11- Contraception Flashcards
methods of contraception
1) Short term contraception
- Combined pill
- Progesterone only pill
- Barrier methods
2) Long term contraception
- IUD
- IUS
- Implant
- Injection
- Surgery e,g. sterilisation
3) Emergency contraception
how % effectiveness works with contraception
What 99% effective means is that if an average person used this method of contraception correctly with a regular partner for a single year, they would only have a 1% chance of pregnancy.
- depends on perfect use vs typical use
3 most effective forms of contraception
long term/permanent
- progesterone only implant
- coils
- surgery e.g. sterilisation
all >99% effective
risk factors to think about when offering contraception
- breast cancer
- cervical or endometrial cancer
- wilsons disease
which contraception to avoid if history of breask cacner
any hormonal contraception and go for the copper coil or barrier methods
which contraception to avoid if history of cervical or endometrial cancer
avoid the intrauterine system (i.e. Mirena coil)
which contraception to avoid if history of Wilsons disease
avoid copper coil
specific risk factors that should make you avoid the combined contraceptive pill
Uncontrolled hypertension (particularly ≥160 / ≥100)
Migraine with aura
History of VTE
Aged over 35 smoking more than 15 cigarettes per day
Major surgery with prolonged immobility
Vascular disease or stroke
Ischaemic heart disease, cardiomyopathy or atrial fibrillation
Liver cirrhosis and liver tumours
Systemic lupus erythematosus and antiphospholipid syndrome
consideration of contraception in older women
- After the last period, contraception is required for 2 years in women under 50 and 1 year in women over 50
- Hormone replacement therapy does not prevent pregnancy, and added contraception is required
- The combined contraceptive pill can be used up to age 50 years, and can treat perimenopausal symptoms
- The progestogen injection (i.e. Depo-Provera) should be stopped before 50 years due to the risk of osteoporosis
fertility after childbirth is considered not to return until …. days after giving burth
21 days… no contraception required
contracpetion in women have have just giving birth
- lactational amenorrheoa
- progesterone only pill and implant
- copper coil or intrauterine system
Lactational amenorrhea
is over 98% effective as contraception for up to 6 months after birth. Women must be fully breastfeeding and amenorrhoeic (no periods).
when are the progestogen-only pill and implant considered safe after birth
me
any time
- will require protection for 2 days for POP
when is the COCP considered safe after birth
should be avoided in breastfeeding (UKMEC 4 before 6 weeks postpartum, UKMEC 2 after 6 weeks).
when can a coil be inserted after birth
A copper coil or intrauterine system (e.g. Mirena) can be inserted either within 48 hours of birth or more than 4 weeks after birth (UKMEC 1),** but not inserted between 48 hours and 4 weeks of birth **(UKMEC 3).
barrier method
provide a physical barrier to semen entering the uterus and causing pregnancy.
- They are the only method that helps protect against sexually transmitted infections (STIs).
- They are not 100% effective for contraception or preventing STIs.
example of barrier methods
- condoms
- diaphragms and cervical caps
- dental dams
effectiveness of condoms
perfect use: 98%
typical use : 82%
- using oil based lube can damage latex condom
diaphragms and cervical caps
Diaphragms and cervical caps are silicone cups that fit over the cervix and prevent semen from entering the uterus. The woman fits them before having sex, and leaves them in place for at least 6 hours after sex. They should be used with spermicide gel the further reduce the risk of pregnancy.
Dental Dams
are used during oral sex to provide a barrier between the mouth and the vulva, vagina or anus. They are used to prevent infections that can be spread through oral sex, including:
- Chlamydia
- Gonorrhoea
- Herpes simplex 1 and 2
- HPV (human papillomavirus)
- E. coli
- Pubic lice
- Syphilis
- HIV
The combined pill
e.g. Microgynon and Yasmin MOA
Pill containing oestrogen and progestogen
3 MOA
- Stopping ovulation
- Making cervical mucus thicker
- Preventing thickening of the endometrium
how does the COCP affect the HPG axis
- Oestrogen and progesterone have a negative feedback effect on the hypothalamus and anterior pituitary, suppressing the release of
- GnRH, LH and FSH. Without the effects of LH and FSH, ovulation does not occur.
- Pregnancy cannot happen without ovulation.
2 types of COCPs
- Monophasic pills contain the same amount of hormone in each pill
- Multiphasic pills contain varying amounts of hormone to match the normal cyclical hormonal changes more closely
which brands of COCP have a lower risk of VTE
Microgynon or Leostrin
which COCP for PMS
Yasmin (contains drospirenone - anti-mineralocorticoid and anti- androgen activity)
correct use of the COCP
- Take 1 every day for 21 days and then have a 7 day break (although can decide not to take a break)
- Take pill at around same time everyday
- When taken correctly 99% effective at preventing pregnancy
Starting this pill
- If you start the combined pill on the 1st day of your period ( day 1 of menstrual cycle) – protection from pregnancy starts straight away
- Starting after the 5th day of your cycle- need to take pill for 7 days
side effects of COCP
Side Effects and Risks
- Unscheduled bleeding is common in the first three months and should then settle with time
- Breast pain and tenderness
- Mood changes and depression
- Headaches
- Hypertension
- Venous thromboembolism (the risk is much lower for the pill than pregnancy)
- Small increased risk of breast and cervical cancer, returning to normal ten years after stopping
- Small increased risk of myocardial infarction and stroke
benefits of COCP
- Effective contraception
- Rapid return of fertility after stopping
- Improvement in premenstrual symptoms, menorrhagia (heavy periods) and dysmenorrhoea (painful periods)
- Reduced risk of endometrial, ovarian and colon cancer
- Reduced risk of benign ovarian cysts
There are several things to check and discuss when prescribing the combined pill:
- Different contraceptive options, including long-acting reversible contraception (LARC)
- Contraindications
- Adverse effects
- Instructions for taking the pill, including missed pills
- Factors that will impact the efficacy (e.g. diarrhoea and vomiting)
- Sexually transmitted infections (this pill is not protective)
- Safeguarding concerns (particularly in those under 16)
Screen for contraindications by discussing and documenting:
- Age
- Weight and height (BMI)
- Blood pressure
- Smoker or non-smoker
- Past medical history (particularly migraine, VTE, cancer, cardiovascular disease and SLE)
- Family history (particularly VTE and breast cancer)
COCP: Missing one pill (less than 72 hours since the last pill was taken):
- Take the missed pill as soon as possible (even if this means taking two pills on the same day)
- No extra protection is required provided other pills before and after are taken correctly
COCP: Missing more than one pill (more than 72 hours since the last pill was taken)
Take the most recent missed pill as soon as possible (even if this means taking two pills on the same day). Additional contraception (i.e. condoms) is needed until they have taken the pill regularly for 7 days straight.
- If day 1 – 7 of the packet they need emergency contraception if they have had unprotected sex
- If day 8 – 14 of the pack (and day 1 – 7 was fully compliant) then no emergency contraception is required
- If day 15 – 21 of the pack (and day 1 – 14 was fully compliant) then no emergency contraception is needed. They should go back-to-back with their next pack of pills and skip the pill-free period.
V and D and COCP
- If you vomit within 3 hours of taking combined pill- take another pill straight and away and the next pill at usual time. If you continue to vomit – use other contraception
- Very severe diarrhoea – use additional contraception when recovering
- If more than 24s hour missed, take 2 at a time