contraception Flashcards
(80 cards)
1
Q
what nerves supply the external genitalia & pelvic floor muscles?
A
S2, S3, S4
pudendal nerve
2
Q
average daily fluid intake
A
1500-2000 mls
3
Q
medication for nocturia
A
desmopressin
4
Q
treatment for urinary retention?
A
bladder catheterisation
5
Q
1st & 2nd line treatment for overactive bladder?
A
1st line = bladder retraining for minimum of 6 weeks
2nd line = oxybutynin, tolterodine, darifenacin
6
Q
what group is oxybutynin in?
A
antimuscarinic
7
Q
type of incontinence overactive bladder causes?
A
urge incontinence
8
Q
mechanism of oxybutynin
A
inhibition of muscarinic action of acetylcholine on smooth muscles therefore relaxing bladder
9
Q
invasive therapies for overactive bladder (2)
A
- Botulinum toxin A for detrusor overactivity
- percutaneous sacral nerve stimulation
10
Q
involuntary leakage of urine during increased intra abdominal pressure e.g. coughing & strauining
A
stress incontinence
11
Q
3 poss causes fo stress incintinecnce?
A
- childbirth weakening pelvic floor muscles
- denervation of pelvic floor muscles through pregnancy
- oestrogen deficient states
- pelvic surgery
- prolapse
12
Q
conservative measures for stress incontinence
A
- lifestyle measures: stop smoking & weight loss
- 3 months pelvixc floor muscles: kegel muscles
- topical oestrogen
13
Q
how does topical oestrogen help incontinence?
A
topical oestrogen helps improve stress incontinence by helping to tone muscles around the urethra to keep it closed
14
Q
causes of urge incontinence
A
overactive bladder
15
Q
symptoms of urge incontinence
A
overactive bladder: urgent desire to void, frequency, nocturia, overactivity of detrusor muscle
16
Q
who can teach you about pelvic floor muscles?
A
referral to community physiotherapist or community continence team for pelvic floor muscle trainng
17
Q
medication group that can cause incontinence through helping to relax urethral sphincter
A
alpha blockers
18
Q
investigation to evaluate bladder function
A
urodynamic studies
19
Q
red flags for incontinence (3)
A
- visible haematuria: bladder cancer
- pain associated with bladder filling: bladder cancer
- abdominal pain: pelvic mass
20
Q
what is urogenital prolapse>
A
when there is descent of one of the pelvic organs resulting in protrusion of the vaginal walls, affecting 40% postmenopausal women
21
Q
Rectocele & enterocele are examples of?
A
posterior vaginal wall prolapses
22
Q
5 risk factors for prolapses?
A
- increasing age
- multiparity
- vaginal deliveries
- obesity
- spina bifida
23
Q
treatment if prolapse is ulcerated
A
topical oestrogen
24
Q
Guidelines used to assess if a patient under 16 is competent for consent for contraception?
A
fraser criteria
25
6 criteria for Fraser guidelines?
1) Have capacity - able to understand the contraception
2) Cannot be persuaded to tell their parents or let you tell them
3) Young person is likely to have sex with or without treatment
4) Best interests of young person to receive advice
5) consideration been given to the effect on physical/mental health of the young person if advice or treatment is witheld
26
where is emergency contraception available?
- GPs
- walk in centres
- out of hours service
- sexual health clinic
27
what causes overflow urinary incontinence
chronic urinary retention due to an obstruction to the outflow of urine
28
3 neurological conditions that can cause overflow urinary incontinence?
- MS
- spinal cord injuries
- diabetic neuropathy
29
how is urodynamic test carried out?
thin catheter inserted into bladder and another into rectum. 2 catheters are used to measure the pressures in the bladder & rectum for comparison. bladder is filled with a liquid & measurements are taken;
- cystometry
- uroflowmetry
- ;etc
30
2nd line medication for stress incontinence
Duloxetine
31
mechanism of duloxetine
SNRI antidepressant
32
side effects of anticholinergic medication e.g. amitriptyline
- dry mouth
- dry eyes
- urinary retention
- memory problems
33
contraception of choice if patient has breast cancer
- copper coil
| - barrier methods
34
contraception to avoid if patient has cervical or endometrial cancer
avoid intrauterine system ( mirena coil)
35
9 ABSOLUTE (UKMEC4) contraindications for combined contraceptive pill
1) uncontrolled HTN (>160/100)
2) migraine with aura
3) hx of VTE
4) aged over 35 smoking more than 15 cigs a day
5) major surgery with prolonged immbolity
6) vascular disease/stroke
7) IHD/cardiomyopathy/AF
8) liver cirrhosis
9) Lupus & antiphospholipid syndrome
36
afetr last period how long is contraception required for
2 years in women under 50 and 1 year in women over 50
37
which contraception should be stopped in over 50s due to risk of osteoporosis
depo provera projesterone injection
38
what is lactactional amenorrhoea?
effective contraception
women must
- fully breastfeeding
- no periods
for up to 6 months
39
when can combined pill be started after pregnancy?
6 weeks post partum
40
3 ways in which the COCP prevents pregnancy
1) Prevents ovulation
2) thickening of cervical mucus
3) Inhibits proliferation of the endometrium - reducing the chance of successful implantation
41
2 types of COCP
1) Monophasic pills - contain the same amount of hormone in each pill
2) Multiphasic pills: contain varying amounts of hromone to match the normal cyclical hormonal changes more closely
42
side effects of COCP
- breast pain & tenderness
- mood changes & depression
- headaches
- HTN
- VTE
- Breast & cervical ca increased risk slightly - this returns to normal 10 years after stopping
43
benefits of COCP
- effective contraception
- rapid return of fertility when stopping
- improvement of menorrhagia, dysmenorrhea
- reduced risk of endometrial, ovarian & colon cancer
44
COCP effect on risk of different cancers?
increases risk of
- breast cancer
- cervical
reduces risk of
- endometrial
- ovarian
- colon ca
45
BMI UKMEC 3 for COCP
> 35
46
when to start the combined pill
start on the first day of the cycle (first day of period) up to 5th day then works striaght away
if starting past day 5 then additional contraception required for first 7 days of consistent pill use
47
what is missing one pill of COCP quantified as?
more than 24 hours late (ie 48 hours since last pill was taken)
48
management if missed more than 1 pill & in day 1-7 of packet
emergency contraception
49
management if missed more than 1 pill & in day 8-14
no emergency contraception required
50
management if missed more than 1 pill & in day 15-21
no emergency contraception required
51
2 types of POP
- traditional POP e.g. norgeston
| - Desogestrel only pill (cerazette)
52
3 effects of progesterone only pill
1) thickens cervical mucus
2) altering endometrium making less accepting of implantation
3) reducing ciliary action in fallopian tubes
53
how long till POP works
if taken in day 1-7 then effective straight away
if taken at other day in cycle then takes 48 hours to be effective as it takes 48 hours for cervical mucus to thicken enough to prevent sperm entering the uterus
54
side effects of POP
- breast tenderness
- headaches
- acne
55
when is emergency contraception required re missing POP pills
if they have had sex since missing the pill or within 48 hours of restarting the regular pills
56
what are the 2 forms of long acting progesterone contraceptives?
Implant
injection
57
mechanisn of progesterone injection
- inhibits ovulation
| - thickens cervical mucus
58
frequency of progesterone injection
12 week intervals
59
side effects of progesterone injection
- weight gain
- acne
- mood changes
60
important side effect of depot injection
osteoporosis (reduced bone mineral density)
61
2 unique side effects of progesterone injection
- weight gain
| - osteoporosis
62
what is the progesteroen implant?
small flexible tube placed in upper arm - releases progesterone into the systemic circulation for 3 years
63
what are the 2 types of intrauterine coils
- Copper coil
| - Levonorgestrel intrauterine system
64
what is the intrauterine coil - device?
copper coil
65
contraindications for intrauterine coils?
- PID
- immunosuppresion
- pregnancy
- unexplained bleeding
- pelvic ca
- uterine cavity distortion ie. fibroids
66
side effects after insertion of coils
crampy abdominal pain
bleeding & pain on insertion
vasovagal reactions
PID
67
when is expulsion rate high after insertion of coil
in first 3 months
68
3 things that need to be excluded for non visible threads?
- expulsion
- pregnancy
- uterine perforation
69
follow up after coil insertion?
3-6 weeks later to check the threads
70
duration of effective contracteption for copper coil
5-10 years
71
mechanism of copper coil?
copper is toxic to the ovum & sperm. also alters endometrium making it less accepting of implantation
72
drawbacks of copper coil
may cause heavy or intermenstrual bleeding
pelvic pain
increased risk of ectopic pregnancies
73
what is the mirena levonorgestrel coil licensed for?
- contraception
- HRT
- menorrhagia
74
benefits of levonorgestrol coil system?
- can make periods lighter
- can improve pelvic pain in endometriosis
- no increase in VTE risk
75
3 options for emergency contraception
Copper coil
Levonorgestrel
ulipristal
76
time frame to take levonorgestrel for emergency contraception
72 hours
77
time frame to take ulipristal for emergency contraception
120 hours
78
side effects of Levonorgestrel
- nausea & vomiting
- spotting/changes to next period
- diarrhoea
- breast tenderness
- dizziness
79
2 significant restrictint to taking Ulipristal?
- breastfeeding avoided for 1 week
| - avoided in patients with severe asthma
80
when can regular contraception be started after taking emergency contraception
for Levonorgestrel: COCP or POP can be started immediately (effective 7 & 2 days respectively later)
Ulipristal: wait 5 days before starting COCP or POP (effective 7 & 2 days respectively later)
