Contraception Flashcards by Hugh Janus

What are the circumstances around breastfeeding being an effective contraception

if a woman is <6 months post-partum, amenorrhoeic and regularly breastfeeding there is a 98% effectiveness

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when is emergency contraception required in the period after pregnancy

21 days+ you consider it, <21 days it is not required

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what is the advice around the COCP with breastfeeding

avoid within first 6 months as affects breast milk volume

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when can you start progesterone only contraception post partum

6 weeks

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when can the IUD be inserted post partum

4 weeks

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how should you deal with contraception in the perimenopausal stage

<50 stay on contraception for at least 2 years after LMP

>50 same but 1 year

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how does the COCP act as contraception

Exerts a negative feedback loop on gonadotrophin causing ovulation to cease

Thin the endometrium and thicken cervical mucus

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what is the regular regime for the COCP

take for 3/52 then skip for 1/52

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what may occur if the COCP is taken back to back with no gaps

not much but some light spotting may occur

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what is the success rate for the COCP with a proper usage

99.8%

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what are some uses outside of contraception for the COCP

Menstrual cycle control in primary dysmenorrhoea

Menorrhagia

Endometriosis protection

Recurrent simple ovarian cysts

Acne

PMS

Reduces risk of PID

Reduced risk of bowel/endometrial/ovarian CA)

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what factors affect the absorption of the COCP

diarrhoea
vomiting
oral Abx

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what is the standard advice for missing 1-2 doses of the COCP, or 1 of the reduced dose pill

1-2 doses is fine, and 1 of the reduced one is fine, but any more and it should be a concern. if this happens you should use condoms for 7 days

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what are the major complications for the COCP and how rare are they

Venous thrombosis

Myocardial infarction

Cerebrovascular accidents

Focal migraine

Hypertension

Jaundice

Liver,breast,cervical carcinoma

2-5 per million excess deaths per year in <35

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what are some side effects of the COCP

Nausea

Breakthrough bleeding

Suppressed lactation

Contraindicated <6 weeks post partum

Headache

Breast tenderness

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what are some absoloute contraindications of the COCP

Clotting disorders (e.g factor V leidans)

> 35 years old smoking >15 day

Migraine with aura

Personal history of thrombotic disease

History of stroke or ischaemic disease

Breast feeding

Uncontrolled hypertension (Syst >160,Diast >95)

Current breast cancer

Major surgery with prolonged immobility

Any hepatic disorders

Any nephropathy

Any neuropathy

Uncontrolled diabetes

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what is the combined transdermal patch

delivers oestrogen and progesterone

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how is the combined transdermal patch delivered

same as COCP, put on for 3 weeks and take off for a week

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how does the combined vaginal ring work

latest ring the releases synthetic oestrogen and progesterone

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how is the combined vaginal ring administered

same as COCP/patch, put in for 3 weeks and taken out for a week

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should the combined vaginal ring be removed for intercourse

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what is the maximum the combined vaginal ring can be removed for

3 hours

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when should the daily progesterone pill be taken

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same time of day +/- 3 hours

how does the progesterone-only pill work

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makes cervical mucus hostile to sperm

what is the effectiveness of the progesterone-only pill

99% (0.8% worse)

what are the side effects of the progesterone-only pill

Premenstrual symptoms Spotting Weight gain Mastalgia - tender breasts Functional ovarian cysts `

what patient population gains the most from the progesterone-only pill

Lactating mothers Older women Those with a higher VTE score – there is no thromboembolic side effects

what should you do if progesterone-only pill has been taken outside the 3-hour window, or not at all

should take one immediately and condoms should be used for 2 days

is the progesterone-only pill affected by antibiotics

what are examples of LARCS (long acting reversible contraceptives)

depot injections of progesterone (depot-provera, noristerat, sayana press) Nexplanon implant

what are some counselling points for the depot provera

<1 per 100 woman years failure rate Cause irregular bleeding for a few months then amenorrhoea Bone density decreases for 2-3 years then stabilises therefore contraindicted In women with osteoperosis and teenagers IM injection every 3 months

what are side effects of the nexplanon implant

irregular bleeding for up to a year

what are the 2 types of the morning after pill

levonelle | ulipristal (ellaONE)

what is the levonelle pills mechanism of action

selevtive progesterone receptor modulator

when is the levonelle pill effective

up to 72 hours post intercourse (58%) but most effective within 24 hours (95%)

what are some side effects of the levonelle pill

vomiting | menstrual disturbance next cycle

what is the mechanism of action of the ellaONE pill

selective progesterone receptor modulator

when is the ellaONE pill effective

up to 120 hours after intercourse, but condoms should be used to prevent transmission until their next period

what is the most effective measure of emergency contraception

IUS

what is the risk of pregnancy with condom use only

2-15 per 100 woman years depending on proper use

what are all the options for barrier contraception

male condom female condom diaphragm and caps spermicides

what are examples of the intrauterine copper devices

copper coil | IUS

when should the IUS be replaced

3-5 years

what is the failure rate for the IUS

<0.5 per 100 woman years failure

what are complications for the IUS

Pain/cervical shock Expulsion Perforation of the uterine wall Heavier, more painful menstruation Infection (20% risk) Ectopic pregnancy

what is the most common female sterilisation technique and whats an alternative

filshie clips - clips applied laproscopically under a GA alt: transvercial sterilisation (hysteroscopic placements of microinserts into the proximal fallopian tube which expand causing tube occlusion)

what are the failure rates of female sterilisation

0.5%

whats an important counselling point for female sterilisation

sterilisation is on the NHS but reversal is not

what is more effective, female sterilisation or male

male

what is the male sterilisation procedure

ligation and removal of a small section of the vas deferens

how is male sterilisation confirmed

2 counts of azoospermia from semen analysis, may take up to 6 months

what are the complications of male sterilisation

Failure Post operative haemoatomas Infection Chronic pain

is male sterilisation reversible

yes but fertility is often affected due to antisperm antibody foundation

what is the effectiveness of male sterilisation

>99%

what are some examples of natural contraceptions

lactation rhythm methods (mentrual period) pull out method

Contraception Flashcards

(55 cards)