17. Contraception Flashcards
What are the 3 different categories of contraceptive methods?
What contracetives work on the following locations: endometrim, cervix, ovary?
What is the mode of action of the following hormones:
a) FSH
b) Oestrogen
c) LH
d) Progesterone
Hormonal vs non-hormonal. Long-acting vs short-acting. Reversible vs irreversible.
Endometrium: IUS (i.e. coil), IUD. Cervix: IUS, progesterone only pill. Ovary: combined pill, progesterone only pill, injection, implant.
a) Ovarian follicular development, oestrogen levels rise
b) Endometrial proliferation, LH surge
c) Ovulation, corpus luteum formation, oestrogen + progesterone rise
d) Endometrial thickening
How does combined hormonal contraception work?
What forms does it come in?
What are some benefits and risks of this method?
Oestrogen + progesterone. Inhibit LH and FSH so prevent ovulation. Thickens cervical mucus = natural sperm barrier, and thins endometrium to prevent implantation. Progesterone decreases GnRH pulse frequency. Oestrogen inhibits follicular development and helps prevent ovulation.
Pill, patch, vaginal ring.
Benefits: reduce menorrhagia/dysmenorrhoea/PMS, reduce risk of PID (pelvic inflammatory disease), reduce risk of benign ovarian tumours/colorectal/ovarian cancer, improve acne.
Risks: VTE/stroke/CV disease, increase risk of breast cancer (returns to normal 10yrs after stopping) and cervical cancer (small), depression/low mood. CAN’T USE IF BREASTFEEDING.
What are some contraindications to the combined hormonal contraceptive?
What is progestogen only contraception?
What forms does it come in?
What are some benefits and risks of this method?
VTE/CVD/stroke, oestrogen dependant cancers, migrane with aura, liver disease, hypertension/diabetes, >35yrs + smoker, BMI >35.
Levonorgestrel/norethisterone/etynoidiol acetate/desogestrel. Thickens cervical mucus (natural sperm barrier), thins endometrium (prevents implantation), inhibits ovulation. Tricks body it’s pregnant.
Pill, injection (3m), implant (3yrs), intrauterine system (5yrs).
Benefits: fewer SEs, reduce menorrhagia/dysmenorrhoea/PMS, amenorrhoea, excellent efficacy, reduce risk of endometrial cancer, can use if breastfeeding
Risks: usually settle by 6m, irregular spotting, acne, headaches, nausea, mood swings, bloating, breast tenderness, weight gain
What are some contraindications to the progestogen only?
What are IUDs?
What are the benefits and risks of this method?
What are some contraindications?
Unexplained vaginal bleeding (could be sign of cancer), if VTE/stroke/IHD occur during use, cancers (breast/ovarian/cervical), liver disease, PID (for IUS).
Prevent gamete viability and possibly implantation, copper (released, stops sperm survival), hormonal/IUS (levonogestrel) e.g. Mirena
Benefits: high efficacy, long acting (5-10yrs), no hormones (copper).
Risks: uterine perforation, expulsion, ectopic pregnancy, PID, menorrhagia (copper coils)
Unexplained vaginal bleeding, PID, cancers (cervical, endometrial), puerperal sepsis, >48h - <4w postpartum.
List some barrier methods of contraception, and one main advantage.
List some natural methods.
Compare male and female sterilisation, and the accompanying risks/complications.
Male and female condom, diaphragm/cap. Protect against STIs.
Charts (temperature measurement, cervical mucus, dates). Withdrawal method.
Female: failure 1/200, bilateral tubal occlusion with clips/ligation/rings/diathermy, under GA/LA - laproscopy/hysteroscopy/mini-laprotomy. Risks: pain, heavier periods if <30, ectopic pregnancy, injury to internal organs
Male: failure 1/2000, ligation/diathermy/excision of vas deferens, under LA - can be done in community. Risks: pain, swelling, infection, retrograde ejaculation
+ REGRET!
Describe male hormonal contraception. (Research).
Which are the most effective contraceptive devices (apart from sterilisation)?
What might some future contraceptive methods be?
Intramuscular norethisterone + testosterone, 8 weekly injections, reversible inhibition of spermatogenesis. SE: acne, injection site pain, increased libido, mood disorders. Safety review committee terminated trial due to mood disorder frequency.
Implants and IUDs.
Female: microchip, intravainal ring (contraceptive and antivirus). Male: clean sheets pill.
How does emergency contraception work?
Oral methods delay ovulation: Levonorgestrel (within 72h, pregnancy rate 0.6-2.6%) and Ulipristal acetate (within 120h, pregnancy rate 1-2%) (both progesterone). Copper IUD inhibits fertilisation by direct toxicity - affects implantation by causing endometrial inflammation (5d after UPSI/earliest possible ovulation, pregnancy rate <0.1%).
