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Gynae > Contraception > Flashcards

Contraception Flashcards

1
Q

Methods` of Contraception

A
  1. Daily pill(s)
  2. IUS/D/vaginal ring
  3. Injection
  4. Patch
  5. Implant
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2
Q

COCP Hormones

A

ethinyl oestradio + progestin (desogestrel/levongestrel)

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3
Q

COCP MoA

A

prevents ovulation

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4
Q

COCP regimen

A

1/day for 3 wks then 1 wk off (withdrawal bleed)
Can tricycle to reduce withdrawal freq.
- preference
- reduces chance of unexpected bleed
If started on first 5 days of cycle (28 day cycle) confers immediate protection (caution shorter cycle length)
Stop >4 wks prior to surgery

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5
Q

COCP Adv+Dis

A

Adv:

  • > 99% effective
  • Reversible upon stopping
  • Regular less painful periods
  • reduced risk of ovarian, endom. bowel ca.

Dis:

  • Adherance
  • No STI protection
  • risk of VTE, breast ca, cervical ca., stroke, IHD
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6
Q

COCP SE profile

A

Headache, N+V, breast tenderness, choice of ABx my be altered (inform GP)

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7
Q

COCP vomiting?

A

If within 2 hours take another

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8
Q

COCP absolute CI

A
  1. <6 weeks post partum and breastfeeding
  2. smoker >35 (>15/day)
  3. HTN (systolic >160 or diastolic >100)
  4. Current or past Hx VTE
  5. IHD
  6. Hx CVA
  7. Complicated valve dx (pHTN, AF, IE)
  8. Migraine w/aura
  9. Breast ca (current)
  10. DM w/retin/nephropathy
  11. Severe cirrhosis
  12. Liver tumer (adenoma or hepatoma)
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9
Q

COCP Missed Pill

A

1 miss: take last and current, no other contraception needed
2 missed: take last and current and continue taking:
Use condoms until 7d correct pill usage
2 missed in wk 1 consider EC
2 missed in wk 2 no need for EC
2 missed in wk 3 finish pills and start new with no break

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10
Q

POP Hormone and MoA

A

Desogestrel (cerazette 12hr), levonogestrel or norethistrone
Thicken cervical mucous
NB. desogestrel also stops ovulation

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11
Q

POP how to take?

A

1 Pill same time every day

NO pill free week

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12
Q

POP protection window

A

Immediate if in first 5 days
If at any other time use additional methods for 2 days
NB. If switching from COCP immediate protection

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13
Q

POP benefits

A

Doesn’t have risks of oestrogen pills

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14
Q

POP disadvantages

A

Adherence daily
Irregular bleeding
osteoporosis
ovarian cysts

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15
Q

POP Missed Pill (3+12hr versions)

A

<3 hrs late: continue as normal
>3hrs take missed pill ASAP, continue, condom until 48 restablished pill taking
EC if UPSI in 48 hr window
2 or more missed pills: take last and next, condoms for 48 hrs

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16
Q

POP SE profile

A 
Irregular vaginal bleeding
acne
breast tenderness
mood changes 
headache
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17
Q

Combined hormonal transdermal patch: Hormones and regime, brand name, risk of clot?

A

Norelgestromin + ethinyl oesteadiol
Applied for 3 wks (new patch per wk), then withdrawal bleed - tricycling possible
Evrapatch
No increased risk of clot

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18
Q

CHTP missed patch

A

<48 hr: change with no precautions
>48 in wk 1 or 2: change and use barrier for 7d (if UPSI within 5d prev. or during patch free consider EC)
>48hr in wk 3: remove and apply next patch on normal date
Delayed at end of withdrawal: barrier for 7d

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19
Q

Combined hormonal ring

A

inserted PV
Novaring
Worn 21d then 7d break

20
Q

Mirena (LNG-IUS): Hormone? MoA? Duration?

A

Levonorgestrel
Thins endometrium and prevents implantation
3-5 years

21
Q

Menses using LNG-IUS

A

tend to be less painful and lighter

however initially bleeding my be heavier

22
Q

Additional contraception after LNG-IUS insertion?

A

Needed for 7d unless inserted within first 7d of cycle

23
Q

SE profile of LNG-IUS

A

Acne
Breast tenderness
Mood disturbance
Headache

24
Q

Indications for LNG-IUS

A

Emergency contraception
HMB
Part of HRT

25
Q

What is Jaydess?

A

Smaller LNG-IUS effective for contraception only (not HMB)

Smaller so easier to fit esp. if nullip

26
Q

Progesterone implant: Hormone? MoA? Application/Duration? Brand name?

A

Etonogestrel
Prevents ovulation
Inserted into non-dom arm, works for 3 years

27
Q

Fertility after implant removal?

A

Restored immediately

28
Q

Side effects of progesterone implant?

A

Irregular bleeding
mood changes
breast tenderness
nausea

29
Q

What can alter effectiveness of implant?

A

Anti-epileptic drugs

Rifampicin

30
Q

Progesterone depot injection: Hormone? Duration? Brand?

A

Medroxyprogesterone acetate
12-14 wks
Depo-provera

31
Q

Depo-provera: additional contraception requirements

A

Contraception for first 7d unless injection given in first 5d of cycle

32
Q

Depo-provera: side effects:

A

Weight gain
reduced bone density
Irregular periods

33
Q

Fertility after depoprovera?

A

May take 6-12 mon. to return

34
Q

Copper coil MoA, Duration

A

Sterile inflammation prevents implantation
Spermicide
5or 10 year options

35
Q

Cu IUD effective window?

A

IMMEDIATE

36
Q

Cu-IUD insertion?

A

Any time during cycle provided not pregnant

37
Q

SE of Cu-IUD`

A

Heavy painful periods
Risk of expulsion
Infection
Perforation

38
Q

LARCs Effective window?`

A

All take 1 week to start except Copper IUD

39
Q

PACES Counselling Contraception:

History

A 
Hx:
 - Personal/family 
   VTE, 
  migraine, 
  cancer, stroke, 
  HTN
-  Menstrual 
  problems?
40
Q

PACES Counselling Contraception:

Options

A

Long acting:

  • IUS/D
  • Injection
  • Implant

Short acting:

  • Pills (PoP/COCP)
  • Patches
  • Rings
41
Q

Female Sterilisation Method

A

Laparoscopic sterilisation: occlude tube using Filshie clips

PERMANENT loss of fertility

42
Q

Female sterilisation Need for contraception?

A

Use until next period (3mo if hysteroscopic)

43
Q

Advise re stertilisation

A

IRREVERSIBLE
Vasectomy safer, quicker, less morbidity
No protection against STI
Pregnancy afterwards vv rare but higher risk ectopic

44
Q

Hysteroscopic sterilisatition

A

Outpt. w/o GA
Expanding rings inserted into tubal ostia
Induce fibrosis
Takes 3 mo so req. contraception until then

45
Q

Vasectomy

A

Interrupt Vas deferens
Small risk of scrotal haematomaand infection
12w post op ejacualate analysis for 0 sperm

Gynae (20 decks)

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