O&G > Contraception > Flashcards

Contraception Flashcards

(50 cards)

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1
Q

What is the MOA of COCP?

A

Inhibition of ovulation

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2
Q

What is the MOA of POP (except desogestrel)?

A

Thickens cervical mucous

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3
Q

What is the MOA of desogestrel?

A

Inhibition of ovulation

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4
Q

What is the MOA of the injectable contraceptive (medroxyprogesterone acetate)?

A

Main MOA:
- Inhibits ovulation

Other MOAs:
- thickens cervical mucous

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5
Q

What is the MOA of the implantable contraceptive (Nexplanon)?

A

Main MOA:
- Inhibits ovulation

Other MOAs:
- thickens cervical mucous

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6
Q

What is the MOA of IUD (copper coil)?

A

Decreases sperm motility and survival

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7
Q

What is the MOA of IUS (Mirena coil)?

A

Main MOA:
- Prevents endometrial proliferation

Other MOAs:
- Thickens cervical mucous

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8
Q

What is the MOA of levonorgestrel emergency contraception?

A

Inhibits ovulation

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9
Q

What is the MOA of ulipristal acetate emergency contraception?

A

Inhibits ovulation

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10
Q

What is the MOA of IUD emergency contraception?

A

Main: toxic to sperm and ovum
Other: inhibits implantation

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11
Q

What are the UKMEC 4 contraindications to COCP?

A
  • > 35 years old and smoking >15 cigarettes/day
  • Migraine with aura
  • History of thromboembolic disease or thrombogenic mutation
  • History of stroke or ischaemic heart disease
  • Breastfeeding < 6 weeks post-partum
  • Uncontrolled hypertension
  • Current breast cancer
  • Major surgery with prolonged immobilisation
  • Positive antiphospholipid antibodies (e.g. in SLE)
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12
Q

What are the UKMEC 3 contraindications to COCP?

A
  • > 35 years old and smoking <15 cigarettes/day
  • BMI > 35 kg/m^2*
  • Family history of thromboembolic disease in first degree relatives < 45 years
  • Controlled hypertension
  • Immobility e.g. wheel chair use
  • Carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
  • Current gallbladder disease
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13
Q

What are UKMEC2 contraindications to COCP?

A

Breastfeeding 6 weeks to 6 months post-partum

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14
Q

What are the benefits of the COCP?

A
  • Less strict “missed pill rules” than the progestogen-only pill
  • May make periods more regular, lighter and less painful
  • May reduce the risk of ovarian, endometrial and bowel cancer
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15
Q

What are the limitations of COCP?

A
  • Side effects may include headaches, nausea, breast tenderness and mood swings
  • Vomiting and diarrhoea may affect the effectiveness
  • Certain drugs including anti-epileptic drugs may affect the effectiveness
  • Increases the risk of VTE and stroke
  • Potentially increases the risk of breast cancer while using the COCP
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16
Q

What are the indications for COCP use besides preventing pregnancy?

A
  • Hyperandrogenism (PCO/PCOS)
  • Menorrhagia
  • Dysmenorrhoea
  • Endometriosis
  • Leiomyomas
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17
Q

What is the Pearl Index?

A

A statistical estimate of the number of unintended pregnancies in 100 woman-years of exposure

  • 100 women over 1 year of 1
  • 10 women over 10 years of use
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18
Q

What is the Pearl index score of COCP?

A

9%

  • Out of 100 women using COCP over 1 year period, 9 would have unintended pregnancy
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19
Q

What should a woman do if she has missed 1 COCP in week 1?

A
  • EC not required
  • take the missed pill ASAP
  • continue remaining pill at same time (2 pills in 1 day)
  • no additional precautions
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20
Q

What should a woman do if she has missed 1 COCP in week 2 or 3?

A
  • EC not required
  • take missed pill ASAP
  • continue remaining pill at same time (2 pills in 1 day)
  • no additional precautions
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21
Q

What should a woman do if she has missed 2-7 COCPs in week 1?

Study These Flashcards
A
  • Consider EC if UPSI has taken place during hormone-free interval or week 1
  • take most recent pill ASAP
  • continue the remaining pills at the same time
  • condoms/avoid sex until pill has been taken for 7 consecutive days
  • consider follow-up pregnancy test
22
Q

What should a woman do if she has missed 2-7 COCPs in week 2 or 3?

Study These Flashcards
A
  • EC not required
  • take most recent pill ASAP
  • continue the remaining pills at the same time
  • Omit the hormone-free interval if 2+ pills missed in the 7 days before it was supposed to occur
  • condoms/avoid sex until pill has been taken for 7 consecutive days
23
Q

What should a woman do if she has missed >7 COCPs in any week of pill taking?

Study These Flashcards
A
  • Consider EC if UPSI at any point
  • Manage as new start contraception
  • Consider immediate pregnancy test
  • Quick start new COC packet
  • Condoms/avoid sex until pill has been taken for 7 consecutive days
  • Consider follow-up pregnancy test
24
Q

What are the benefits of the POP?

Study These Flashcards
A
  • Suitable for patients where oestrogen is contraindicated or those who are intolerant to oestrogen
  • Taken without breaks so don’t have to remember to start and stop pills
25
What are the limitations of the POP?
- Protection from pregnancy affected if a pill is forgotten - More strict “missed pill rules” than COCP - May cause irregular bleeding, amenorrhoea or more frequent bleeding - Vomiting and diarrhoea may affect protection - Certain drugs including some enzyme-inducers may affect the effectiveness
26
When can initiation of the POP provide immediate protection?
- If started up to and including day 5 of the cycle | - If switching directly from the end of a COC packet
27
If the POP is initiated after day 5 of the cycle, how long does it take to become protected?
2 days
28
What is the missed pill advice for the POP?
Cerazette (desogestrel): - 12h period allowed - <12h late: continue as normal - >12h late: take missed pill ASAP, continue with rest of pack, extra precautions for 48h All other POPs (micronor, noriday): - 3h period - <3h late: continue as normal - >3h late: take missed pill ASAP, continue with rest of pack, extra precautions for 48h
29
Which abx can affect the effectiveness of the POP?
Rifampicin
30
What is the Pearl index of the POP?
9%
31
What are the contraindication to injectable contraceptives?
- Current and past breast cancer
32
What are the adverse effects of Depo Provera?
- Irregular bleeding - Weight gain - Delay in return to fertility (1 year) - Potentially increased risk of osteoporosis
33
How often is Depo Provera given?
Every 12 weeks
34
What is the Pearl index of Depo Provera?
6%
35
What are the UKMEC 4 contraindications to Nexplanon?
Current breast cancer
36
What are the UKMEC 3 contraindications to Nexplanon?
- IHD/Stroke - Unexplained, suspicious vaginal bleeding - Past breast cancer - Severe liver cirrhosis - Liver cancer
37
What are the adverse effects of Nexplanon?
- Irregular/heavy bleeding - Acne - Progestogen effects: headache, nausea, breast pain
38
Which drugs can interact with Nexplanon?
- Rifampicin | - AEDs: phenytoin, carbamazepine
39
What is the Pearl index of Nexplanon?
0.05% --> most effective method of preventing pregnancy
40
How long can Nexplanon be kept in for?
3 years
41
How long does it take for Nexplanon to offer protection from pregnancy?
7 days
42
How long does it take for the IUS to offer protection from pregnancy?
7 days
43
How long can the IUS be kept in for?
5 years - Mirena and Kyleena | 3 years - Jaydess
44
What are the adverse effects of the IUS?
- Irregular bleeding and amenorrhoea - Acne, headaches, breast tenderness - Small risk of uterine perforation (2 per 1000) and uterine infection - Expulsion (1 in 20) - If pregnancy does occur, more likely to be ectopic
45
How long does it take for the IUD to offer protection from pregnancy?
Works immediately
46
How long can the IUD be kept in for?
5-10 years depending on how much copper is on the device
47
What are the adverse effects of the IUD?
- Heavier, longer, and more painful periods - Small risk of uterine perforation (2 per 1000) and uterine infection - Expulsion (1 in 20) - If pregnancy does occur, more likely to be ectopic
48
What is the Pearl index of the IUS?
0.2%
49
What is the Pearl index of the IUD?
0.8%
50
What are the best contraceptive options for women 50+ years old?
Implant POP IUS IUD
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