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MRCOG Part 2 Sexual and Reproductive Health > Contraceptive method and issues around the menopause TOG 2017 > Flashcards

Contraceptive method and issues around the menopause TOG 2017 Flashcards

1
Q

How does the perimenopause effect peroids?

A

Prolonged or shorter cycles
Can be HMB

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2
Q

What proportion of pregnancies are age > 40 yrs?

A

1/5

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3
Q

What proportion of pregnancies > 40 yrs are unplanned?

A

28%

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4
Q

For women > 50 yrs and < 50 non hormonal when can contraception be stopped?

A

> 50 1 year ammenorhhoea
<50 2 years

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5
Q

For which women using hormonal contraception can you use FSH to determine menopausal status?

A

POP
Subnormal implant
IUS

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6
Q

Dx menopause based on FSH

A

2 x FSH > 30 6 weeks apart

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7
Q

If going to test FSH in those on COCP, how long should stop before?

A

2 weeks before

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8
Q

If going to test FSH in those on DEPO, how long should stop before?

A

1 year

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9
Q

If not testing FSH when can stop contraception?

A

Age 55 years

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10
Q

If using HRT in perimenopause, what contraception can be advised?

A

POP methods and intrauterine contraception

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11
Q

Which contraception can provide endometrial protection for HRT users

A

Mirena levonorgestrel 52mg IUS, liscensed for 4 years but can use up to 5

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12
Q

If on COCP how to minimise menopausal Sx

A

Short pill free intervals

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13
Q

Advantages/disadvatnages COCP in perimenopausal, failure rate 1st year non perfect use

COCP

A

Regular bleeding pattern, reduction in menstrual bleeding and flushed

Increased risk thrombosis, breast/cervical cancer

9%

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14
Q

Advantages/disadvatnages in perimenopausal, failure rate 1st year non perfect use

POP

A

Very few medical contraindications

Dailing dosing required
Irregular bleeding

9%

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15
Q

Advantages/disadvatnages in perimenopausal, failure rate 1st year non perfect use

Depo

A

Long acting
Often induces amenorrhoea

Masks menopause
Bone mineral density concerns
Unable to remove after injection

6%

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16
Q

Advantages/disadvatnages in perimenopausal, failure rate 1st year non perfect use

POP implant

A

Few CI
Easily removed

Irregular bleeding
Reguires trained operatior

0.05%

17
Q

Advantages/disadvatnages COCP in perimenopausal, failure rate 1st year non perfect use

Cu-IUD

A

Hormone free
Does not mask menopause
Long acting

Heavy bleeding,c rmaps
unsuitable if women has distorted cavity

0.8%

18
Q

Advantages/disadvatnages in perimenopausal, failure rate 1st year non perfect use

LG-IUD

A

Long actin
tx heavy bleeding
endometrial protection

Irregular bleeding
Unstable distorted cavity

0.2

19
Q

Most popular contraception in >40yrs

A

Vasectomy 28%

20
Q

Criteria to exclude pregnancy

A

No signs or symptoms of pregnancy
No intercourse since last census
Reliable contraception
Miscarriage/terminaton within 7 days of the onset of menstruation

Neg preg test only accurate if > 3 weeks since last SI

21
Q

When should COCP be stopped based on age if no other CI

A

50 years

If smoker stop at 35

22
Q

CHC increase risk of VTE by how much

A

6 fold, highest in first few months of stateing

23
Q

What % of women with implant have ammnorhoea

A

20%

24
Q

What proportion of implant will have it removed in 1st year due to irregular PV bleeding

A

1/5

25
Q

How often does DEPO provera need to be administered

A

Liscenced 12 weeks, but effective 14

26
Q

With DEPO provera what proportion amennhorea after 1 and 2 years

A

1yr: 50%
2yrs: 70%

27
Q

What % of bone lost within 2 years of DEPO

A

5%, unknown if bones make full recovery

28
Q

How much of which hormone in Mirena and levosert?

A

52mg levonorgestrel

29
Q

What dose of levonorgestrel is in Jaydess?

A

13.5mg levonorgestrel

30
Q

How much does the IUS reduce bleeding within 3 months for women with HMB

A

80%

31
Q

If on tamoxifen what can be offered for endometrial protection

A

52mg IUS

32
Q

Which bacteria is associated with IUD and IUS

A

Actinomycetes

33
Q

Effectiveness if condoms and women barrier methods (perfect use)?

A

99%
95%

34
Q

What should not be used with condoms

A

Oil based lubricants
Oestrogen containing vaginal creams

Weaken latex

35
Q

What proportion of women >40yrs use sterilisation?

A

18%

Can be before open, lap, hysteroscpically

Contraception should still be used for 3 months until occlusion is confirmed

36
Q

Failure rate of vasectomy vs female sterilisation

A

vasectomy 1/2000
female 1/200

37
Q
A

MRCOG Part 2 Sexual and Reproductive Health (15 decks)

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