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Contraception Flashcards

1
Q

What is the most common type of contraception used by women in the UK?

A

Combined hormonal contraception (CHC)

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2
Q

Which contraceptives are reversible?

A

ALL

except sterilisation

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3
Q

Which contraceptive has a delayed reversal?

A

Injectables

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4
Q

Which contraceptives are 100% effective?

A

None

Vasectomy

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5
Q

Which contraceptives are free of adverse side-effects?

A

None

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6
Q

Which contraceptives protect against STIs?

A

None

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7
Q

Which contraceptives have non-contraceptive benefits?

A

CHC

IUS

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8
Q

Which contraceptives are best for low maintenance and no ongoing medical input?

A

Implant

IUT

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9
Q

What is The Pearl Index?

A

No of contraceptive failures per 100 women-years of exposure

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10
Q

What is Life Table Analysis?

A

Provides contraceptive failure rate over specified time-frame and can provide cumulative failure rate for any specific length of exposure

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11
Q

What is method failure?

A

Pregnancy desperate correct use of method by user

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12
Q

What is user failure?

A

Pregnancy because method not used correctly by user

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13
Q

What is LARC?

A

Long-acting reversible contraception

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14
Q

What are the benefits of LARC?

A

Minimises user input + failure rates

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15
Q

When during the cycle is there the highest chance of pregnancy?

A

Day 8-19

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16
Q

What days are likely ovulation days in the cycle?

A

Day 12-18

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17
Q

How long does an egg usually survive?

A

24hrs

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18
Q

How long does sperm usually survive?

A

<4 days

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19
Q

What are examples of combined hormonal contraception?

A

Pill, patch, vaginal ring

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20
Q

What are the two hormones used in combined hormonal contraception?

A

Ethinyl estradiol (EE) and synthetic progesterone

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21
Q

How does combined hormonal contraception work?

A

Stops ovulation, affects cervical mucus and endometrium

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22
Q

What is the standard regime for combined hormonal contraception?

A

21 days with hormone free week

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23
Q

What are tailored regimes for combined hormonal contraception?

A

Tricycling

Continuous use

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24
Q

How is the pill taken when combined hormonal contraception?

A

Taken daily

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25
How is the patch used when combined hormonal contraception?
EVRA, changed weekly
26
How is the vaginal ring used when combined hormonal contraception?
Nuvaring, changed every 3 weeks
27
When can the vaginal ring (combined hormonal contraception) be taken out?
3hrs in 24
28
What are the non-contraceptive benefits of the combined hormonal contraceptives?
Regulate/reduce bleeding - painful/heavy periods Stop ovulation - help premenstrual syndrome Reduction functional ovarian cysts 50% reduction ovarian/endometrial cancer Improve acne/hirsutism Reduction benign breast disease, RA, colon cancer, osteoporosis
29
What are side effects of combined hormonal contraception?
``` Breast tenderness Nausea Headaches Irregular bleeding first 3mo Mood Weight gain ```
30
What are serious risks associated with CHC use?
Venous thrombosis: DVT, PE Arterial thrombosis: MI, ischaemic stroke Cervical cancer Breast cancer
31
Who is not allowed CHC?
``` Active gall bladder disease Previous liver tumour BMI >34 Previous VTE 1st degree relative VTE <45 Thrombophilis Smokers >35 Hx arterial thrombosis Focal migraines Age >50 Hypertension >140/90 ```
32
How is the progestogen-only pill (POP) taken?
Same time every day without pill-free interval
33
When is POP not a good contraceptive choice?
GI upset
34
What is the window period for the desogestrel pill?
12hr window period
35
What is the window period for the traditional POP pills?
3hr window period
36
What are the side effects of the POP?
``` Appetite increase Hair loss/gain Mood change Bloating/fluid retention Headache Acne ```
37
What are there not risk of with the POP?
Venous/arterial thrombosis
38
When should you avoid POP?
Current breast cancer | Previous liver tumour
39
How often for the injectable progestogen contraceptive?
150mg 1ml deep IM injection every 13wks
40
What does injectable progestogen do?
Prevents ovulation Alters cervical mucus making it hostile to sperm Makes endometrium unsuitable for implantation
41
What are the advantages of injectable progestogen?
Need to remember every 13wks 70% amenorrhoeic after 3 doses Estrogen-free so few contraindications
42
What are the disadvantages of injectable progestogen?
Delay in return to fertility ~9mo Reversible reduction in bone density Problematic bleeding first 2 doses Weight gain
43
What is the brand name for the subdermal progestogen implant?
Nexplanon
44
How does the progestogen implant work?
Inhibition ovulation + effect on cervical mucus
45
How long does the progestogen implant last?
3yrs
46
What are the side effects of the progestogen implant?
Prolonged/frequent bleeding | Mood change
47
What is an example of a LARC?
IUC = intrauterine contraception
48
How long can the IUC last?
5-10yrs
49
What age/parity for IUD?
Any age, any parity
50
What are the risks with IUD?
Small infection risk Perforation Expulsion Ectopic
51
What is the mode of action of the copper IUD?
Toxic to sperm, may prevent implantation of fertilised egg
52
What hormones are in the copper IUD?
Hormone free
53
What are the side effects of the copper IUD?
Periods heavier/crampier
54
How long can copper IUD last?
5-10yrs depending on type
55
What is the mode of action of levonorgestrel IUD?
Affect cervical mucus and endometrium, stop fertilisation of egg, may prevent implantation Most women still ovulate
56
What hormones are in levonorgestrel IUD?
Progestogen
57
What are the levels of progestogen like in Levonorgestrel IUD compared to pill/implant/injection?
Low circulating progestogen levels
58
What are brand examples f Levonorgestrel IUD?
Mirena | Kyleena
59
How long does Mirena Levonorgestrel IUD last?
5yrs
60
What is Mirena also licensed for?
Treat heavy menstrual bleeding
61
What is menstrual bleeding like in Levonorgestrel IUD?
Reduced after up to 4mo, initial irregular
62
What is the most effective emergency contraception option?
Copper IUD
63
What are the 3 options for emergency contraception?
Copper IUD Levonelle Ellaone
64
Within how long of unprotected sexual intercourse should a copper IUD be fitted for emergency contraception?
Within 120hrs (5 days)
65
Within how long of unprotected sexual intercourse should Levonelle be taken as emergency contraception?
Within 72hrs (3 days)
66
Within how long of unprotected sexual intercourse should Ellaone be taken as emergency contraception?
Within 120hrs (5 days)
67
What are the contraindications of Ellaone?
Breast feeding Enzyme inducing drugs Acid reducing drugs
68
When should contraception be started?
First 5 days of cycle = immediate cover | Other times in cycle = 7 days
69
How long after delivery of baby can you get pregnant again?
21 days
70
How long after miscarriage/abortion can you get pregnant again?
5 days
71
How long is breast feeding a contraceptive for and under what conditions?
6mo Feeding every 4hrs Amenorrhoeic
72
What can does female sterilisation reduce the risk of?
Ovarian
73
Does female sterilisation have effect on periods/hormones?
No
74
What happens in vasectomy?
Vas deferens divided and ends cauterised
75
How long does a vasectomy take to be effective?
4-5mo
76
What are the risks of vasectomy?
Long term testicular pain | If vas reconnected, anti-sperm antibodies
77
What is the risk for testicular/prostate cancer with vasectomy?
No increased risk of either
78
What act gives medical staff right to refuse participation in abortion?
1967 Abortion Act
79
How many Drs to sign to support women request for abortion in 1967 Abortion Act?
2 Drs
80
What are the conditions of the 1967 Abortion Act?
Grave risk if continued to women, physical or mental Under 24wks Substantial risk if child were born it would suffer physical/mental abnormalities
81
What should be checked at abortion clinic?
``` Scans Medical Hx - risks Circumstances Methods of abortion Contraception for after FBC/Rhesus group Vaginal swab for chlamydia/gonorrhoea STI bloods ```
82
What is the surgical procedure for abortion and at what time in pregnancy?
Cervical priming, GA/LA cervical block, transcervical suction catheter 5-12wks
83
What are the two medications taken for medical abortion?
Mifepristone | Misoprostol
84
What is the procedure for a medical abortion?
Mifepristone oral antiprogestogen tablet | 36-48hrs later Misoprostol initiates uterine contraction which opens cervix and expels pregnancy
85
How long does it take to expel medical abortion <12wks?
4-6hrs
86
If choosing home abortion which drug would be given?
Misoprostol
87
What are non-hormonal barrier methods of contraception?
Diaphragm Cervical cap Male/female condoms Spermicidal foams/sponges/film

Reproductive (20 decks)

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