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Women's health > Contraception > Flashcards

Contraception Flashcards

1
Q

UKMEC 1- for contraception- what is it?

A

Condition for which there is no restriction for the use of the contraceptive method

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2
Q

UKMEC 2- for contraception- what is it?

A

advantages generally outweigh the disadvantages

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3
Q

UKMEC- 3- for contraception- what is it?

A

disadvantages generally outweigh the advantages

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4
Q

UKMEC- 4 - for contraception- what is it?

A

represents an unacceptable health risk

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5
Q

Examples of UKMEC- 3 conditions where the disadvantages generally outweigh the advantages

A

more than 35 years old and smoking less than 15 cigarettes/day
BMI > 35 kg/m^2*
family history of thromboembolic disease in first degree relatives < 45 years
controlled hypertension
immobility e.g. wheel chair use
carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
current gallbladder disease

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6
Q

Examples of UKMEC 4 conditions- unacceptable health risk

A

more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation

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7
Q

What is the main injectable contraceptive used in the UK?

A

Depo Provera- contains medroxyprogesterone acetate 150mg. Given via IM injection every 12 weeks.

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8
Q

What is the main method of action of Depo Provera?

A

Inhibits ovulation. Secondary effects include cervical mucus thickening and endometrial thinning

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9
Q

Disadvantages of Depo Provera

A

Once injected, the injection cannot be reversed once given. Potential delayed return to fertility (up to 12 months)

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10
Q

Adverse effects of Depo Provera

A

irregular bleeding
weight gain
may potentially increased risk of osteoporosis: should only be used in adolescents if no other method of contraception is suitable
not quickly reversible and fertility may return after a varying time

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11
Q

Contraindications of depo provera

A

Breast cancer: current breast cancer is UKMEC 4- past breast cancer is UKMEC 3

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12
Q

Two methods of emergency hormonal contraception

A

Emergency pill and morning after pill- levonorgestrel and ulipristal- progesterone receptor modulator

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13
Q

Levonorgestrel MOA

A

Not fully understood- acts to stop both ovulation and inhibit implantation

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14
Q

Within how many hours of unprotected sexual intercourse (UPSI)

A

72 hours

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15
Q

What is the dose of levonorgestrel to be taken

A

single dose of levonorgestrel 1.5mg (a progesterone)
the dose should be doubled for those with a BMI >26 or weight over 70kg
84% effective is used within 72 hours of UPSI

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16
Q

What is Ulipristal?

A

Selective progesterone receptor modulator currently markets as EllaOne- primary mode of action - inhibition of ovulation

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17
Q

Dose of ulipristal to be taken

A

30mg oral dose as soon as possible- no later than 120 hours after intercourse

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18
Q

When should contraception with pill, patch or ring be started after taking ulipristal

A

5 days after- barrier methods should be used during the 5 days

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19
Q

Within how many days of UPSI should IUD be fitted

A

5 days - if woman presents after more tha 5 days then IUD may be fitted up to 5 days after likely ovulation date

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20
Q

Two types of intrauterine contraceptive

A

IUDS and IUS

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21
Q

Mode of action of IUD and IUS

A

IUD: primary mode of action is prevention of fertilisation by causing decreased sperm motility and survival (possibly an effect of copper ions)
IUS: levonorgestrel prevents endometrial proliferation and causes cervical mucous thickening

22
Q

How long after insertion can IUD be relied upon

A

immediately - majority effective for 5 years

23
Q

How long after insertion can IUS be relied upon

A

after 7 days- Mirena- IUS most common for 5 years

Used as endometrial protection for women taking oestrogen only hormone replacement therapy

24
Q

Problems with IUDS and IUS

A

IUD- periods heavier, longer and more painful
IUS- initial frequent uterine bleeding and spotting
Uterine perforation

25
Q

After which day post partum do women require contraception

A

Day 21

26
Q

POP postpartum- when to start

A

Any time

27
Q

Combined oral contraceptive pill (COC) points when is it UKMEC 4 and when is it UKMEC2

A

absolutely contraindicated - UKMEC 4 - if breast feeding < 6 weeks post-partum
UKMEC 2 - if breast feeding 6 weeks - 6 months postpartum*
the COC may reduce breast milk production in lactating mothers
may be started from day 21 - this will provide immediate contraception
after day 21 additional contraception should be used for the first 7 days

28
Q

How long does the contraceptive patch cycle last

A

4 weeks
First 3 weeks- patch worn everyday and needs to be changed each week. 4th weeks- patch not worn and there will be withdrawal bleed

29
Q

Combined oral contraceptive pill mode of action

A

Inhibits ovulation

30
Q

Progestogen-only pill (excluding desogestrel) MOA

A

Thickens cervical mucus

31
Q

Desogestrel- only pill MOA

A

Primary: inhibits ovulation
Also: thickens cervical mucus

32
Q

Implantable contraceptive (etonogestrel)

A

Primary: inhibits ovulation
Also: thickens cervical mucus

33
Q

Intrauterine contraceptive device

A

Decreases sperm motility and survival

34
Q

Intrauterine system (levonorgestrel)

A

Primary: Prevents endometrial proliferation
Also: Thickens cervical mucus

35
Q

Intrauterine contraceptive device

A

Primary: Toxic to sperm and ovum
Also: Inhibits implantation

36
Q

Timeline that people who have had UPSI should be advised to get tested for an STI

A

young people should be advised to have STI tests 2 and 12 weeks after an incident of unprotected sexual intercourse (UPSI)

37
Q

Epilepsy contraception factors to consider for women with epilepsy

A

the effect of the contraceptive on the effectiveness of the anti-epileptic medication
the effect of the anti-epileptic on the effectiveness of the contraceptive
the potential teratogenic effects of the anti-epileptic if the woman becomes pregnant

38
Q

UKMEC points for different methods of contraception in women taking phenytoin,carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine:

A

UKMEC 3: the COCP and POP
UKMEC 2: implant
UKMEC 1: Depo-Provera, IUD, IUS

39
Q

UKMEC points for different methods of contraception for lamotrigine

A

UKMEC 3: the COCP

UKMEC 1: POP, implant, Depo-Provera, IUD, IUS

40
Q

Implantable contraceptive moa

A

releases the progestogen hormone etonogestrel
They are typically inserted in the proximal non-dominant arm, just overlying the tricep. The main mechanism of action is preventing ovulation. They also work by thickening the cervical mucus.

41
Q

What is the most effective form of contraceptive

A

Implantable contraceptive
Lasts 3 years
Doesn’t contain oestrogen so can be used if past history of thromboembolism, migraine etc

42
Q

Disadvantages of implantable contraceptive include

A

the need for a trained professional to insert and remove device
additional contraceptive methods are needed for the first 7 days if not inserted on day 1 to 5 of a woman’s menstrual cycle

43
Q

Adverse effects of implantable contraceptives

A

Irregular/heavy bleeding is the main problem: managed used a co-prescription of the COCP
Progestogen effects- headache, nausea, breast pain

44
Q

Name of implantable contraceptive

A

Nexplanon

45
Q

Interactions of nexplanon

A

enzyme-inducing drugs such as certain antiepileptic and rifampicin may reduce the efficacy of Nexplanon
the FSRH advises that women should be advised to switch to a method unaffected by enzyme-inducing drugs or to use additional contraception until 28 days after stopping the treatment

46
Q

Contraindications of implantable contraceptives

A

UKMEC 3*: ischaemic heart disease/stroke (for continuation, if initiation then UKMEC 2), unexplained, suspicious vaginal bleeding, past breast cancer, severe liver cirrhosis, liver cancer
UKMEC 4**: current breast cancer

47
Q

What time should the POP be taken everyday

A

should be taken at same time everyday, without a pill free break (unlike the COC)

48
Q

Missed POP- what to do

A

if < 3 hours* late: continue as normal
if > 3 hours*: take missed pill as soon as possible, continue with rest of pack, extra precautions (e.g. Condoms) should be used until pill taking has been re-established for 48 hours

49
Q

Potential other problems of POP

A

diarrhoea and vomiting: continue taking POP but assume pills have been missed - see above
antibiotics: have no effect on the POP**
liver enzyme inducers may reduce effectiveness

50
Q

Progestogen only pill: missed pil rule for Traditional POPS

A

If less than 3 hours late
no action required, continue as normal

If more than 3 hours late (i.e. more than 27 hours since the last pill was taken)
action needed - see below

51
Q

Missed POP- Cerazette desogestrel rules if late

A

If less than 12 hours late
no action required, continue as normal

If more than 12 hours late (i.e. more than 36 hours since the last pill was taken)
action needed - see below

52
Q

COCP potentials harms and benefits

A

the COC is > 99% effective if taken correctly
small risk of blood clots
very small risk of heart attacks and strokes
increased risk of breast cancer and cervical cancer

Women's health (2 decks)

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