months exposure

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FAILURE RATES

Name 5 types of contraceptive which have typical use failure rates > perfect use failure rates?

Fertility awareness

Female diaphragm

Male condom

CHC

POP

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FAILURE RATES

Name 5 types of contraceptives which have typical use failure rates = to perfect use failure rates?

Cu-IUD

IUS

Implant

Female steralisation

Male steralisation

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FACTORS AFFECTING CHOICE

Name 6 factors (other than for contraception) which people may use a form of contraception for?

Heavy menstrual bleeding

Painful or irregular periods

Premenstrual symptoms

Endometriosis

Menstrual migraine (no aura)

Acne, mood, hirsutism

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COMBINED HORMONAL CONTRACEPTION

What hormones do these types of contraceptives contain?

How do they work primarily?

What secondary effects do they have?

Oestrogen and progesterone

Inhibition of ovulation

Thickens the cervical mucus and thins the endometrium

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COMBINED HORMONAL CONTRACEPTION

Is this a short or long term method?

What is the failure rate?

What are the 2 main reasons why someone shouldn’t use these methods of contraception?

Short term

0.2%

Weight > 90kg or aged > 35 and smokes

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COMBINED HORMONAL CONTRACEPTION

When should these methods ideally be started?

If these methods are not started at the recommended time, what additional measure needs to be taken?

If a pregnancy cannot be excluded, when should a pregnancy test be done?

Within 5 days of starting your period

The pill can be started on any day (assuming the patient is not pregnant), but if not within 5 days of starting your period, condoms should be used for the next 7 days

3 weeks after the last unprotected sex

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COMBINED HORMONAL PILL

How long should the pill be taken for and then stopped for?

If a patient has just had a miscarriage/abortion, when can the pill be started again?

Take the pill for 21 days and then have a 7 day break

Within 5 days (no other contraception needed), after this can be started but need to use condoms for 7 days

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COMBINED HORMONAL PILL

What happens if you miss one pill or start a new packet one day late?

What happens if you miss two pills or start a new packet two days late?

You are still protected against pregnancy. Take the missed pill as soon as you realise, even if that means taking two in one day.

Protection against pregnancy may be compromised. Take the missed last missed pill as soon as you realise. Use condoms for the next 7 days and may need emergency contraception.

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COMBINED HORMONAL CONTRACEPTION

What factors may affect the effectiveness of these methods?

Impaired absorption (i.e. diarrhoea or vomiting) - the pill only

Increased metabolism (drug interactions, liver enzyme inducers)

Forgetfulness

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COMBINED HORMONAL CONTRACEPTION

What are some temporary side effects which may occur for a few months after starting these contraceptive methods?

What should you do if these do not go away?

Headaches, nausea, breast tenderness and moodswings

Try a different pill

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COMBINED HORMONAL CONTRACEPTION

These contraceptive methods have a risk of venous thromboembolism. What are the rules (generally) with regards to a patient with other risk factors?

Usually prescribed with caution if they have one other risk factor, but usually not prescribed if there are two other risk factors

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COMBINED HORMONAL CONTRACEPTION

What are some other risk factors for venous thromboembolism?

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Obesity, smoking, age

Personal or family history (aged < 45) of clots

Thrombophilia, APS

Post-natal

Trekking, reduced motility

COMBINED HORMONAL CONTRACEPTION

Which users of these contraceptive methods are at especially increased risk of arterial thrombosis/disease?

What other condition is a major contra-indication to the use of combined hormonal contraception due to increased risk of ischaemic stroke?

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Those who are already hypertensive/smokers

Migraine with aura

**_COMBINED HORMONAL CONTRACEPTION_** How often should BP be checked? What is the cut off limit where combined hormonal contraception should not be used?

Before starting, at 3 months and annually thereafter 140/90

**_COMBINED HORMONAL CONTRACEPTION_** This increases the risk of which cancers? Do these risks ever reduce back to baseline? What are the rules with prescribing and personal/family history of breast cancer? This decreases the risk of which cancers?

Breast and cervical Yes, after being stopped for 10 years Contra-indicated in personal history of breast cancer or family history where BRCA gene is identified as the cause. A Fx of non-genetic breast cancer is fine. Ovarian, endometrial and colonic

**_COMBINED HORMONAL CONTRACEPTION_** These contraceptive methods cannot be taken alongside which other medications?

Rifampicin/rifabutin Liver enzyme inducers e.g. anti-epileptics, anti-retrovirals and St John's Wort

**_COMBINED HORMONAL CONTRACEPTION_** This should not be prescribed to people aged \> 35 who have what other risk factor? If there are no other risk factors, these methods of contraception can be used until when?

Smoke (or have only stopped in the last year) Menopause

**_COMBINED HORMONAL CONTRACEPTION_** What effect do these methods usually have on acne? Which specific type of this is licensed for acne (with contraception as an extra gain)?

Beneficial effect Cyproterone acetate

**_COMBINED HORMONAL CONTRACEPTION_** What are some non-contraceptive benefits of using these?

Reduced acne Lighter, more regular and less painful periods Less risk of ovarian cysts Reduces PMS Improvement in PCOS

**_COMBINED TRANSDERMAL PATCH_** How is this taken? Do diarrhoea and vomiting impact its use? When should it be started? What happens if it falls off?

Use one patch a week for 3 weeks, then a patch free week No First 5 days of period (if not, same rules apply as with the pill) Same rules apply as with missing a pill

**_COMBINED TRANSDERMAL PATCH_** What are some side effects specific to this?

Breast pain Nausea Painful periods

**_COMBINED VAGINAL RING_** How is this used? What are some side effects specific to this?

Leave it in for 21 days and then have a 7 day break Less bleeding, acne, irritability and mood change

**_PROGESTOGEN ONLY PILL_** How do these work primarily? What are some of their secondary effects?

Inhibits ovulation Effects on cervical mucus, endometrium and Fallopian tube transport

**_PROGESTOGEN ONLY PILL_** How should this be taken? What effect does this have on periods?

At the same time every day, without a pill-free break Often causes irregular bleeding at first, with continued use lots of women have regular or no periods at all

**_PROGESTOGEN ONLY PILL_** What happens if this pill is taken late, but still within 3 hours of normal? What happens if this pill is taken late, \> 3 hours after normal?

Continue as normal Take the missed pill as soon as possible, continue with the pack and use condoms for 48 hours

**_PROGESTOGEN IMPLANT_** This provides contraception for how long? What is its primary method of action? What are some secondary actions? What is the failure rate?

3 years Inhibits ovulation Effects on the cervical mucus and endometrium 0.05%

**_PROGESTOGEN DEPOT INJECTION_** What is its primary mechanism of action? What are some secondary effects? How often is it given? How long will one last? What is the failure rate?

Inhibits ovulation Effects on the cervical mucus and endometrium Every 13 weeks 14 weeks 0.2%

**_PROGESTOGEN ONLY CONTRACEPTION_** How should these be started?

Ideally should be started within 5 days of the period Can be started anytime if there is reasonable certainty that the woman is not pregnant. If not started within the 5 days then condoms should be used for 7 days for implant/Depot or 2 days for the pill

**_PROGESTOGEN ONLY CONTRACEPTION_** What is the only main contraindication to the progestogen only pill and implant? What effect of the Depot injection must you be aware of? What are some other factors which increase risk of this?

UKMEC4 for breast cancer Decreases bone mineral density Smoking, low BMI, malabsorption, hyperthyroidism, amenorrhoea

**_PROGESTOGEN ONLY CONTRACEPTION_** Which type of progestogen only contraception takes a while to regain fertility after stopping?

Depot injections

**_INTRAUTERINE SYSTEM_** What is the primary mode of action? What are some secondary effects?

Inhibits implantation by releasing progestogen every day Thickens the cervical mucus and thins the endometrium

**_INTRAUTERINE SYSTEM_** Which hormone, and which specific type of this hormone, does this contraceptive contain?

Progestogen Levonoregestrel

**_INTRAUTERINE SYSTEM AND DEVICE_** When can these be started? What must you make sure of first? How long does it take for each to be effective?

Any time in the cycle There has been no unprotected sex in the last 3 weeks, or since the last period, AND an ongoing pregnancy has been excluded IUS takes 7 days to be effective, IUD is effective immediately

**_INTRAUTERINE SYSTEM AND DEVICE_** What are some general risks of these? What is the main risk if a women does happen to get pregnant while she is on these?

Infection, perforation, expulsion Increased chance of ectopic pregnancy

**_INTRAUTERINE SYSTEM_** How long does this stay in place for? What effect does this have on periods?

5 years Irregular bleeding is common for the first 6-9 months, after which time most women benefit from reduced/stopped menstrual flow

**_INTRAUTERINE DEVICE_** What is the primary mechanism of action? What is this made of, and what is the purpose of this?

Prevention of fertilisation, by producing an inflammatory response in the endometrium Copper, toxic to an egg and sperm

**_INTRAUTERINE DEVICE_** How long is this licensed to be used for? What is its failure rate? Why is this higher than the IUS?

5-10 years 0.6% - if it is not in the exact right place then a pregnancy can form above it

**_INTRAUTERINE DEVICE_** What effects does this have on periods? In the first 20 days after insertion, there is a 6 fold increased risk of what?

Heavy and painful periods Pelvic inflammatory disease

**_BARRIER METHODS - CONDOMS_** How do these work? What is the major advantage of these?

Block sperm from getting into the female genital tract Also protects against STIs

**_BARRIER METHODS - DIAPHRAGMS_** How do these work? What also needs to be used alongside them? When do they need to be put in and taken out?

Block sperm from entering the cervix Spermicide gel Put in 4 hours before sex and take out no earlier than 6 hours after sex

**_BARRIER METHODS - DIAPHRAGMS_** Why do these initially need to be fitted by a medic? When may you need to change diaphragm? Do these prevent infections?

Because you need to use the correct size May need to change size if you gain or lose weight No

**_STERILISATION - FEMALE_** How do these work? What must you make sure of before performing this procedure and why?

Filshie clips are used to block the Fallopian tubes You must make sure the woman is not pregnant in the current cycle as this could cause an ectopic pregnancy to form

**_STERILISATION - FEMALE_** What are the risks of this? What other contraceptive methods are recommended first? Is this reversible?

Surgical and anaesthetic risks, increased risk of ectopic if pregnant at insertion LARC or vasectomy No

**_STERILSATION - VASECTOMY_** Can this be reversed? What are some complications?

Yes, but not on the NHS Anaesthetic risk, pain (acute or chronic), infection, bleeding, failure

**_ETHICS_** What do you do if a girl aged \< 16 presents wanting contraception?

Give contraception and don't tell parents if the child is deemed to be competent and understands the infomation given. Encourage the girl to talk to her parents.

**_ETHICS_** When is the only time as a doctor that you would be obliged to tell someone about a girl aged \< 16 requesting contraception? What should you do first?

If you thought she was at serious risk of harm Discuss your decision with the girl first

Contraception Flashcards

(57 cards)