14 - Repro - Contraception Flashcards
Name the 2 methods of natural contraception:
1) Fertility awareness
2) Lactational amenorrhoea
What can be used to monitor fertility, as a method of natural contraception?
- Cervical secretion
- Body temperature
- Length of cycle
What are the advantages of natural contraception?
- No hormones
- No contraindications
What are the disadvantages of natural contraception?
- Not as effective
- Unreliable
Name the 6 main types of contraception:
1) Natural
2) Barrier
3) Prevention of ovulation
4) Inhibition of sperm transport
5) Inhibition of implantation
6) Sterilisation
List 2 types of barrier contraceptions:
1) Condoms
2) Female diaphragm/cap
What are the advantages of barrier contraceptions?
- Can prevent STIs
- No hormones
What are the disadvantages of barrier contraceptions?
- Latex allergies (male condoms)
- Female condoms are not widely available
- Female diaphragms/cap require spermicide
What hormone is used in contraceptions which prevent ovulation? How does it work?
Progestogen (synthetic progesterone) at moderate/high dose
- Inhibits positive feedback of oestrogen on the hypothalamus
= no LH surge = no ovulation
What are the 3 methods of contraception used to prevent ovulation?
1) Combined Oral Contraceptive Pill (COCP)
2) Progesterone Implant
3) Progesterone Depot (injection)
What are the disadvantages/side-effects of the Combined Oral Contraceptive Pill?
- User dependent (inconvenient)
- Bleeding
- Breast tenderness
- Mood disturbances
- Headaches
- Hypertension
- Gallstones + cholestatic jaundice
- Increased risk of venous thromboembolism
- Increased risk of myocardial infarction
- Many contraindications
What are the disadvantages of the prosterone depot (injection)?
- Bleeding
- Not quickly reversible (return of fertility <1yr)
- Small loss of bone mineral density
How long does the progesterone depot (injection) last?
~ 8-13 wks
How long does the progesterone implant last?
~ 3yrs
What are the disadvantages of the progesterone implant?
- Small procedure required
- May have local adverse effects
- Can affect bleeding
Name the main method of contraception which inhibits sperm transport:
Progesterone-only pill (POP)
How does the progesterone-only pill work as a method of contraception?
Low-dose progesterone thickens cervical mucous, which becomes impenetrable to sperm
What are the disadvantages/side-effects of the progesterone-only pill?
- Breast tenderness
- Mood swings
- Heavy bleeding or spotting
- Abdominal cramps
- User dependent, must be taken at same time everyday (error margin = 3hrs)
What are the 2 main methods of contraception which inhibit implantation?
1) IUD (copper coil)
2) IUS (progesterone coil)
How does an Intrauterine System work as contraception?
Progestogen:
- Decreases endometrial proliferation
- Thickens cervical mucous
How does an Intrauterine Device work as contraception?
Copper:
- Toxic to sperm and ovum
- Inflammatory endometrial reaction = prevents implantation
- Changes cervical mucous
What are the disadvantages of using a coil for contraception? (copper + progestogen)
- Unpleasant insertion
- Displacement/expulsion may occur
- Menstrual irregularity + may be longer/heavier/painful
- Uterine perforation
What are the methods of sterilisation used as contraception?
- Vasectomy
- Tubal ligation
Define primary infertility:
Failure of conception in a couple having regular unprotected sex for 1+ yr, with no previous pregnancy.
Define secondary infertility:
Failure of conception in a couple having regular unprotected sex for 1+ yr, with 1+ previous pregnancy.
What percentage of couples concieve within 1 yr of havinf regular unprotected sex?
~ 75 - 80%
Is infertility more likely due to the female or male?
Female ~ 70%
What causes Polycystic Ovary Syndrome (PCOS)?
Lack of pulsatile GnRH secretion
= abnormal oestrogen secretion
What is the typical presentation of Polycystic Ovary Syndrome?
- Secondary amenorrhoea
- Hirsutism
- Infertility
- Obesity
Why are women with Polycystic Ovary Syndrome at higher risk of endometrial carcinoma?
Abnormal oestrogen secretion
= Abnormal endometrial proliferation
Why are women with Polycystic Ovary Syndrome at higher risk of diabetes + CVD?
Commonly have high insulin resistance = obese
What investigations may you do on a couple presenting with infertility?
Female:
- LH/FSH/Progesterone check
- Cervical smear
- Pelvic USS
Male:
- Sperm analysis
- LH/FSH/Testosterone check
- USS
What are some methods of inducing ovulation?
- Weight loss/gain
- Clomiphene citrate
- Gonadotrophins
- GnRH agonists
- Ovum donation
How does clomiphene citrate induce ovulation?
Anti-oestrogen = reduces negative feedback of oestrogen at the hypothalamus
= ^ GnRH = ^ FSH + LH
