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L09: Contraception And HRT Flashcards

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1
Q

What are the 3 main methods contraception aims to prevent pregnancy

A

1) Preventing ovulation
2) preventing fertilisation
3) preventing implantation of a fertilised egg

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2
Q

Does contraception include abortifacients

A

No

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3
Q

What happens to fertility as you age

A

Decrease

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4
Q

Is contraception 100% effective

A

No

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5
Q

What is the pearl index

A

Failure rate per 100 woman years of exposure

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6
Q

What is the typical use

A

Failure rate when used in real life e.g when patients forget to take the pill

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7
Q

What is the perfect use

A

The failure rate when method is consistent and correct at all time

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8
Q

What are the 2 broad categories of types of contraception

A

Methods with no user failure

Methods with user failure

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9
Q

What are the methods with no use failure

A

Intrauterine device IUD- copper
Intrauterine system- levonorgestrel hormonal coil
Implant: under the skin
Sterilisation (male and female)

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10
Q

What are the methods with user failure

A

Barrier: condones, diaphragm and cap
Hormonal: combined pill, patch, ring, POP injectable
Natural family planning and lactational ammenorhhea
Emergency contraception

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11
Q

What is the first of day of menstrual cycle

A

Day 1

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12
Q

What is the last day of menstrual cycle

A

Day 28

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13
Q

What happens to progesterone levels in the second half of menstrual cycle if there is pregnancy

A

Increases

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14
Q

What does the LH surge stimulate

A

Ovulation to kick off

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15
Q

What happen to oestrogen in the second half the cycle if there is pregnancy

A

Increases

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16
Q

What is new hormone is produced by the placenta that causes oestrogen and progesterone to rise

A

HCG

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17
Q

What are the barrier methods in males known as

A

Condom

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18
Q

Where is a condom places

A

Over an erect penis

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19
Q

What is the advantages of using a male condom

A

Protection against STI and HIV

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20
Q

What are barrier methods for females known as

A

Female condom
Diaphragm
Caps

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21
Q

Where is a female condom placed

A

Into the vagina which covers the lining of the vagina and partially the vulva

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22
Q

What is the advantage of using a female condom

A

STI and HIV protection

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23
Q

What do diaphragms and cap cover

A

Cervix

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24
Q

What has to be done to the diaphragm and cap after sexual intercourse

A

Left in for 6 hours after sex

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25
What are the disadvantages of diaphragms and caps
Does not offer protection for STI and HIV
26
What can be used with diaphragm and caps
Spermicide
27
What are the risk of using a spermicide an diaphragm/cap
Increased risk of HIV transmission
28
What are the long acting reversible contraception methods
Intra uterine system- hormonal coil Intra uterine device- copper coil Implant Progesterone only injection (POP)
29
What are the advantages of using long acting reversible contraception
Does not require memory Is reversible Administration is required less than once per cycle
30
What is the intra-uterine system
A coil that had levonorgestrel at the body
31
What hormone is levonorgestrel
Progesterone
32
What is the action of intra-uterine system
Thins endometrium Thickens cervical mucus Inhibit ovulation
33
What are the benefits of intra-uterine system
Reduce menstrual bleeding Reduced painful bleeding Reduce pain from endormetriosis
34
What are the disadvantages of intra-uterine system
Requires pelvic examination Can lead to irregular bleeding up to 9 months No STI protection Benign ovarian cysts Coils can become expelled: so patient has to feel for string
35
What are the contraindications of intra uterine system
Pregnancy Post partum sepsis Cardiac arrhythmias
36
What are the 4 types of intra-uterine system coils dependent on
Dosage of levonorgestrel
37
What is the intra uterine device
A t shaped coil that is made of copper
38
What is the mode of action of intra-uterine devices
The foreign body in the uterus prevents implantation | Copper is toxic to the egg and sperm
39
What are the advantage of intra uterine device i.e copper
Effective Can be used as emergency contraception Doesn’t involve hormones which some women will be sensitive to
40
What are the disadvantages of intra-uterine device
``` Requires pelvic examination May increase menstrual bleeding Painful periods No STI protection Risk of ectopic pregnancy if pregnancy occurs ```
41
What are the contraindication of intra uterine device
Same as IUS
42
What are implants
A device that sits under the skin in the harm
43
What hormone does implants contain
Etonogestrel
44
What is the duration of use of implants
3 years
45
What is the mode of action of implants
Inhibit ovulation | Thicken cervical mucus
46
What hormone is etonogestrel
Progesterone
47
What are the advantages of implants
Reduces heavy bleeding Reduces painful bleeding May reduce endometrial cancer
48
What are the disadvantages of implants
No protection for STI Hormonal side effects Irregular bleeding Affected by enzyme inducer medication
49
What are the mode of action of progesterone only injectable
Inhibit ovulation Thickens cervical mucus Thins endometrium
50
What are the advantages of injectable
Reducing bleeding and pains | Reduces sickle cell crises if sickle cell disease
51
What are the disadvantages of injectable
``` No STI protection Irregular bleeding Delayed fertility up to 1 year Hormonal side effects Decreases bone mineral density (for 55+) ```
52
What hormones does combined hormonal contraceptive pill contain
Oestrogen | Progesterone
53
What forms can combined hormonal contraception be found in
Pill Patch Vaginal ring
54
What is the mode of action of combined hormonal contraception
Prevent ovulation Thicken cervical mucus Thin endometrium
55
What are the benefits of combined hormonal contraception
Gives regular bleeeding, lighter and less painful Reduces pre-menstrual symptoms Reduces ovarian cancer risk Improve acne
56
What are the disadvantages of combined hormonal contraception.
``` Venous or arterial thrombosis Heart attack Breast cancer Cervical cancer Hypertension No STI protection ```
57
What is the effectives of combined hormonal contraception affected by
Enzyme inducers
58
What is the standard use regime to use combine hormonal contraception
Use 21 days with 7 days break (where you get the withdrawal bleed)
59
What is the combined hormonal contraception patch called
Evra
60
How many patches do you use for 1 week for 3 weeks
1
61
What is the brand for combined vaginal ring known as
Nuvaring
62
What is the oestrogen in the combined hormonal contraception called
Ethinyl estradiol
63
What is the progesteron only pill (pop)
A pill that contain progesterone only
64
What is the mode of action of pop
Prevent ovulation Thin endometrium Thicken cervical mucus
65
How long does it take for a pop to be effective
2 days
66
What are the benefits of pop
Can be used in breastfeeding
67
What drugs can pop not be used with
Enzyme induce drug
68
What are the disadvantages of pop
Hormonal side effects No STI protection Change periods Memory dependent
69
What are the 2 natural family planing methods
Fertility awareness method | Lactational ammenorhhea
70
What is fertility awareness method about
Working out when you are the most fertile by looking at the indicators
71
What are the main fertility indicators
Basal body temperature Cervical secretions Length of menstrual cycle
72
When can you only use the fertility awareness methods
If you have a regular period
73
What are the disadvantages of fertility awareness method
Time consuming | Events such as illness can change indicators such as body temperature
74
What is lactational ammenorhhea for
Post partum women
75
What are the criteria’s needed for lactational amennorhea
Baby less than 6 months old Women has remained ammenorhoic Need to be regularly breastfeeding : every 4 hours and 6 hours at night Have to breast feeding only : should not involve bottles
76
How many of the criteria’s should be met
All
77
What are the 2 types of sterilisation
Male sterilisation | Female sterilisation
78
What does male sterilisation involve
Cut and tie the vas deferens
79
What does the female sterilisation involve
Clipping the Fallopian tube
80
What are the disadvantages of sterilisation
Risk of regret as it is permanent
81
What is required for people wanting sterilisation
Counselling so they know the disadvantages
82
What are the 2 main categories of emergency contraception
Copper iud | Hormonal
83
What are the 2 hormonal pills used in emergency contraception
``` Levonorgestrel Ulipristal acetate (Ella one) ```
84
When can levonorgestrel be used
Up to 96 hours
85
When can ulipristal acetate (Ella one) be used
5 days
86
What is the definition of menopause for patients over the age of 45
Ammenorhhea for at least 12 months with no other cause
87
What is the definition of menopause for people under the age of 45
Amennorhea for at least 24 months with no other cause
88
Which hormonal emergency contraception is the most effective
Ella one
89
Why do we have symptoms in menopause as a result of
Low oestrogen | Low progesterone
90
What are the menopausal symptoms
``` Loss of libido Mood change Hot flushes Vaginal dryness Fatigue ```
91
What are the long term effects of oestrogen deficiency
Increased risk of mi | Osteoporosis
92
What treatment is offered to women with menopause symptoms
Hormonal replacement therapy
93
What are the types of hormonal replacement therapy
Combine (oestrogen and progesterone) | Oestrogen only
94
Who can receive eostrogen only
Woman with no uterus
95
What are the risk of hormonal replacement therapy
Increased risk of breast cancer
96
How does using spermicide increase the risk of STI
Spermicide can irritate the vagina and make it easier for STD germs to enter the body
97
Up to how many days can copper IUD be inserted after unprotected sexual intercourse
5 days after UPSI
98
Up to how many days can you insert the copper IUD after the earliest estimated ovulation
5 days therefore if the average cycle is 28 days at 14 days ovulation occurs, + 5 days= 19 day. Therefore at day 19 it can be inserted.

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