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Contraception Flashcards

1
Q

What is the combined oral contraceptive pill?

A

Combination of synthetic progesterone and Ethinyl Estradiol

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2
Q

Describe the regime of the combined oral contraceptive pill

A

Taken for daily for 21 days with a pill free week

Or can use for 3 months continuously and then pill free week

Takes 7 days to switch off ovaries

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3
Q

What is the mode of action of the combined oral contraceptive?

A

Inhibits ovulation

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4
Q

What is the dose of the combined oral contraceptive?

A

20-35mg or 50 if on liver inducers

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5
Q

Give benefits of the combined oral contraceptive pill

A

Regular bleed with potential reduction in pain

Reduction in functional ovarian cysts

Stops ovulation

50% reduction in ovarian and endometrial cancer

Improvement in acne/hirsutism

Reduction in benign breast disease, RA, colon cancer and osteoporosis

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6
Q

Give complications of the combined oral contraceptive pill

A

Breast tenderness

Nausea

Headache

Irregular bleeding for first 3 months

Mood change

Weight gain

VTE

MI/Stroke

Breast cancer

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7
Q

Give contrandications of the combined oral contraceptive pill (and other combined contraception)

A

BMI>35

Smoker>35

Previous VTE

Migraine with aura

Breast feeding

Wheelchair use

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8
Q

What advice is given if a dose of the oral contraceptive pill is missed?

A

If 1 pill missed, at any time in cycle

  • Take two pills in a day and then continue normal regime

If 2 or more pills missed

  • Take two pills in a day, leaving earlier missed pills and continue normal regime
  • If days 1-7, emergency contraception considered if uprotected sex in pill free interval or week 1
  • If days 8-14, no need for emergency contraception if 7 consecutive days of taking pill
  • If days 15-21, finish pills in current pack and start next pack immediately
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9
Q

how long should patients stop the cocp before surgery?

A

4 weeks before

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10
Q

How often does the patch have to be changed?

A

Wear one patch a week for three weeks and do not wear a patch on week 4

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11
Q

What action is required if there is delayed patch change?

A

If over 48 hours, use barrier protectionf or 7 days and emergency contraception if required

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12
Q

How often is the vaginal ring changed?

A

Changed every 3 weeks, can take out for 3 hours in 24 hours so many take out for intercourse

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13
Q

Describe the regime of the progestogen only pill

A

Same time every day, without pill free interval (effect lost if more than 3 hours late)

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14
Q

What is the mode of action of the progestogen only pill?

A

Thickening of cervical mucus

(Desogestrel’s main method is inhibiting ovulation)

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15
Q

Give benefits of the progestogen only pill

A

Amenorrhoea

Useful for those contraindicated using combined pill

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16
Q

Give complications of the progestogen only pill

A

Irregular bleeding, most common adverse effect

>Appetite

Hair loss/gain

Mood change

Bloating/fluid retention

Headache

Acne

Erratic bleeding

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17
Q

Give contraindications of the progestogen only pill

A

Severe liver disease

Current VTE

Hormone dependent tumour

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18
Q

What is the dose of Depo-Povera/injectable progestogen?

A

150mg IM to upper quadrant of buttock

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19
Q

What is depo-provera?

A

An aqueous solution of crystals of the progestogen depomedroxyprogesterone acetate

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20
Q

How often do women have to get depo-provera?

A

Every 12 weeks

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21
Q

What is the mode of action of depo-provera?

A

Inhibits ovulation

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22
Q

Give benefits of depo-provera

A

Good for forgetful pill takers

70% women amenorrhoeic after 3 doses

Estrogen free so few contraindications

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23
Q

Give complications of depo-provera

A

Delay in return to fertility

Reversible reduction in bone density

Problematic bleeding

Weight gain

Not suitable in women over 50

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24
Q

What is the subdermal impant?

A

Progestogen etonogestrel in a matrix of ethinylvinylacetate (EVA)

25
Q

How long does the implant last?

A

3 years

26
Q

What is the mode of action of the implant?

A

Primary method is inhibition of ovulation, but also thickening of cervical mucus

27
Q

Give benefits of the implant

A

Oligomenorrhoea

28
Q

Give complications of the implant

A

Irregular menstrual bleeding, main complication

Mood change

Delayed return to fertility

29
Q

How long does the copper IUD last?

A

Lasts 5-10 years depending on the type

30
Q

What is the mode of action of the copper IUD?

A

Decrease sperm motility and survival (toxic to sperm and prevent implantation)

31
Q

Give benefits of the copper IUD

A

Hormone free, so most suitable for breast cancer patients

Long term

32
Q

Give complications of the copper IUD

A

May make periods heavier/crampier

Ectopic pregnancy

Perforation and expulsion

PID

33
Q

Give contraindications of the copper IUD

A

Menorrhagia

Copper allergy

Uterine abnormalities

PID

Cervical/endometrial cancer

34
Q

How long does the hormonal IUS last?

A

Lasts 3-5 years depending on type

35
Q

What is the mode of action of the hormonal IUS?

A

Primary method is preventing endometrial proliferation

Also thickening of cervical mucus

36
Q

Give benefits of the hormonal IUS

A

Long term

Oligomenorrhoea/Amenorrhoea

37
Q

Give complications of the hormonal IUS

A

Initial irregular bleeding, later followed by light menses or amenorrhoea

Ectopic pregnancy

Perforation and expulsion

PID

38
Q

Give contraindications of the hormonal IUS

A

<8-12 weeks after C section

Uterine abnormalities

PID

Cervical/endometrial cancer

39
Q

What is the mode of action of barrier methods?

A

Prevents sperm transport

40
Q

Give benefits of barrier methods

A

Protects against STI’s

41
Q

Give complications of barrier methods

A

Diaphragms and caps require the correct size and fitting

42
Q

What is a vasectomy?

A

Permanent division of vas deferens under local anaesthetic

43
Q

Give compliations of vasectomy

A

Pain due to sperm granuloma

Irreversible

Requires semen analysis at 3 months to ensure effective

Additional contraception for 2-3 months

Bleeding

44
Q

What is fertile sterilization?

A

Fallopian tubes are blocked, usually Filshie clips applied across tube to block tube lumen

45
Q

Give complicatins of female sterilization

A

Irreversible

Risks associated with surgery: Pain, bleeding and visceral damage

Ectopic pregnancy

46
Q

Give contraindications of female sterilization

A

Uncertainty

>BMI

Comorbidities that contraindicate general anaesthetic

47
Q

Give the 3 methods of emergency contraception

A

Copper IUD

Ellaone pill

Levonorgestrel pill

48
Q

How long after unprotected sex can the copper IUD be used for emergency contraception?

A

5 days

Or up to 5 days after earliest possible day of ovulation (Take shortest cycle length and subtract 14 to get earliest possible day of ovulation)

49
Q

How long after unprotected sex can the ellapone pill be used for emergency contraception?

A

Up to 120 hours (5 days)

50
Q

How long after unprotected sex can the levonergestrel pill be used or emergency contraception?

A

72 hours (3 days)

51
Q

When is the ellaone pill only effective?

A

Only effective before the release of egg

52
Q

When is levonergestrel pill only effective?

A

Before the release of an egg

53
Q

What is the most effective emergency contraception?

A

Copper IUD

54
Q

What is the most effective contraception?

A

Hormonal IUS

55
Q

How long after giving birth do women not require contraception?

A

Up to 21 days

56
Q

When is lactational amenorrhoea a reliable form of contraception?

A

Baby is less than 6 months

Amenorrhoeic

Breast feeding exclusively

57
Q

Describe the management if individual vomits after taking levonorgestrel

A

If within 3 hours, take another dose

58
Q

What is the contraception of choice in epileptics?

A

Injection

Reproduction (18 decks)

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