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Reproduction > Contraception > Flashcards

Contraception Flashcards

1
Q

what axis controls the menstrual cycle?

A

hypothalamic-pituitary-ovarian axis

  • hypothalamus produces GnRH
  • pituitary releases LH and FSH
  • ovary produces oestrogen and progesterone
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2
Q

what % of pregnancies in the UK are unplanned?

A

40

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3
Q

what contraception methods prevent ovulation?

A

most hormonal methods (inc emergency contraception)

*work by suppressing FSH and LH

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4
Q

what contraception methods work by preventing fertilisation?

A

condoms, diaphragm + spermicide, female and male sterilisation, intrauterine devices, hormonal methods (cervical mucous effect)

*work by creating a mechanical or surgical barrier or by direct toxicity

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5
Q

what contraception methods work by preventing implantation?

A

intrauterine devices (esp copper coil when used as emergency contraception), hormonal methods

*works by creating hostile endometrium or direct toxicity

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6
Q

what are the hormonal methods of contraception?

A

combined pill, ring, patch and “minipill”

DMPA injection and contraceptive implant (nexplanon)

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7
Q

what are the barrier methods of contraception?

A

male and female condoms

diaphragm or cervical cap (plus spermicide)

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8
Q

what are the intrauterine methods of contraception?

A 
intrauterine device (copper coil)
intrauterine system (hormone coil)
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9
Q

what are permanent methods of contraception?

A 
female sterilisation 
male sterilisation (vasectomy)
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10
Q

what are fertility awareness methods of contraception?

A

basal temperature, calendar and cervical secretion monitoring methods

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11
Q

what are emergency methods of contraception?

A 
emergency IUD
emergency pills (ulipristal acetate or levonorgestrel)
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12
Q

what are the window periods for STI risk?

A

NAAT CT/GC = 2 weeks
HIV / syphilis = 4 weeks
HepB/C = 12 weeks

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13
Q

what are the non-contraceptive benefits of hormonal contraception?

A 
decreased period pain 
decreased heavy menstrual bleeding 
decreased irregular bleeding 
decreased ovulation pain (mittelschmerz)
decreased PMS
decreased cyclical breast tenderness
decreased ovarian cysts 
decreased endometriosis 
decreased ovarian cancer 
decreased acne or hirsutism (CHC only)
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14
Q

how long do hormonal and copper coils last?

A

LARC between 3-10 years, depending on device

*<1% failure rate

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15
Q

copper and hormonal coils are non-invasive options - true or false?

A

false - invasive
quick but open painful (3/10 for parous women and 5/10 for nulliparous women)

*small risk of perforation, PID, malposition/expulsion

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16
Q

what condition is hormonal and copper coils unsuitable for?

A

submucosal fibroids etc

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17
Q

what type of coil can be used as emergency contraception?

A

copper (IUD)

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18
Q

what effects does the IUD have on periods?

A

often makes them heavier, longer and more painful especially during first 3/12 post insertion

*NSAIDs like ibuprofen can help with both pain and bleeding

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19
Q

IUD might be the only reliable method for women after what illness?

A

breast cancer

20
Q

what is more effective - IUD or IUS?

A

IUS

21
Q

what four main IUS devices are in the market?

A

mirena, levosert and kyleena (5 years)

jaydess (3 years)

22
Q

what other things is the mirena licensed to treat?

A

heavy periods
can be part of HRT
has other therapeutic uses (endometriosis, hyperplasia etc)

23
Q

what is a common side effect of IUS in the weeks or months after insertion?

A

spotting

*50% of amenorrhoea on mirena at 6/12

24
Q

hormonal side effects are often a problem in IUS - true or false?

A

false - rarely a problem due to systemic hormone levels

25
Q

what is the most effective of all contraceptive methods?

A

subdermal contraceptive implant - nexplanon

26
Q

how long does the SDI last?

A

3 years

27
Q

what hormone does the SDI contain?

A

progestogen

*low and stable level of hormones so less hormonal side effects

28
Q

what is the main side effect of SDI?

A

prolonged PV bleeding

*often controlled by CHC taken additionally if not contraindicated

29
Q

what is the rough guide for the UK medical eligibility criteria for contraceptive use?

A

1 = always useable (no increased risk due to condition)

2 = broadly useable (advantages > risk, consider close follow up)

3 = counsel / caution (risks due to condition > advantage of method - expert opinion or specialist referral required)

4 = do not use (method contraindicated due to condition - do not prescribe)

30
Q

what is the failure rate of combined hormonal contraception?

A

perfect use = 0.3%

typical = 9%

31
Q

how should COC be took?

A

start in first 5 days of period or at any time in cycle plus condoms for 7 days

take daily for 21 days followed by 7 day break

32
Q

what factors may affect the effectiveness of CHC?

A

impaired absorption - GI conditions

increased metabolism - liver enzyme induction, drug interaction

forgetting

33
Q

what are the risks of CHC?

A

venous thrombosis
arterial thrombosis
adverse effects on some cancers

34
Q

what has a higher risk of VTE - being on pill & not pregnant OR during and post pregnancy?

A

being on pill and not pregnant

35
Q

what unwanted circulatory effect can come with COC?

A

systemic hypertension
*must check initially, at 3 months then annually

arterial disease
*MI and ischaemic stroke

36
Q

in what individuals is CHC use contraindicated due to increased risk of ischaemic stroke?

A

migraine with aura

37
Q

CHC can cause increased risk of what cancers?

A

breast

cervical (small increase with long term use but reduces to baseline 10 years after stopping, discussing HPV/condom use, check up to date with cervical screening)

38
Q

what examination should you do before prescribing CHC?

A

record BP and BMI before first prescription

check smear status if relevant

39
Q

what type of cancers do CHC protect against?

A

ovarian and endometrial

40
Q

what conditions can CHC help improve?

A

premenstrual syndrome

PCOS

41
Q

what are side effects of CHC?

A

nausea
spots
bleeding
breast tenderness

42
Q

how do you take / start progestogen only methods of contraception (POP, subdermal implant, DMPA)?

A

start on day 1-5 of period
or
anytime if reasonably certain not pregnant plus condoms for 7 (2 for POP) days

43
Q

when should progestogen only contraception not be given?

A

current breast cancer

44
Q

how do injectable forms of contraception work?

A

depo provera = lowers estradiol

sayana press = suppress FSH

45
Q

what are the different techniques of vasectomy?

A

local or general anaesthetic

no-scalpel technique

46
Q

what are the complications of vasectomy?

A 
anaesthetic 
pain 
infection 
bleeding / haematoma 
failure - early (non-compliance)

Reproduction (45 decks)

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