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Flashcards in Contraception LARC Deck (33):
1

every 2 seconds there are how many births and how many deaths

9 births
3 deaths

2

what happens to the basal body temp during a cycle

goes up after ovulation
increase by >0.2
has to be sustained for 3 days after at least 6 days of lower temp

3

cervical mucous before and after ovulation

post thick and sticky
after thinner, watery, stretchy

4

cervical position when fertile/less fertile

fertile - high in vagina soft and open
less fertile - low firm and closed

5

during a standard 28 cycle which days are the most fertile

8-18

6

criteria for breast feeding

exclusive VF
less than 6/12 post natal
amenorrhoeic

7

UK MEC categories

1. no restriction
2. advantages outweigh risks
3. risks generally outweigh advantages
4. unacceptable risk

8

pear index is calculated how

number of accidental preg x 1200 / total number of months of exposure

9

list the types of LARC and the difference between the types

injectable contraceptive - depo, sayana

depo - IM
sayana - SC version

10

VLARC

IUD
IUS
Implant

11

how does LARC work
how often is it given
how long does it last
what are the other effects
what is the failure rate

inhibits ovulation
every 13 weeks
lasts 14 weeks
makes mucous thick and sticky
makes endometrium thinner and less likely for implantation
0.2%

12

what examination is done before a LARC is given

BP and BMI recorded
smear test check
risk factors for osteoporosis

13

what is a person at risk of with injections and what other risks are there

osteo

underweight, anorexia, steroid use, FH, smoking, low trauma fracture, hypothyroid, coeliac, rheumatoid, IBD, chronic renal disease

14

when is depo started
how long does it take depo to start
when can depo be given if the first window is missed

up to and including day 5 without the need for additional contraception - before ovulation that month

7 days

after 5 days if certain not pregnant and needs to use condoms/abstain for the following 7 days

15

how can a person be reasonably certain that they are not pregnant

not had sex since their last periods
using reliable contraception
<7 days since last normal period
<4 weeks post partum and not breast feeding
breast feeding, amen and <6 months post partum
negative preg test and >3 weeks since UPSI

16

starting depo post partum
post TOP
if preg cannot be excluded

up to day 21 with immediate cover

up to day 5

do preg test in 3 weeks if neg then give depo

17

side effects of depo

weight gain due to stimulation in appetite
delayed in returning fertility
irregular bleeding - commonest SE
osteo risk

18

which is more cost effective LARC or VLARC

VLARC

19

IUD shape
hormonal?
contains what
gold standard
how does it work

T shaped
non hormonal
copper and plastic
380mm2 copper
copper is toxic to sperm and ovum joining

20

IUD primary mode of action
other action
failure rate

prevention of fertilisation
inflam response in endometrium making it a toxic environment

0.6-0.8% (1/200)

21

IUS what is it
types
what is the drawback for the second one

T shaped device with elastomere core (prog core)

52mg levonorgestrel
20 mcg daily released - decreases to 10 a day in year 5

13.5mg
14ug per day for first 24 days
decreases to 5ug per day at 5 years

not licensed for heavy periods and hormone replacement therapy

22

IUS primary mode of action
other actions
failure rate

effect on implantation
can also stop ovulation (in some women)
endometrium made thinner, cervical mucous thicker

0.2% (1/500)

23

what are some contra indications of IUD/IUS

current pelvic infection
abnormal uterine anatomy
wilsons disease
preg - esp if HCG are high
sensitivity to any of the constituents
gestational trophoblastic disease where bHCG levels are abnormal/persistently raised
endometrial cancer
cervical cancer awaiting treatment

24

what examination is done prior to insertion of IUS/IUD

PV to check uterine size/position
BP/pulse if condition indicates e.g. anxious, ht

25

when can an IUD be fitted

within the first 7 days of a period
any time - if not pregnant
5 days after UPSI for EC
5 days after predicted ovulation
48 hours or >4 weeks post partum
immediately post TOP

26

when can an IUS be fitted
what is it not used for

within the first 7 days of a period
any time if not preg

not used for EC - doesn't work quick enough - takes 7 days to have an effect

if fitted outwith the 7/7 - use condoms

within 48 hours or >4 weeks post partum
immediately post op TOP up to day 7

27

SE/problems with IUD

heavy prolonged menses
pain, infection, PIV - increased risk in first 20 days
perforation
expulsion
higher post 2nd trimester abortion, post natal
ectopic risk 9-50% if become pregnant

28

SE of IUS

lighter, less frequent bleeding, can be erratic
pain, infection PID in first 20 days
perforation
expulsion
ectopic risk lower

29

what is an implant
how long is it licensed for
what does it contain

single non biodegradable subnormal rod
3 years
68mg ENG - released 60/70ug in weeks 5-6 and 25-30 per day at the end of the 3rd year

30

how does an implant work
other mechanisms
failure rate

inhibitor of ovulation
effects on endometrium and mucous
0-0.1%

31

when can an implant be fitted

within first 5 days of cycle
up to day 5 post first/second trim abortion
on or before day 21 post partum

additional precautions first 7 days if she id not preg, quick start after EC, off license

32

switching from another method to implant
when is immediately effective
when should she take extra precautions

immediate affective if fitted within 14 weeks of last active pill or depo
within 2-3 weeks of COC, patch, vaginal ring

additional precautions for 7 days if changing from POP or LNG-IUS
or switching from non hormonal method

33

side effects of implant

irregular bleeding
weight gain
acne

nerve damage/vascular injury
deep insertion