Reproduction > Contraception > Flashcards

Contraception Flashcards

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1
Q

what hormone are in combined hormonal contraception

A

oestrogen and progesterone

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2
Q

what are the combined hormonal contraceptive methods

A

pill, patch, vaginal ring

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3
Q

what is the failure rate of CHC

A

perfect use 0.3%

typical use 9%

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4
Q

how do you take the COC

A

start in first 5 days of period or at any time if reasonably sure you arent pregnant
take for 21 days and have 7 day break
OR
tricycle (run three packets together and have 7 days withdrawal bleed at end of three months)

if you bleed for more than 4 days or more stop for another 4 and then restart (some people cannot take pills continuously will still bleed)

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5
Q

what can affect the effectiveness of CHC

A 
impaired absorption (GI condition and COC) 
increased metabolism (liver enzyme induction, drug interaction) 
compliance
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6
Q

what are the risks of CHC

A

venous thrombosis (especially with other RF- BMI, smoking)
arterial thrombosis
adverse effects on some cancers

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7
Q

which type of pill have bigger risk for VTE

A

oestrogen dominant ones- gestodene, desogestrel, etonogestrel

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8
Q

what are oestrogen dominant pills better for

A

skin

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9
Q

when are you most at risk of VTE

A

postnatally

also high risk in pregnancy

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10
Q

what are the unwanted circulatory effect of COC

A

systemic hypertension (need to check before starting prescription)

arterial disease - increased risk of MI (esp in smokers), and ischaemic stroke (both higher in HPTx)

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11
Q

what does migraine with aura mean for contraception

A

increases risk of ischaemic stroke

CHC use is contraindicated in patients with migraine with aura

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12
Q

what age is a relative CI to COC

A

> 35

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13
Q

what cancers can be affected by CHC

A 
breast 
cervical (long term use >5 years, returns to baseline after 10 years not taking, condom use + cervical screening important)
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14
Q

what is the UKMEC

A

quantifies risk of contraception

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15
Q

what cancers can CHC protect against

A

ovarian and endometrial

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16
Q

which CHC have a beneficial act on acne

A

all

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17
Q

why is dianette good and bad

A

EE/Cyproterone acetate (Dianette)

very good for acne= antiandrogen/ progestagen/ antiglucocorticoid

higher risk of blood clots

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18
Q

what are the non contraceptive benefits of CHC

A 
less bleeding 
fewer functional decreased ovarian cysts 
premenstrual syndrome (cycling stops so no ups and downs) 
polycystic ovarian syndrome- helps regulate cycle 
endometriosis
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19
Q

what are the common side effects of CHC

A 
nausea 
spots 
breast tenderness 
bleeding 
headaches
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20
Q

should you avoid CHC in people with thrombophilia/ FHx of clots

A

yes

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21
Q

how do you take the progesterone only pill

A

every day, dont have a break, even if getting period
day 1-5 of period/ any time if sure not pregnant
use condoms when starting pill for 7 days/ 2 days if POP

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22
Q

what are the forms of progesterone only contraception

A

progesterone only pill
subdermal implant
DMPA

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23
Q

what is the lower risks of in progesterone only methods rather than CHC

A

cardio events, clots, cancer

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24
Q

is a common SE of progesterone only treatments

A

irregular bleeding

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25
what is depo provera / sayana press
large injection of progesterone lasts 3 months syanan press is self administered, depo is done by health care professional
26
what are the pros of progesterone injection
very effective high chance of amenorrhoea lasts 3 months doesnt interact with enzyme inducing drugs (antiepileptics)
27
how does depo injection work
lowers estradiol | suppresses FSH
28
what is a risk of depo injection
oestopenia due to lack of oestrogen
29
what advice should you give on condoms
wear them with other contraceptive methods, good for STIs | not good on own
30
who are diaphragms good for
women in 40s with CI to hormonal contraceptives
31
how do diaphragms work
put spermacide along rim squeeze into right shape then insert leave in for 6 hours after sex, gives spermicide and vaginal acid time to kill sperm if have sex 3 hours after insertion need to reapply spermicide
32
what is more invasive, male or female sterilisation
male - no scalpel technique | can be done under local or general anaesthetic
33
what are the possible complications of a vasectomy
anaesthetic pain infection bleeding/ haematoma
34
can a vasectomy fail
yes
35
what method of female sterilisation is done in UK
clips
36
is female sterilisation good
no high failure rate invasive permanent if successful
37
how effective is natural family planning
76% with typical use
38
what are the possible SEs of estrogenic contraceptives
``` bloating breast swelling and tenderness decreased sex drive growth of uterine fibroids headaches irregular bleeding mood swings nausea and vomiting raised BP weight gain (water retention, cyclical gain) ```
39
what are the possible SEs of progestogenic contraceptives
``` acne anxiety bloating breast tenderness associated with depression depression headaches hirsutism irregular bleeding mood swings weight gain (increased appetite, sustained gain, mostly DMPA) ```
40
what are the possible side effects of combined
``` acne/ hirsutism bloating breast tenderness headache heavy withdrawal bleeding loss of sex drive mood changes (depression, anxiety, irritability) nausea unscheduled bleeding water retention weight gain ```
41
how many pregnancies a year are unplanned
40%
42
what are the mechanisms of action of contraception
preventing ovulation- hormonal methods, suppresses FSH and LH preventing fertilisation- condoms, diaphragms + spermicide, female and male sterilisation, IUD, hormonal methods (cervical mucous effect) prevention of implantation- IUD (esp copper coil) hormonal method, create a hostile endometrium/ direct toxicity
43
what contraceptives thicken the cervical mucous
IUS (hormonal coil, IU system), DMPA, POP, SDI (subdermal implant)
44
what contraceptives have a direct toxic effect
IUD (Copper), spermicides
45
what contraceptives act as a mechanical barrier
F+M condoms, diaphragms, cervical caps
46
what contraceptives cause endometrial changes/ thinning
IUS, IUD, SDI, DMPA, POP, CHC
47
what contraceptives suppress ovulation
CHC, DMPA, SDI, LAM (lactational amenorrhoea method), desogestrel-containing POP, IUS
48
what are the emergency methods of contraception
copper IUD | pills- ulipristal acetate, levonorgestrel
49
what is the most important thing when choosing a contraceptive method
her personal preference
50
what are the 3 most effective contraceptive methods
``` SDI vasectomy IUS female sterilisation IUD ```
51
what type of lube shouldnt you use with condoms
oil based
52
what is the average pain for IUD insertion
parous women 3/10 | nulliparous 5/10
53
what makes a women unsuitable for and IUD
submucosal fibroids
54
how long does a copper IUD last
up to 10 years
55
what are the common SEs of the copper IUD
often makes periods heavier, longer and more painful (especially in first 3 months)
56
what can help with pain and bleeding caused by the copper IUD
NSAIDs
57
is a copper IUD or IUS more effective
IUS
58
how long can IUS's last
3-5 years
59
what is common in the weeks/ months following IUS insertion
spotting, unpredictable periods/ bleeding, acne or headaches for first few months usually settles to no/ light periods
60
what can a mirena treat
heavy periods, HRT, endometriosis, hyperplasia
61
how many women with IUS have amenorrhoea
50% at 6 months
62
why are hormonal side effects low with an IUS
as systemic hormones low
63
what is nexplanon
subdermal contraceptive device
64
how long does an SDI last
3 years
65
what hormone in SDI
progesterone only
66
what is the main side effect of SDIs
prolinged PV (vaginal) bleeding
67
what can help prolonged bleeding in a SDI
CHC
68
how long after sex can a copper coil be used an emergency contraception
5 days
69
how does the CHC help to regulate cycle and reduce acne
decreases testosterone in blood by increasing sex hormone binding globulin
70
what do you have to do in patients under 13 having sex
involve social work
71
when should patients check threads of an IUD after fitting
4-6 weeks after fitting
72
when should you use condoms when getting IUD fitted/ rmoved
7 days before/ after insertion/ removal
73
what are the big risks in contraception
VTE, cardiovascular, liver problems, breast cancer, IUDs- perforation, ectopic pregnancy
74
how do you use the patch
how to use a patch apply 1 on 8th day apply another after 7 days (take old one off) apply another for last 7 days if falls off for less than 48 hours reapply, if more than than use condoms and start a whole new patch cycle
75
what is the main side effect of the implant
bleeding problems
76
what are the differentials for irregular bleeding
STI, cancer, miscarriage, pregnancy
77
what are the negatives of the depot injection
Risk of weight gain Can not be stopped once injected Delayed return of fertility (up to a year) (CVD risk, VVA, osteopenia/osteoporosis, mood/depression)
78
what has higher risk of VTE the ring or the COC
ring
79
how do you use the ring
keep ring in the fridge, lasts 3 week when inserted, ring free week, insert again on same day as taken out. if falls out in weeks 1-2 then rinse and reinsert if out for less than 3 hours, more than 3hrs use condoms. if more than 3 hours in 3rd week then insert new ring immediately (may have withdrawal bleed) or stay ring free week
80
what are the pros and cons of 2nd gen and 3rd gen CHC
2nd gen CHC have lower risk of DVT than 3rd gen but 3rd may have better non contraceptiv effects
81
what is the mini pill
progesterone only pill
82
what are the option of emergency contraception
IUD (copper coil) up to 5 days after, most effective pills that stop ovulation:- ulipristal acetate (progesterone receptor, non hormonal, makes uterine contract) (aka ellaone) and levonorgestrel (progesterone pill) pills need to be taken before ovulation so only work at specific time in cycle
83
what are the pros and cons of levonorgestrel
least effective EC method only works up to 72hrs after UPSI not effected after start of LH surge (48 hours before ovulation) affectiveness best at BMI<30 can quick start it Double dose can be given when on liver enzyme inducers. No reduced effectiveness with lower gastric pH. No problems with breastfeeding.
84
what are the pros and cons of ulipristal acetate
most effective pill effective after LH surge not affected by BMI effective up to 120 hours after UPSI (5 days) less effective if already on pill delay in quick starting necessary Not effective just before LH peak (24 hours before ovulation). Can’t be given with liver enzyme inducers. Can’t be given with drugs reducing gastric pH. Breast-feeding is contraindicated (or discard milk for a week). wait 5 days before starting normal pill again if forgot (ella one stops ovulation for 5 days)
85
when can you start contraception after mini pill
48 hours
86
what are the non contraception benefits of progesterone
thins endometrium- light periods and prevents endometrium cancers, ovarian cysts. Thickens cervical mucous so protective against PID
Reproduction
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