Contraception Flashcards
(102 cards)
1
Q
What is the only Long-Acting Reversible Contraception available to women
A
Depot
2
Q
What actually is the depot
A
A depot of progesterone (medroxyprogesterone acetate) given IM
3
Q
How long does the depot provide contraceptive cover for
A
14 weeks
Replaced every 13 weeks
4
Q
What is the pearl index of the depot
A
0.2%
5
Q
What is the mechanism of action of the depot
A
Inhibition of Ovulation
6
Q
Name 4 absolute contra-indications to using the depot contraceptive
A
Pregnancy
Breast cancer
Severe cardiac disease
Undiagnosed vaginal bleeding
7
Q
When can depot be started without the need for further contraception
A
Up to and including day 5 of the menstrual cycle
8
Q
When can depot be started with regards to after a termination of pregnancy
A
Up to 5 days after
9
Q
When can depot be started with regards to after a birth
A
Up to day 21 postpartum
10
Q
What is the most common side effect of the depot
A
Weight gain
11
Q
Which bone condition can the depot increase chances of
A
Osteoporosis
12
Q
Which metal is the non-hormonal intra-uterine device made of
A
Copper
13
Q
When can the copper IUD be started
A
At any time since it is non-hormonal
14
Q
What is the mechanism of action of the copper IUD
A
Prevention of fertilisation
15
Q
How long can a copper IUD be left in the uterus
A
5-10 years
16
Q
What is the pearl index of the copper IUD
A
0.6-0.8%
17
Q
Name 3 contraindications to using the copper IUD
A
Peptic ulcer disease
Current pelvic infection
Abnormal uterine anatomy
History or current endometrial or cervical cancer
18
Q
When can the copper IUD be started with regards to after a birth
A
< 2 days or > 4 weeks post partum
19
Q
Which VLARC can be used as emergency contraception a
A
Copper IUD
20
Q
How many days after Unprotected Sexual Intercourse can you use the copper IUD
A
Up to 5 days
21
Q
What is the main side effect of the copper IUD
A
Heavy, prolonged periods
22
Q
What are the 3 IUS variants available
A
Mirena®-52 mg
Kyleena- 19.5 mg
Jaydess®- 13.5mg
23
Q
How does the Mirena coil work
A
A coil that is impregnated with a synthetic progesterone
24
Q
What is the mechanism of action of the Mirena Coil
A
Prevention of implantation
25
How long can the IUS be left in for
Either 3 or 5 years
26
When can the IUS be started
Within the first 7 days of a period
27
When can the IUS be started with regards to birth
<2 days or > 4 weeks postpartum
28
What are the side effects of the IUS
irregular menstrual bleeding, that usually becomes lighter with most women becoming amenorrhoeic
29
What is the pearl index of the Mirena IUS
0.2%
30
What is the implant
A non-degradable rod that is impregnated with progesterone and inserted into the arm
31
What is the mechanism of action of the implant
Inhibition of ovulation
32
How long can the implant be left in the arm of a woman
3 years
33
What is the pearl index of the implant
0.05%
| the most effective form of contraception
34
When can the implant be inserted with no need for an additional cover
Within the first 5 days of a cycle
35
Name 3 scenarios in which additional 7/7 condom cover would be required upon inserting the implant
Started at any other time in the cycle other than first 5 days
Used as a quick start after emergency contraception.
Switching from POP, Mirena, IUD
36
Name 3 side effects of the implant
Weight gain
Irregular bleeding
Acne
37
What problems could you encounter upon insertion of the implant
Nerve damage
Vascular damage
Pain
38
How does short-acting combined hormonal contraception
Contains estrogen and progesterone
39
What is the mechanism of action of all combined hormonal contraception
Inhibition ovulation
40
How does the transdermal patch work
A single patch is applied for one week at a time for three weeks
Last week is a patch-free week which allows for a withdrawal bleed
Releases oestrogen and progesterone
41
What condition might decrease the efficacy of the patch
Obesity
42
Which contraceptive comes with a slight thrombotic risk
Transdermal patch
43
Name 3 side effects which are more common with the patch than with other combined hormonal preparations
Nausea
Breast pain
Painful period
44
How many days is the vaginal ring inserted for
Inserted for 21 days
| 7 days left ring free to allow withdrawal bleed
45
How many consecutive days is the COCP (pill) taken for
21 days
46
What is the difference in how the pill works during the first 7 days and the next 14 days of taking it
First 7 days act to prevent ovulation and the next 14 days act to maintain anovulatory state
47
When can the COCP pill be started with no additional cover required
Up to day 5 of the cycle
48
When can the COCP pill be started with regards to termination of pregnancy
Immediately
49
When can the COCP pill be started with regards to birth
3 weeks if not breastfeeding
50
Which cancers does the COCP protect against
Ovarian
Endometrial
Colorectal
51
Which dermatology condition can the COCP help with
Acne vulgaris
52
Name 4 minor side effects of the COCP
Nausea + vomiting
Increase in blood pressure
Mood swings
Irregular bleeding
53
What is the major side effect of the COCP
Increased VTE, stroke risk
54
Which cancers does the COCP increase the risk of
Breast
| Cervical
55
What blood pressure reading would contraindicate the prescription of the COCP pill
>160/95
56
Which connective tissue disease is a contraindication to prescribing the COCP
Anti-phospholipid syndrome
57
What is the mechanism of action of the progesterone only pill
thickens cervical mucus +/- suppression of ovulation
58
What are the three options for Emergency Contraception
Copper IUD
Levonelle (LNG)
ellaOne (UPA)
59
What is the most effective form of emergency contraception
Copper IUD
60
How long after unprotected sexual intercourse can the Levonelle pill be used
Licensed for 72hrs post-UPSI
| but ineffective after 96 hours
61
What is the mechanism of action of the Levonelle pill
Levonelle is a high dose of progesterone – levonorgestrel
| Mechanism of action: suppress ovulation
62
What is the mechanism of action of the ellaOne pill
EllaOne is an anti progesterone – Ulipristal acetate.
| Mechanism of action: inhibition or delay of ovulation
63
With relation to the LH surge before ovulation, when can the Levonelle and ellaOne pills be used
Levonelle - works before LH surge
| ellaOne - can work during LH surge but not after peak
64
When can the copper IUD be used as emergency contraception
Up to 5 days post-UPSI
OR
Up to 5 days post ovulation
65
What must you screen for before fitting the copper IUD
Chlamydia
66
How long after unprotected sexual intercourse can the ellaOne pill be used
Up to 120hrs post-UPSI
67
Within the terms of the abortion act, who can terminate a pregnancy
Only a registered medical practitioner
68
What are the three legal forms which need to be filled out when an abortion is carried out
HSA1
HSA2
HSA4
69
What is the HSA1 form
2 doctors are required to sign this form
70
When must the HSA2 form be filled out
To be completed by the doctor within 24 hours of an emergency abortion
71
What is the HSA4 form and who must it be sent to
Must be completed by the doctor and sent to the Chief Medical Officer (CMO) within 7 days of the abortion taking place
72
When can treatment not be denied on the grounds of conscientious objection
When the treatment is in the event of an emergency
73
What are the legal gestation limit for
- social termination of pregnancy
- fetal anomaly termination of pregnancy
For social termination of pregnancy – 23 weeks 6 days
| For fetal anomaly- any gestation
74
What is the NHS Tayside gestation limit for medical termination of pregnancy
18 weeks and 6 days
75
What is the NHS Tayside gestation limit for surgical termination of pregnancy
12 weeks
76
What are the three types of medical termination of pregnancy (gestation times)
Early - up to week 9
Late - 9-12 weeks
Mid-trimester 12-24 weeks
77
What is the first stage of a medical termination of pregnancy
Oral Mifepristone 200mg (anti-progesterone)
78
What is stage 2 of a medical termination of pregnancy and when can it be performed at home
24-48 hours after stage 1 – Vaginal (or oral) prostaglandin e.g. misoprostol, gemeprost
Can be performed at home if <9weeks
79
What are the two types of surgical termination of pregnancy
```
Vacuum aspiration (6-12weeks)
Dilatation and evacuation (13-24 weeks) - not available in Scotland
```
80
If the IUS is started outside of first 7 days of period, what must be done
7 days of condom cover
81
When can the IUS be started with regards to after a Termination of Pregnancy
Immediately
82
How many days can the transdermal patch be worn for before efficacy is lost
9 Days
83
How many days can the transdermal patch be removed for before efficacy is lost
2 days
84
Which combined hormonal contraception has an increased thrombotic risk apart from the COCP
Transdermal Patch
85
When can the COCP pill be started with regards to birth if breastfeeding
> 6 weeks
86
When can the COCP pill be started with regards to emergency contraception
Immediately after levonelle
| 5 days after ellaONE
87
What is the timeframe within which if you vomit, you should take the COCP again
2 hours
88
What is the timeframe within which if you have diarrhoea, you should take the COCP again
24hours
89
If you miss your COCP and it has been over 24hours but less than 48hours -->
Take missed pill and continue with pack
| No EC needed
90
If it is week 1 of your COCP regimen and you miss your pill and it has been over 48 hours -->
Take most recent pill
Use condoms 7 days
Consider EC if UPSI
91
If it is week 2 of your COCP regimen and you miss your pill and it has been over 48 hours -->
Take most recent pill
| 7 days condoms
92
If it is week 3 of your COCP regimen and you miss your pill and it has been over 48 hours -->
Take most recent pill
7 days condoms
Omit break
93
If you miss more than 2 of your COCP pills -->
EC if in first week
| Continue with rest of pack and omit break
94
If you miss 1 POP -->
7 day condoms
95
If you miss 1+ POP -->
EC + 7 days condoms
96
For the old POP's, if you are <3 hours late in taking your pill -->
Continue as normal
97
For the old POP's, if you are >3 hours late in taking your pill -->
Take missed pill
| Condoms for 2 days
98
What is the time period you are allowed to miss the new POP's
12 hours
99
Name 2 situations when the POP might be used instead of the COCP
Breastfeeding women
| >35 and smoking
100
Name 3 side effects of the POP
Dysfunctional Uterine Bleeding
Weight gain
Headaches
101
Name a contraindication to the POP
Active breast cancer
102
Why is EC not required before day 21 post-partum
The earliest date of ovulation in a non-breastfeeding woman is thought to be day 28 postpartum. Therefore, contraception is required from day 21 onwards, as sperm can survive for up to 7 days
