O&G contraception Flashcards
(94 cards)
1
Q
MIrena IUS license time
A
5 years
1
Q
copper IUD license time
A
5-10 years
2
Q
Kyleena IUS license time
A
5 years
3
Q
Jaydess IUS license time
A
3 years
4
Q
IUD mode of action
A
decreases sperm motility and survival
prevents fertilisation
5
Q
IUS mode of ation
A
levonorgestrel prevents endometrial proliferation and causes cervical mucous thickening
6
Q
IUD copper coil can be relied on after how long
A
immediately
7
Q
IUS can be relied on after how long
A
after 7 days
8
Q
If mirena IUS coil is used for endometrial protection in HRT for women taking oestrogen-only HRT, how long is the coil licensed for
A
4 years
(it is 5 years when for contraception)
9
Q
which contraceptive is most associated with weight gain
A
depo-provera injection
10
Q
Depo Provera is the main injectable contraceptive used in the UK. It contains ..?
A
medroxyprogesterone acetate 150mg
11
Q
How often is Depo Provera (injectable progesterone contaception) given
A
Every 12 weeks - IM injection
12
Q
Depo Provera is given every 12 weeks. It can be given up to what timeframe after the last dose WITHOUT the need for extra precautions
A
14 weeks
13
Q
Noristerat is another injectable progesterone contraception. Depo Provera is the most common in the UK given every 12 weeks. How often is Nortisterat given?
A
every 8 weeks
14
Q
Mode of action of Depo Provera (injectable contraceptive)
A
Inhibits ovulation
Secondary effects: cervical mucous thickening, endometrial thinning
15
Q
What is the main contraindication (UKMEC 4) for injectable contraceptions (i.e. Depo Provera)
A
Current breast cancer - UKMEC 4
Past breast cancer - UKMEC 3
16
Q
Obesity increases the risk of VTE in women taking the COCP. What are the UKMEC rules for COCP and obesity:
A
BMI 30-34 - UKMEC 2
BMI >35 - UKMEC 3
ALL OTHER METHODS OF CONTRACEPTION WITH OBESITY ARE UKMEC1 (ACCEPTABLE)
17
Q
Which form of contraception is the only one that obesity BMI 30+ is classed as not UKMEC1
A
COCP
BMI 30-34 - UKMEC 2
BMI >35 - UKMEC 3
18
Q
What form of contraception has UKMEC 2-4 with regards to smoking?
A
COCP
Age <35 and smokes - UKMEC2
Age >35 , smokes <15/day - UKMEC3
Age >35 , smokes >15/day - UKMEC4
19
Q
What effect does smoking have on UKMEC of POP?
A
NO EFFECT
Classed as UKMEC1
As no increased risk of cardiovascular disease with age/smoking
20
Q
Migraines with aura
COCP - what is UKMEC
A
UKMEC4
21
Q
Migraines without aura
COCP - what is UKMEC
A
UKMEC3
22
Q
3 factors to consider with women with epilepsy and starting contraception
A
- Contraception making epilepsy medication less effective
- Epilepsy medication making contraception less effective
- Teratogenic effects of epilepsy medication if woman becomes pregnant
23
Q
Migraine with aura
POP - what is the UKMEC
A
UKMEC2
24
Migraine with aura
Progesterone implant - what is the UKMEC
UKMEC2
25
Migraine with aura
Progesterone injection (depo provera) - what is the UKMEC
UKMEC2
26
What do FSRH recommend for patients with epilepsy when using contraception
Consistent use of condoms
In addition to other forms of contraception
27
For women taking:
phenytoin
carbamazepine
barbiturates
topiramate
oxcarbazepine
primidone
(PCBTOP)
what contraception options are UKMEC3
COCP and POP - UKMEC3
28
For women taking:
phenytoin
carbamazepine
barbiturates
topiramate
oxcarbazepine
primidone
(PCBTOP)
what contraception options are UKMEC2
Implant - UKMEC2
29
For women taking:
phenytoin
carbamazepine
barbiturates
topiramate
oxcarbazepine
primidone
(PCBTOP)
what contraception options are UKMEC1
Depo-provera, IUS, IUD - UKMEC1
30
For patients taking lamotrigine, what contraception is UKMEC 3
COCP
31
For patients taking lamotrigine, what contracpetion is UKMEC1
POP
Implant
Depo-provera
IUD
IUS
32
If a COCP is chosen for a patient who takes anti-epileptic medication, what level of ethinylestradiol should it contain as a minimum
minimum of 30 µg of ethinylestradiol
33
when starting the COCP, what additional contraception is needed
If COCP is started in first 5 days of menstrual cycle then no need for additional
If after, then for first 7 days use condoms
34
3 situations where efficacy may be reduced
1. Vomiting within 2 hours of taking COCP pill
2. Medication e.g. orlistat - causing diarrhoea or vomiting
3. If taking liver enzyme inducing drugs
35
precautions of COCP should be taken when taking enzyme inducing antibiotics such as
rifampicin
36
patients with starting COCP 2 months ago having irregular bleeds. what should be advised?
NO EXAMINATION NEEDED
Continue pill at same dose and review at 3 months.
Most bleeding settles after 3 months.
After 3 months - can examine and consider changing COCP/dose to increase ethinylestradiol to max of 35 micrograms
37
After taking ulipristal acetate (EllaOne) women should wait how long before starting ALL (COCP/POP) regular hormonal contraception
5 days
38
Levonorgestrel (Levonelle) mechanism of action
Stops ovulation
Inhibits implantation
39
Take levonorgestrel (Levonelle) within how many hours of unprotected sexual intercourse
Within 72 hours
40
Dose of levonorgestrel (Levonelle) for emergency contraception
Single dose of 1.5mg levonorgestrel
Double dose if BMI >26 or weight >70
41
Levonorgestrel (Levonelle) - dose should be repeated if vomiting occurs within how long after taking it...?
Within 3 hours of taking it
42
How many times can levonorgestrel (Levonelle) be taken in one cycle?
More than once!
43
When can you start hormonal contraception after using:
1. Levornogestrel (Levonelle)
2. Ullipristal (EllaOne)
1. Levornogestrel (Levonelle) - immediately
2. Ullipristal (EllaOne) - after 5 days, then use extra precaution for 7 days (COCP) or 2 days (POP)
44
Ulipristal (EllaOne) mechanism of action
Selective progestrone receptor modulator
Inhibits ovulation
45
What dose of Ulipristal (EllaOne) is given and up to what timeframe can it be given
30mg oral dose
Up to 120 hours after UPSI
46
Patients with severe asthma should be cautious when taking which emergency contracpetion
Ullipristal (Ellaone)
47
When can breastfeeding be restarted after taking:
1. Levornogestrel (Levonelle)
2. Ullipristal (EllaOne)
1. Levornogestrel (Levonelle) - immediately
2. Ullipristal (EllaOne) - after 1 week
48
When can copper IUD coil be inserted after UPSI?
1. Within 5 days of UPSI; or
2. Up to 5 days after expected ovulation in cycle (i.e. cycle length = 28. Then do 28-14 = 14 and then add 5, so day 19 would be the latest)
49
If 1 COCP pill is missed (at any time in the cycle) what should you do
Take the last pill even if it means taking 2 pills in one day
continue taking pills daily
no additional contraceptive protection neededI
50
If 2 COCP pills or more missed in week 1 (days 1-7)
emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1
take the last pill even if it means taking 2 pills in one day, then continue taking pills daily
use condoms or abstain from sex until pills have been taken for 7 days in a row
51
If 2 COCP pills or more missed in week 2 (days 8-14)
there is no need for emergency contraception (after taking 7 consecutive days of taking COCP)
take the last pill even if it means taking 2 pills in one day, then continue taking pills daily
52
If 2 COCP pills or more missed in week 3 (days 15-21)
finish pills in current pack (if have to take 2 pills in one day from yesterdays)
start a new pack straight after - omitting the pill free interval
no need for emergency contraception
53
For patients assigned female at birth, who are taking testosterone therapy, which contraceptives are not recommended?
Contraceptives containing oestrogen
This is because oestrogen can antoganise the effect of testosterone therapy
54
patients assigned male at birth engaging in vaginal sex wishing to avoid the risk of pregnancy should be advised on what contraception
condoms
55
COCP in women aged over 40 may offer what 2 benefits
1. Maintain bone mineral density in perimenopause
2. Reduce menopausal symptoms
56
Pill containing how much ethinylesteradiol may be more suitable for women >40 yers
<30 micrograms
After 50 years, they should stop using COCP for contraception and use alternative methods that are non-hormonal or progesterogen-only
57
What two contraceptions should be stopped after woman reaches over 50 years
COCP
Depo-provera
58
Women who are using COCP/depo-provera and reach the age of 50 or older should stop these and switch to...
Progestogen-only methods (and stop at 55 years, or if FSH >30 after amonorrhoeic for 1 year)
Or non-hormonal methods (and stop after 2 years of amenorrhoea)
59
When should non-hormonal contraception options e.g. IUD, condoms, be stopped in women?
After 2 years of amenorrhoea if <50 years
Or after 1 year of amenorrhoea if >50 years
60
If a woman is using POP as contraception and peri- or post-menopausal, do they need another progestogen component in HRT?
YES
POP is not enough o protect the endometrium
IUS can provide progestogen component of HRT, or another combined oral/patch option
61
When should the progesterone implant, POP or IUS be stopped in women?
After 55 years
Or if amenorrhoeic after 1 year and FSH >30
62
family history of thromboembolic disease in first degree relatives < 45 years - UKMEC for COCP
UKMEC3
63
breast feeding < 6 weeks post-partum - COCP
UKMEC?
UKMEC4
64
History of thromboemoblic disease/ thrombogenic mutation
COCP - what UKMEC?
UKMEC4
65
Breastfeeding 6 weeks to 6 months post-partum
COCP - what UKMEC
UKMEC2
66
Examples of UKMEC4 for COCP
1. migraine with aura
2. age >35 and >15cigs/day
3. BMI >35
4. history of VTE/clotting disease
5. breastfeeding <6 weeks post-partum
6. current breast cancer
7. uncontrolled HTN
8. history of stroke/IHD
9. major surgery with prolonged immobilisation
67
COCP increases risk of which cancers
Breast
Cervical
68
COCP decreases risk of which cancers
Endometrial
Ovarian
69
Progesterone implant (Nexplanon) mechanism of action
Prevents ovulation
And thickens cervical mucous
70
How long does the implantable progesterone (Nexplanon/Implanon) last for
3 years
71
How quickly does the implantable progesterone (Nexplanon/Implanon) work?
If inserted in first 5 days of cycle - immediately
If afterwards - after 7 days, extra contraception is needed for that
72
Main side effect with the implantable progesterone (Nexplanon/Implanon)
Irregular/heavy bleeding
73
Irregular/heavy bleeding that sometimes occurs with the implantable progesterone (Nexplanon/Implanon) can be managed with?
COCP co-prescription
Or speculum/STI if bleeding continues for >3 months after starting the implant
74
What medications may reduce efficacy of the implantable progesterone (Nexplanon/Implanon)
Antiepileptics
Rifampicin
- advised to use additional contraception until 28 days after stopping above medications
75
UKMEC4 for the implantable progesterone (Nexplanon/Implanon)
Current breast cancer
76
Contraceptives - time until effective (if not first day period):
instant
2 days
7 days
instant: IUD
2 days: POP
7 days: if not day 1-5: COC, injection, implant
if not inserted day 1-7: IUS
77
lactational amenorrhoea method (LAM) of contraception effectiveness decreases after...?
6 months
78
After giving birth, women require contraception after what day
after day 21
note that progesterone implant or POP can be given sooner
79
When can POP be started postpartum
Anytime
After day 21 - additional contraception is needed for the first 2 days
80
When can COCP be started postpartum
After 6 weeks postpartum if breastfeeding
After 21 days if not breastfeeding
Use 7 days condoms!
UKMEC 2 - 6 weeks - 6 months breastfeeding postpartum
81
When is COCP contraindicated postpartum
UKMEC 4 if breastfeeding <6 weeks
Contraindicated also in first 21 days due to increased VTE risk
Use condoms for 7 days afterwards
82
Lactational amenorrhoea method (LAM) is 98% effective if what 3 conditions
Fully breast feeding
Amenorrhoeic
<6 months post-partum
83
When can a Levonorgestrel-IUS be inserted during the cycle to ensure that no additional contraception required?
day 1-7 of cycle
84
COCP choice of pill for first time users
30 mcg ethinyloestradiol with 150mcg levonorgestrel/norethisterone
85
Qlaira missed pills are complicated
If a pill is taken how many hours late is it classed as "missed"
12 hours = missed pill
If a woman has missed more than 2 pills, emergency contraception may be needed
86
Following Faculty of Sexual and Reproductive Health (FRSH) guidelines, what is the most appropriate time to test for STIs after UPSI
2-12 weeks after UPSI incident
87
In a woman who has an undiagnosed breast mass continuing the combined hormonal contraceptive pill is classified as UKMEC...
UKMEC 2
88
When switching from a traditional POP to COCP (with correct prior use) how many days of barrier contraception is needed
7 days
89
The combined contraceptive transdermal patch may be less effective in patients over what weight
90kg
90
if inserted at 45 years or over, the levonorgestrel intrauterine system (LNG-IUS) can be used for contraception until the age of ...?
55 years
91
The VTE risk of Dianette is around how many times more versus standard COCPs
1.5-2 times more
92
Co-cyprindiol (dianette) is licensed for the following conditions:
Severe acne in women refractory to prolonged oral antibacterial therapy
Moderately severe hirsuitism
93
Coils can be inserted post-partum after what timeframe
Between 48hours - 4 weeks postpartum is UKMEC 3
Therefore <48hours or after 4 weeks, coils can be inserted
