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Obstetrics and Gynaecology > Contraception > Flashcards

Contraception Flashcards

(84 cards)

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1
Q

What general advice would you give about taking contraceptive pills?

A

Doesn’t interfere with intercourse
Easily reversible

No protection against STI’s
May forget to take

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2
Q

How does the COCP work?

A

Negative feedback suppress FSH and LH surge - stop ovulation

Also thicken cervical mucus and reduce endometrial receptivity to blastocyst

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3
Q

What is the failure rate of the COCP?

A

9% with typical use - lot lower if used properly

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4
Q

What are the main risks and ADR’s of the COCP?

A 
VTE
Stroke
MI
Breast and cervical cancer
Breakthrough bleeding
Breast tenderness
Mood swings
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5
Q

What are the main benefits of the COCP?

A

Easy to reverse
Relief from menstrual problems
Reduce risk of ovarian, endometrial and colorectal cancer
Reduce risk of benign breast disease and ovarian cysts
Reversible upon stopping

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6
Q

What is the effect of vomiting, diarrhoea or CYP inducing drugs on the efficacy of COCP?

A

Reduced efficacy

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7
Q

What are the main contraindications for the COCP?

A 
>35yo + smoking >15/day
Migraine with aura
Uncontrolled hypertension
History of VTE, stroke or IHD
Current breast cancer
Breast feeding <6 weeks post partum
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8
Q

When should you be cautious with prescribing COCP?

A 
>35yo + smoking <15/day
Hypertension
BMI >35
FH of VTE
Immobility
BRCA 1/2
Diabetes diagnosed >20 years ago
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9
Q

What must you advise a woman if she starts COCP on day 10 of her cycle?

A

Require alternative contraceptive for 7 days

Needed unless starting in first 5 days of cycle

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10
Q

What advice is given regarding taking the COCP?

A

Take at same time every day

Regimes personalised

  • Continuous use 21 day, 7 day off
  • Tricycling - 3 packs then 7 day break

Intercourse when on pill free period is safe if next pack started on time

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11
Q

What advice is given if someone misses a pill while taking the COCP?

A

1 missed - take missed pill next day (2 pills taken) and continue as normal

Multiple missed - take last pill the next day (2 taken) and then continue as normal. Use condoms for 7 days.

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12
Q

If the COCP pill is missed during week 1, what additional action is needed?

A

Emergency contraception

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13
Q

If the COCP pill is missed during week 2 what additional action is needed?

A

Nothing

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14
Q

If the COCP pill is missed during week 3, what additional action is needed?

A

Start next pack as soon as current finish - omit pill free period

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15
Q

What are the forms of combined contraception?

A

COCP
Transdermal patch - Evra
Vaginal ring - Nuvaring

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16
Q

How is the transdermal contraceptive patch taken?

A

Change every week for 3 weeks then remove for 7 day patch free period - withdrawal bleed

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17
Q

How is the vaginal contraceptive ring taken?

A

Ring inserted for 21 day
Remove for 7 days
Insert new ring

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18
Q

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

A 
Thicken cervical mucus - prevent entry of sperm
Thin endometrium - inhibit implantation
Suppress ovulation (vary depending on exact pill)
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19
Q

How does the progesterone implant/injection work?

A

Suppress ovulation
+ thicken cervical mucus
+ thin endometrium

Implant = nexplanon
Injectable = depo-provera
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20
Q

When should the progesterone only pill be taken? What should be done if you miss a pill?

A

Exact time every day! No pill free period

<3hr late - continue as normal
>3hr late - take missed pill ASAP, continue, cover with condoms for 48hrs

Unless started within first 5 days, alternate contraception req. for first 2 days

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21
Q

What are the side effects and risks of progesterone only contraception?

A 
Irregular/heavy bleeding
Headache
Nausea
Breast tenderness
Skin changes
Increased risk of breast cancer
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22
Q

What is the failure rate of the progesterone only pill?

A

9%

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23
Q

What are the benefits of the progesterone only pill?

A

Can be used when COCP contraindicated

Reduce risk of endometrial cancer

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24
Q

What are the negatives of the progesterone only pill?

A

Increased risk of ovarian cysts

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25
What are the contraindications for the progesterone only pill?
History of breast cancer, stroke, IHD, TIA Liver cirrhosis Weight >70kg
26
What are the benefits of the implant?
``` 0.05% failure rate Pill benefits + Don't think about contraception Can be used at any BMI Fertility return as soon as removed Safe when breastfeeding ```
27
What are the negatives of the implant?
Fitting and removing can be painful and bruise | Implant may break in situ
28
How is the implant used?
Last for 3 years Unless started within first 5 days, other contraception needed for 7 days Affected by enzyme inducing drugs
29
What are the contraindications for the implant?
History of breast cancer, stroke, IHD, TIA Liver cirrhosis Unexplained vaginal bleeding
30
What is the failure rate of depo-provera?
6%
31
What are the benefits of depo-provera?
Pill benefits + Dont think about contraception No known drug interactions
32
What are the negatives of depo-provera?
Take upto 1 year for fertility to return Gain 2-3kg weight/year Lose bone mineral density with >1year usage
33
How long does depo-provera last?
12 weeks
34
What are the contraindications for depo-provera?
BMI > 35 Current breast cancer History of severe arterial disease or diabetes with complications
35
What is the mechanism of action of the copper IUD?
Copper decrease sperm motility and survival + reduced penetration - copper effect on cervical mucus + endometrial inflammatory response reduce chance of implantation
36
When does the copper IUD become effective? How long does it last?
Immediately following insertion Last 5 years
37
What is the failure rate of the copper IUD?
0.8%
38
What are the main benefits of the copper IUD?
``` Effective on insertion Some last upto 10 years No hormones Reduced risk of endometrial cancer No delay in return to fertility ```
39
What are the main problems with the copper IUD?
Higher risk of PID in first 20 days Intermenstrual spotting and bleeding Increased menstrual loss Pelvic pain and dysmenorrhoea
40
What are the contraindications for copper IUD?
Wilson's disease | Copper allergy
41
What is the mechanism of action of the mirena child (IUS)?
Reduce endometrial growth - prevent implantation | + thicken cervical mucus - progesterone
42
When is the mirena coil effective and how long does it last?
Need alternate contraception for 7 days post insertion Licensed for 5 years
43
What is the failure rate of the mirena coil?
0.2%
44
What are the main benefits of the Mirena coil?
Reduce blood loss and dysmenorrhoea Reduced risk of PID compared to IUD - thickened cervical mucus Act locally - minimal drug interactions No delay in return to fertility
45
What are the main problems with the mirena coil?
6 month irregular menstruation common
46
When is the mirena coil contraindicated?
Breast cancer
47
What are the common problems associated with intrauterine contraception?
Insertion unpleasant Risk of displacement or expulsion Risk of uterine perforation If pregnancy occur - higher risk of ectopic
48
What are the common contraindications for intrauterine contraception?
``` History of PID Recent STI Structural uterine abnormality Ovarian, cervical or endometrial cancer Unexplained vaginal bleeding ```
49
What are the main forms of barrier contraception?
Diaphragm and caps Female condoms Male condoms
50
What are the common benefits of barrier contraception?
No hormones - work by blocking sperm entry
51
What are the common risks of barrier contraception?
Can get local reaction | Not as effective
52
What are the ads and disads of diaphragms and caps as contraception?
Insertion before - spontaneity Women need to be careful in using them Little protection from STI's
53
What are the ads and disads of female condoms as contraception?
Prevent against STI's Can be uncomfortable and noisy
54
What are the ads and disads of male condoms as contraception?
Prevent against STI's Readily available Latex allergy Lack spontaneity Can break or slip off
55
What counselling is required for sterilisation?
Can fail - unlikely Considered irreversibly - can be reversed privately No protection against STI's Explain all other options
56
Which sterilisation technique is more likely to succeed/have fewer complications?
Vasectomy
57
What happens in a vasectomy?
Simple operation - seal vas deferens Done under local Doesn't work immediately - semen analysis 12 weeks later to confirm azoospermia before unprotected sex
58
What are the main complications of a vasectomy?
``` Bruising Haematoma Infection Sperm granuloma Chronic testicular pain ```
59
How successful are vasectomy reversals?
Upto 55% if within 10 years
60
How is tubal occlusion carried out?
Laparoscopically or hysteroscopically
61
When do you become infertile following tubal occlusion?
Immediately
62
What are the main complications associated with tubal occlusion?
Operation complications Risk of ectopic if fails Some say worsening menstrual problems - pain/heavy
63
What are the options for emergency contraception? When can each be used?
Levonorgestrel - Within 3 days Ulipristal - EllaOne - Within 5 Days IUD - Within 5 days
64
What is the MOA of levonorgestrel?
Stop ovulation and inhibit implantation
65
How effective is levonorgestrel?
84% if within 72 hrs
66
What are the main side effects and drug interactions for levonorgestrel?
Vomiting - if within 2 hr then repeat dose Disturb current menstrual cycle Abdominal pain Double dose if on enzyme inducing drugs
67
How does ulipristal work?
Progesterone receptor modulator - inhibit ovulation
68
What are the main side effects of ulipristal?
Vomiting - if within 3hrs - repeat dose Disturb current menstrual cycle Abdominal pain
69
What is important to know about using ulipristal?
Reduces effectiveness of hormonal contraception Barrier methods should be used for 5 days after Stop breastfeeding for 1 week
70
What are the contraindications of ulipristal?
Enzyme inducing drugs | Caution in severe asthma or if on Ranitidine/omeprazole
71
What other things should be considered when giving emergency contraception?
Offer STI screen If <16 - prescribe emergency contraception if meet Fraser guidelines If <12 - safeguarding Talk about long term contraception
72
What contraception is given in 40-50year olds?
``` COCP Injectable - depo-provers POP Implant IUS ``` Non-hormonal - condoms, IUD - stop after 2 years amenorrhoea
73
What is the contraception advice in >50year olds for those on non-hormonal contraception?
Stop after 1 year amenorrhoea
74
What is the contraception advice in >50year olds for those on COCP?
Switch to non-hormonal or progesterone only
75
What is the contraception advice in >50year olds for those on depo-provera?
Switch to either non-hormonal and stop after 2 years amenorrhoea OR Switch to progesterone only with advice for stopping
76
What is the advice for progesterone only contraception (POP, IUS, Implant) in >50yo?
Can be continued Amenorrhoeic - check FSH and stop after 1 year if FSH >=30 u/l or stop at 55yo Not amenorrhoeic - consider investigating abnormal bleeding pattern?
77
What is the advantage to COCP in >40 yo?
Maintain bone mineral density Reduce menopausal symptoms
78
What is the advantage of depo-provera in >40yo?
Small loss in bone mineral density Delay in return to fertility
79
What contraception should be used alongside HRT?
Oestrogen and Progesterone - POP | Oestrogen alone - IUS
80
When is contraception needed post-partum?
After day 21
81
When can POP be used post partum?
Any time post partum Need additional contraception for first 2 days Small amount enter breast milk but harmless
82
When can the COCP be used post partum?
Absolutely CI if breast feeding and <6 weeks post partum Caution 6 week - 6 month if breastfeeding May reduce breast milk production Can be started day 21 if not breastfeeding - need addition contraception for first 7 days
83
When can the IUD and IUS be used post partum?
Within 48hrs after childbirth OR | After 4 weeks
84
What is the lactational amenorrhoea method?
98% effective "contraception" if woman fully breast feeding, amenorrhoeic and <6months post partum

Obstetrics and Gynaecology (21 decks)

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