Gynaecology Pg No 205 -214 (Infertility&Contraception)
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What is a primary mechanism of action for progesterone-only pills (POPs)?

  • Thins cervical mucus
  • Increases estrogen levels
  • Thickens cervical mucus (correct)
  • Stimulates ovulation

    • POPs are recommended for breastfeeding females.

    True

    What is the delay in returning fertility associated with DMPA injections?

    Delayed return of fertility

    Desogestrel containing POPs have a window period of ______ hours.

    <p>12</p> Signup and view all the answers

    Match the following types of contraception to their characteristics:

    <p>MiniPill (LNG) = 35 mcg, 3 hrs window period Desogestrel (Cerazette) = 75 mcg, 12 hrs window period DMPA = Delayed return of fertility, Bone loss POPs = Safe for breastfeeding and smokers</p> Signup and view all the answers

    Which of the following is an absolute contraindication for using an IUCD?

    <p>Active pelvic infection</p> Signup and view all the answers

    It is safe to use an IUCD in a patient with known Wilson's disease.

    <p>False</p> Signup and view all the answers

    What is the first step in managing an IUCD situation where the thread is not visible?

    <p>Transvaginal ultrasound (TVS)</p> Signup and view all the answers

    If there is a known pregnancy and the IUCD is in situ with the thread visible, it should be ___ along with antibiotics.

    <p>removed</p> Signup and view all the answers

    Match the management action with the situation regarding IUCD and pregnancy:

    <p>Thread visible, pregnancy not desired = Remove IUCD + antibiotics Thread not visible, pregnancy desired = Leave IUCD in situ + continue pregnancy Known/suspected pregnancy with IUCD = Terminate pregnancy + IUCD removal Active liver disease = Avoid using Mirena</p> Signup and view all the answers

    What is the recommended time frame to start hormonal pill consumption?

    <p>Day 1 - Day 5 of the cycle</p> Signup and view all the answers

    If a patient misses 2 pills in the 3rd week, they do not need to use backup contraceptive methods.

    <p>False</p> Signup and view all the answers

    How long does it typically take for fertility to return after stopping contraceptive pills?

    <p>Less than or equal to 3 months</p> Signup and view all the answers

    If a person has missed 1 pill, they should take one pill _____ or at the scheduled time.

    <p>ASAP</p> Signup and view all the answers

    Match the following missed pill scenarios with the correct actions:

    <p>Missed 1 pill = Take one pill ASAP Missed 2 pills = Take one pill ASAP and backup method for 7 days Missed ≥ 2 pills in the 1st week = Emergency contraceptive if unprotected in the last 72 hours Missed ≥ 2 pills in the 3rd week = Start new pack immediately</p> Signup and view all the answers

    When can non-breastfeeding females ideally start using contraceptives after delivery?

    <p>6 weeks</p> Signup and view all the answers

    IUCD can be inserted up to 48 hours after delivery.

    <p>True</p> Signup and view all the answers

    What is the time frame for beginning DMPA after delivery if it is given to avoid osteoporosis?

    <p>4 weeks</p> Signup and view all the answers

    Postpartum contraception can be initiated ideally at __________ weeks for exclusively breastfeeding females.

    <p>6</p> Signup and view all the answers

    Match the contraceptive method with its correct initiation timing after delivery:

    <p>Condoms = Day-1 after delivery IUCD = Up to 48 hours after delivery Minilaparotomy = Till 1 week postpartum DMPA = ≥ 4 weeks after delivery</p> Signup and view all the answers

    Which type of contraceptive implant has a single rod composition?

    <p>Implanon</p> Signup and view all the answers

    Nexplanon is a biodegradable contraceptive implant.

    <p>False</p> Signup and view all the answers

    What is the efficacy period of Capronor?

    <p>1 year</p> Signup and view all the answers

    The most common organism associated with pelvic inflammatory disease (PID) is __________.

    <p>Actinomyces</p> Signup and view all the answers

    Match the following contraceptive devices with their characteristics:

    <p>Implanon = Etonogestrel, single rod, 3 years efficacy Mirena = Used for heavy menstrual bleeding, anticoagulant usage Norplant = 6 rods, 0.5% failure rate Capronor = Biodegradable, 1 year efficacy</p> Signup and view all the answers

    What is the primary material used for male condoms?

    <p>Polyurethane</p> Signup and view all the answers

    The female condom can only be used once.

    <p>False</p> Signup and view all the answers

    What is the maximum duration for which the Today Sponge can be used after insertion?

    <p>30 hours</p> Signup and view all the answers

    The diaphragm is made of ______.

    <p>rubber/latex/silicone</p> Signup and view all the answers

    Match the following barrier methods with their characteristics:

    <p>Male condoms = Single usage, protects against STDs Female condoms = Coitus independent, can be used twice Today Sponge = Mushroom-shaped, contains spermicide Diaphragm = Dome-shaped, reused for up to 1 year</p> Signup and view all the answers

    What is the main mechanism of action of Levonorgestrel in emergency contraceptives?

    <p>Delays LH surge and prevents ovulation.</p> Signup and view all the answers

    Levonorgestrel requires a prescription for use.

    <p>False</p> Signup and view all the answers

    What is the failure rate of Levonorgestrel in accidental pregnancy?

    <p>1.1%</p> Signup and view all the answers

    Ulipristal acetate is indicated for use in patients who are ___ or have had unprotected intercourse ___ hours prior.

    <p>obese; ≥72</p> Signup and view all the answers

    Match the emergency contraceptive methods with their respective doses:

    <p>Levonorgestrel (LNG) = 1.5 mg single dose or 0.75 mg 12 hours later OCPS - Yuzpe method = 100 mcg EE + 0.5 mg Progesterone high dose Ulipristal acetate = 30 mg, OD</p> Signup and view all the answers

    What is the minimum age requirement for eligibility for tubal ligation?

    <p>28 years</p> Signup and view all the answers

    Individuals over the age of 28 are eligible for tubal ligation.

    <p>True</p> Signup and view all the answers

    What is tubal ligation classified as?

    <p>Permanent method of contraception</p> Signup and view all the answers

    The minimum age for eligibility for tubal ligation is ______ years.

    <p>28</p> Signup and view all the answers

    Match the following terms to their definitions:

    <p>Tubal ligation = A permanent method of contraception Eligibility = Criteria for accepting candidates Contraception = Methods to prevent pregnancy Permanent method = Irreversible birth control method</p> Signup and view all the answers

    Which method of tubal ligation is commonly used and is only done as interval ligation?

    <p>Laparoscopic Tubal Ligation</p> Signup and view all the answers

    The Essure device is a temporary method of hysteroscopic tubal occlusion.

    <p>False</p> Signup and view all the answers

    What type of sutures are used in the ligation of the isthmus of the fallopian tube during interval ligation?

    <p>absorbable sutures</p> Signup and view all the answers

    The coiled device introduced into the fallopian tube for hysteroscopic tubal occlusion is called __________.

    <p>Essure</p> Signup and view all the answers

    Match the following tubal ligation techniques with their characteristics:

    <p>Pomeroy = Uses chromic catgut Modified Pomeroy = Uses plain catgut Fallope rings = Applied at the isthmus using a ring applicator Hulka/Filshie clips = Used mainly outside India</p> Signup and view all the answers

    Which of the following conditions can be treated with oral contraceptives? (Select all that apply)

    <p>Dysmenorrhea</p> Signup and view all the answers

    Oral contraceptives decrease the risk of ovarian cancer.

    <p>True</p> Signup and view all the answers

    What is one common adverse effect associated with oral contraceptive use?

    <p>Nausea</p> Signup and view all the answers

    Oral contraceptives are associated with an increased risk of _____ cancer.

    <p>breast</p> Signup and view all the answers

    Match the following cancers with their risk status associated with oral contraceptives:

    <p>Breast cancer = Increased risk Endometrial cancer = Decreased risk Ovarian cancer = Decreased risk Liver cancer = No effect</p> Signup and view all the answers

    Study Notes

    Progesterone Only Pills (POPs) & Tubal Ligation

    • POPs thicken cervical mucus and may lead to anovulation.
    • Desogestrel containing POPs have a 12-hour window period.
    • Minipill (LNG) has a 3-hour window period.
    • POPs are safe for breastfeeding women, smokers, and those with a history of thrombosis.
    • DMPA (Depot medroxyprogesterone acetate) can cause delayed return of fertility and bone loss.
    • POPs are the preferred method for lactating women over IUCDs.
    • For women 40 years and older, progesterone is preferred over oral contraceptives (OCPs).
    • Absolute contraindications for IUCD include undiagnosed vaginal bleeding, severe distortion of the uterine cavity, active pelvic infection, and known or suspected pregnancy.

    Intrauterine Contraceptive Device (IUCD)

    • If the IUCD thread is missing, a transvaginal ultrasound (TVS) should be performed.
    • If the thread is not visible after TVS, serial abdominal X-rays are recommended.
    • If the thread is coiled, no intervention or hysteroscopy is required.
    • If the IUCD is malpositioned in the myometrium, intervention is required.
    • If the IUCD is malpositioned in the cervix, it should be removed.
    • If the IUCD is in the peritoneal cavity, urgent laparoscopy or laparotomy is required for removal.
    • If the IUCD is in situ during pregnancy, termination of pregnancy and IUCD removal is recommended unless continuation of pregnancy is desired.
    • If pregnancy is desired, the IUCD is left in situ and monitored for potential risks like infection, preterm labor, abortions, and IUGR.
    • IUCDs do not pose a risk of teratogenicity.

    Regimen for OCP Consumption & Missed Pills

    • Oral contraceptives can be started at any time.
    • It is ideal to start on days 1-5 of the cycle.
    • After day 5, a backup method is required for 7 days.
    • OCPs should be taken daily at the same time.
    • If one or two pills are missed, take one pill as soon as possible or at the scheduled time. No backup method is required.
    • If two or more pills are missed, a backup method is required for 7 days. If unprotected intercourse occurred in the previous 72 hours, an emergency contraceptive pill should be taken.
    • If pills are missed in the first week, take the pill immediately, complete the pack as per schedule, and use a backup method for 7 days. If intercourse occurred in the previous 72 hours, take an emergency contraceptive pill.
    • If pills are missed in the third week, take the pill immediately, complete the pack as per schedule, and start a new pack immediately.

    Post-Partum Contraception

    • The "Rule of 3" states: If not breastfeeding or partially breastfeeding, contraceptives can be initiated after 3 weeks; if exclusively breastfeeding, contraceptives can be initiated after 3 months.
    • Condoms, Centchroman, POPs, and progesterone implants can be used after delivery on day 1.
    • Oral Contraceptives can be started 3 weeks after delivery for non-breastfeeding women and 6 weeks after delivery for exclusively breastfeeding women. Ideally, OCPs should be started 6 weeks after delivery for non-breastfeeding women and 6 months after delivery for exclusively breastfeeding women.
    • IUCD can be inserted within 10 minutes of delivery (postplacental) or up to 48 hours after delivery (postpartum) or 6 weeks after delivery (interval).
    • Emergency contraception can be implemented after 4 weeks.
    • Tubectomy can be performed after delivery (minilaparotomy) or 6 weeks after delivery (interval). Laparoscopic tubal ligation is not indicated in the postpartum period.
    • DMPA (Depot medroxyprogesterone acetate) should not be administered within the first 4 weeks postpartum as it can lead to osteoporosis.

    Implants

    • Implanon and Nexplanon are single-rod implants containing Etonogestrel, effective for 3 years. Nexplanon is radiopaque.
    • Norplant is a six-rod implant with a 0.5% failure rate.
    • Jadelle Norplant 2 and Capronor are biodegradable implants with a one-year efficacy.

    Usage of IUCDS

    • Frameless IUCDs are recommended for nulliparous women.
    • Mirena IUCDS is recommended for patients with heavy menstrual bleeding and those on anticoagulants.
    • CuluCD and Mirena are recommended for women with a history of thrombosis.

    PID (Pelvic Inflammatory Disease)

    • The risk of PID is increased in the first 3 weeks after IUD insertion.
    • The most common causative organism for PID is Actinomyces.
    • Management of PID includes IUCD removal and antibiotics. If no improvement after 48-72 hours, intravenous antibiotics can be administered.

    Barrier Methods

    • Male condoms are single-use, coitus-dependent devices that protect against HIV, cervical dysplasia, pregnancy, PID, and STDs.
    • Female condoms are coitus-independent devices, available in polyurethane and nitrile. They can be used twice.
    • The Today Sponge is a mushroom-shaped device containing nonoxynol-9 (spermicide). It can be used for up to 24 hours, with a maximum duration of 30 hours. There is no risk of toxic shock syndrome.
    • The diaphragm is a dome-shaped device with a flexible rim, made of rubber, latex, or silicone. It can be reused for up to a year and requires spermicidal agents.

    Emergency Contraceptives (AKA Interceptives)

    • Emergency contraceptives are indicated after unprotected intercourse, rape, or condom rupture.
    • Levonorgestrel (LNG) is a one-pill method effective up to 72 hours, delaying ovulation and potentially fertilization but not impacting implantation. It is the most effective and does not require a prescription.
    • Levonorgestrel (Plan B) is available in a single 1.5 mg dose or two 0.75 mg doses 12 hours apart, and no prescription is required.
    • The Yuzpe method uses oral contraceptives (OCPs), with a high-dose regimen of 4 pills 12 hours apart, repeated once, or a low-dose regimen of a pills 12 hours apart, repeated once.
    • Ulipristal acetate is a more effective emergency contraceptive compared to LNG, with a dose of 30 mg once daily. It is recommended especially for individuals near mid-cycle, for more than 72 hours after unprotected intercourse, or for obese patients.

    Routes of Tubal Ligation & Hysteroscopic Tubal Occlusion

    • Tubal ligation is a permanent method performed after delivery or as an interval procedure.
    • Laparoscopic tubal ligation is the most common method, with techniques like Pomeroy (chromic catgut), Modified Pomeroy (plain catgut), Fallope rings, Hulka/Filshie clips.
    • Hysteroscopic tubal occlusion is a permanent method using an Essure device, a coiled device made of nickel titanium and stainless steel introduced hysteroscopically into the fallopian tube. It requires backup contraception for 3 months, followed by HSG to confirm complete tubal blockage.

    Tubal Ligation (Permanent Method)

    • Eligibility for tubal ligation is determined by age of 28 years or below.

    Non-Contraceptive Uses, Side Effects & Cancers Associated with OCs

    • Oral contraceptives can be used for irregular cycles, hirsutism, acne with elevated androgens, atypical uterine bleeding, dysmenorrhea, endometriosis, mittelschmerz syndrome, menstrual migraine, ovarian cysts, and as hormone replacement therapy (HRT).
    • They are generally safe and have a low failure rate, with a rapid return of fertility.
    • Common side effects include nausea, vomiting, bloating, and breast tenderness.
    • Increased risk of breast cancer, venous thromboembolism, stroke, Candidiasis/Chlamydia infection (though the overall risk of PID is reduced).
    • Increased risk of breast cancer, cancer cervix, and hepatic adenoma, though these risks are reversible.
    • Decreased risk of endometrial cancer, ovarian cancer, colon cancer, benign breast disease, and ovarian cysts.
    • Oral contraceptives have no effect on the risk of liver or gallbladder cancer.

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    Description

    Test your knowledge on progesterone-only pills (POPs) and Intrauterine Contraceptive Devices (IUCD). This quiz covers the mechanisms, safety, and contraindications of these contraceptive methods, along with important considerations for specific populations. Explore how these options are chosen for different circumstances.

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