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Family Planning Flashcards

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1
Q 
In developed countries of the Western world, the
most widely used methods in order of preference are
the 
1
2
3
4
5
A

male condom, combined oral contraceptive pill,
intra-uterine device (IUD), female sterilisation and
withdrawal

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2
Q

________ methods are defined as non-permanent
contraception administered less frequently than
once a month

A

LARCLong-acting reversible contraception (LARC).

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3
Q

Examples of LARC method

A

They include implants, IUDs and

injectables

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4
Q

LARC methods are the most effective
reversible contraceptives, with failure rates for typical
use _________

A

virtually the same as for perfect use

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5
Q

Examples of Combined hormonal contraceptives

A

— combined oral contraceptive pill (COC or
‘the pill’)
— vaginal ring (NuvaRing)

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6
Q

Examples of Progestogen-only contraceptives

A 
— etonogestrel implant (Implanon NXT)
— levonorgestrel-releasing IUD (Mirena)
— depot medroxyprogesterone acetate
(DMPA
— progestogen-only pill (POP or ‘mini-pill’)
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7
Q

Post-coital contraception

A

— levonorgestrel emergency contraceptive pill

(ECP

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8
Q

Combined hormonal contraceptives contain an
oestrogen and progestogen, and their main mode of
action is ______

A 
inhibition of hypothalamic and pituitary
function leading to anovulation.
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9
Q

COCs in Australia contain ________, _______, ________

Efficacy is 99.7% with perfect use, 91% with typical use.

A

ethinyloestradiol (EE), oestradiol valerate (EV) or oestradiol (E2) and one of a range of progestogens.

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10
Q

The active oestrogen in the newer E2 and EV pills is structurally identical to the E2 produced by the ovaries. They have a theoretical but unproven benefit in terms of _______

A

venous

thromboembolism (VTE) risk

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11
Q

Use of formulations containing _____ is no longer
recommended because there is no known additional
benefit from their use and they are associated with
an increased risk of VTE.

A

50 mcg EE

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12
Q

Women starting on a 20 mcg EE pill have a higher

chance of discontinuation due to ______

A

breakthrough

bleeding

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13
Q

The early progestogens include_____ and ____

A

levonorgestrel and

norethisterone

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14
Q

Newer progestogens have been developed over recent decades to reduce ____

A

androgenic
side effects and to minimise the effect EE has on
lipids.

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15
Q

Nomogestrol acetate, gestodene, desogestrel
and etonogestrel are less androgenic, while
_______, ______, _______
are anti-androgenic

A

cyproterone acetate, drospirenone and dienogest

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16
Q

Drospirenone is an analogue

of ______ and has a mild diuretic effect

A

spironolactone

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17
Q

Starting a pill

Suitable first choice is a:

A

monophasic pill containing 30 mcg or 35 mcg ethinyloestradiol (EE) with levonorgestrel or norethisterone (e.g. Nordette, Microgynon 30, Monofeme, Levlen ED, Brevinor

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18
Q

What is the quickstart technique

A

If commenced at any time other
than day 1–5 of the menstrual cycle, abstinence/
condoms are required for the first 7 days after the
start

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19
Q

The oestrogen in any CHC may improve acne and hirsuitism via______ and ____

A

increased
sex hormone binding globulin (SHBG) levels and
reduction of free testosterone

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20
Q

CHC is not recommended if:

A

a woman is over 35 years and has multiple cardiovascular risk factors, including obesity, smoking, diabetes and
hypertension

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21
Q

Women taking liver enzyme-inducing drugs.
Alternative contraception is strongly advised. The
only hormonal contraceptives not affected by liver
enzyme-inducing drugs are _____ and ____

A

DMPA and IUDs

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22
Q

Current evidence suggests that most antibiotics do not
interact with combined hormonal contraceptives. The
only exceptions are liver enzyme-inducing _____ and _____

A

rifabutin

and rifampicin.

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23
Q

For women who still request

the use of COC while on meds with liver inducing enzyme properties, an _______may be effective

A

extended or tricycling regime
of a higher dose pill (e.g. containing at least 50 mcg
EE)

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24
Q

A number of significant beneficial effects arising
from the use of COCs have now been documented:

• Reduction in most menstrual cycle disorders,
including ______
• Reduction in the incidence of ______

A

dysmenorrhoea, symptoms of endometriosis and heavy menstrual bleeding

functional ovarian cysts and benign ovarian tumours

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25
A number of significant beneficial effects arising from the use of COCs have now been documented: ``` • Reduced incidence of ______ • Can reduce acne • Can be useful in managing symptoms of _______ • Can assist with perimenopausal symptoms ```
ovarian and endometrial cancer polycystic ovarian syndrome
26
A number of significant beneficial effects arising from the use of COCs have now been documented: * Can be used to manage ____ and ____ * Can reduce the risk of______
premenstrual syndrome (PMS) and its more severe form (PMDD) in some women bowel cancer
27
The following circulatory disorders have been | linked with pill usage
• Venous deep vein thrombosis, pulmonary embolism, rarely: mesenteric, hepatic and kidney thrombosis • Arterial myocardial infarction, thrombotic stroke, haemorrhagic stroke, rarely: retinal and mesenteric thrombosis
28
T or F in pill use The risk of circulatory disease has not been related to duration of use and there is no increased risk in perpetual users
T
29
The______ content of the pill is considered | to be the aetiological factor in pill associated VTE
oestrogen
30
The progestogen effect on ______ is not considered significant in the aetiology of circulatory disease.
lipid metabolism
31
``` Venous thromboembolism (VTE) risk is increased _____ times in users of CHCs compared to non-users. ``` The risk is highest in the first______of use and gradually decreases with duration of
2–3 4 months
32
Studies have shown that COCs containing cyproterone, desogestrel, drospirenone or gestodene have a higher risk of VTE than COCs containing ______ and ______
levonorgestrel or other progestogens
33
T or F
the absolute risk of VTE in users of any CHC is very low and much lower than the risk associated with pregnancy and the postpartum period.
34
Possible very small increased risk of CA in CHC and COC:
— cervix (benefits of use outweigh the risk with a low- or high-grade squamous intraepithelial lesion) — breast
35
• Protective effect in CA: 1 2 3
— endometrial — epithelial ovarian — bowel
36
A common nuisance side effec in COCt is _____
breakthrough bleeding in the | first 2 months
37
What to do if woman vomits after taking pill
If a woman vomits within 2 hours of taking an active pill, she should take an additional active pil
38
Running packs of ________ together can result in unpredictable bleeding as a result of the fluctuating dose of hormones.
multiphasic pills
39
A missed pill is defined as one that is taken____
more than 24 hours late (>48 hours since last pill was | taken).
40
What to do if missed pill
Condoms or abstinence should be used for 7 days (the ‘Seven-day rule’). This
41
If the pill is missed with <7 pills left before the | next placebo break, ________
skip placebos and continue active | pills.
42
If <7 active pills were taken before the missed pill, | consider ________
emergency contraception if unprotected sex | took place in the past 5 days.
43
``` Causes of oral contraceptive failure include 1 2 3 4 ```
errors in administration, decreased absorption, missed pills and use of liver enzyme-inducing drugs
44
The first available contraceptive vaginal ring is ______, a flexible polymer ring with 15 mcg EE and 120 mcg etonogestrel being released per 24 hours
NuvaRing®
45
T or F, In Nuvaring, Metabolic effects and side effects are virtually the same as for the COC
T
46
How to use the vaginal ring
It is immediately protective when inserted on days 1–5 of the menstrual cycle. It is then removed after 21 days with a break of 7 days or can be used ‘back-to-back
47
When is Nuvaring post useful?
This method may be useful for women who prefer the COC but are prone to missing pills, or women with inflammatory bowel disease or other malabsorption syndromes
48
How to delay a period
• prescribe norethisterone 5 mg bd or tds for 3 days prior to expected period • period resumes 2–3 days after stopping tablets
49
These methods are safe in women who are breastfeeding or have a contraindication to taking oestrogen
Progestogen-only contraception
50
Progestogen-only contraception is | contraindicated in women with ______
active breast cancer | within the past 5 years
51
The harms outweigh | the benefits in the following conditions (MEC 3):
antiphospholipid antibodies with systemic lupus erythematosus, unexplained vaginal bleeding, ischaemic heart disease or stroke, severe cirrhosis or hepatocellular carcinoma.
52
Use of progestogen-only contraception is not | associated with an increased risk of ______
VTE
53
If postcoital contraception is | required in patients on POP, a double dose of the _______
levonorgestrel-ECP is | recommended.
54
This is a subdermal contraceptive implant; it is a 3-year system consisting of a single rod containing the progestogen etonogestrel. It inhibits ovulation and has an anti-cervical mucus effect
Etonogestrel implant (Implanon NXT)
55
Approximately ________ of women request the implant to be removed within 12 months and it is important to provide information about expected bleeding patterns prior to insertion
20–25%
56
IUD is made of?
They are made of an inert material to which may be added a bioactive substance such as copper (e.g. Multiload Cu375) or a progestogen (e.g. Mirena).
57
Mechanism of IUD
All IUDs prevent pregnancy by inhibiting sperm migration | and ovum transport and preventing implantation
58
The levonorgestrel IUD also causes_____ and ____
endometrial suppression and cervical mucus thickening and may prevent or delay ovulation
59
Absolute contraindications for IUD
active PID, undiagnosed abnormal genital tract bleeding and current or past history of breast cancer for those considering levonorgestrel IUD (MEC 4).
60
Recommended use time: copper IUD ____years | depending on brand, Mirena____ years
5–10 5
61
Women with a copper IUD will have their usual menstrual periods, usually with an increase in __________. Spotting, heavier and prolonged bleeding are common in the __________
menstrual loss and dysmenorrhoea first 3–6 months but usually decrease with time.
62
The levonorgestrel IUD results in a reduction | _______
of blood loss
63
______ and _______are the most common reason for IUD discontinuation. Discontinuation rates for both IUDs are similar
Menstrual bleeding and pain
64
SE of IUD If pregnancy occurs there is an increased risk of _______ and ______during the second trimester. Early removal of the IUD is essential
abortion and intra-uterine sepsis
65
Since the IUD prevents intra-uterine rather than tubal pregnancies, the proportion of ________ is higher in the case of IUD failure, although the absolute risk is low compared to the risk for women using no contraceptio
ectopic pregnancy
66
IUD There is a small increased risk of PID in the first _______ post-insertion. Subsequent risk of PID reverts to baseline and is related to the risk of STIs
20 days
67
IUD Spontaneous extrusion occurs in about ______with the highest risk within the first year.
5%
68
IUD Perforation of the uterus occurs in up to ______
2.3 in 1000 insertions.
69
IUD factors that increase risk of perforation include 1 2 3
breastfeeding, first 6 months postpartum and previous caesarean section
70
_________ is the only injectable intramuscular contraceptive available in Australia
Depot medroxyprogesterone acetate (DMPA)
71
Although DMPA is technically a LARC, it is not ________ and is less effective than implants and IUDs due to the need for repeated injections.
immediately reversible
72
Dose of DMPA: ______
150 mg by deep IM injection in first 5 days of the menstrual cycle. The same dose is given every 12 weeks ± 2 weeks to maintain contraception
73
SE of DMPA
Side effects include a disrupted menstrual cycle (amenorrhoea rate 50–70% by 12 months), weight gain (average 2–6%), breast tenderness, mood changes and a delay in return of fertility (mean time 8 months).
74
DMPA use Long-term use is associated with ______
accelerated bone loss, but this is not clinically | significant and does not translate into fracture risk.
75
_________ is most commonly prescribed for breastfeeding women for whom an oestrogen contraceptive would potentially suppress milk supply
The POP (mini-pill)
76
The two common formulations of POP are: 1 2
* levonorgestrel 30 mcg/day | * norethisterone 35 mcg/day
77
POP mechanism
The primary mechanism of action is cervical | mucus thickening, preventing sperm penetration
78
The POP is considered to have a more vulnerable efficacy, and it is important that the woman strictly adheres to taking the pill ___________
within a daily 3-hour timeframe for maximum | efficacy.
79
Example of post coital contraception
• Levonorgestrel 1.5 mg as a single dose • 25 levonorgestrel POPs (25 × 30 mcg) as an initial dose, repeating the same dose 12 hours later
80
What is the Yupze method for post coital contraceptin
Yuzpe method: a large initial dose of COC, which is repeated 12 hours later, with each dose containing at least 100 mcg of EE and 500 mcg of levonorgestrel (example: 4 tablets of either Microgynon 30 or 5 tablets of Microgynon 20)
81
The levonorgestrel emergency contraceptive pill (LNG-ECP) is a high dose of progestogen that acts to prevent or delay ovulation by______
interfering | with follicular development
82
The ECP is licensed for use up to ______after unprotected intercourse, but may be effective for up to_____
72 hours 120 hours (5 days).
83
The Yuzpe method has an efficacy of______ and is reserved only for when levonorgestrel is unavailable
57–74%
84
If used correctly, male condoms are very effective contraceptives with an efficacy of _____ with perfect use and____ with typical use
98% 82%
85
Diaphragms are inserted at any convenient | time before intercourse and removed after _______
6 hours | have elapsed since the last act of intercourse
86
Basal body temperature method Coitus should occur only after there has been a rise in basal body temperature of _________ above the basal body temperature measurement during the preceding 6 days, until the onset of the next menstrual period
0.2 ° C for 3 days (72 hours)
87
How to do calendar method
She then subtracts 21 from the shortest cycle and 10 from the longest cycle to work out fertile and safe days
88
Example Fertility in 26-30 day cycle Regular : 28 day cycle
(i.e. for a 26 to 30-day cycle: fertile days 5–20; for regular 28-day cycle: fertile days 7–18).
89
This method is based on careful observation of the nature of the mucus so that ovulation can be recognised and intercourse confined to when the vagina is dry
Billings or mucus method
90
Fertile mucus is _______
wet, clear, stringy, | increased in amount and feels lubricative
91
The peak mucus day is the last day with this oestrogenised mucus before the abrupt change to thick tacky mucus associated with the______
secretion of progesterone
92
The infertile phase begins on the____
fourth day after | the peak mucus day
93
________reliable as hormonal methods of contraception if the baby is younger than 6 months, is exclusively breastfed with no long intervals between feeds (no more than 4 hours during the day or 6 hours at night) and the woman remains amenorrhoeic postpartum.
Lactational amenorrhoea method (LAM)
94
Women using non-hormonal contraception (i.e. barrier, copper IUD, rhythm) can be advised that contraception is no longer required once they ____________
have been amenorrhoeic for 12 months over the age of 50 years and after two years before the age of 50.
95
Oestrogen-containing contraception and DPMA | injections are not recommended after ______
50 years.
96
Women over the age of 50 who are amenorrhoeic while using progestogen-only contraception are advised to continue the method for a further 12 months if they have_______
two follicle stimulating hormone levels of 30 IU/L or above taken 6 weeks apart.
97
_______interruption or occlusion of the vas deferens, preventing the passage of sperm from the testes to the penis
Vasectomy
98
Vasectomy It is important to confirm the______
absence of spermatozoa in the ejaculate 2–3 months after the operation, before ceasing other contraceptive methods.
99
For the average man undergoing vasectomy | reversal, pregnancy rates range between _____
50 and 70%.
100
______is usually performed by minilaparotomy or laparoscopy, at which time clips are applied to each fallopian tube
Female sterilisation
101
__________involves the placement of a flexible titanium micro-insert into each fallopian tube. The insert expands and over time reactive tissue growth occludes the tubes
Hysteroscopic transcervical | occlusive sterilisation
102
Up to _______of Australian women have experienced | an unplanned pregnancy
51%
103
Surgical abortions can be performed from | ______weeks.
6–7
104
Medical abortions are usually performed before 9 weeks using
mifepristone, an anti-progesterone, and then the prostaglandin analogue misoprostol 24–48 hours later.

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