20 - Contraception Flashcards
define the pearl index?
the number of contraceptive failures per 100 women-years of exposure
what statistical tool is used for providing contraceptive failure rate?
Life Table Analysis
what is LARC?
long-acting reversible contraception
what is a benefit of using LARC?
minimises user input and so minimises user failure rates
2 ways in which LARC may fail?
Method failure
user failure
what is the % of women who will get pregnant while using no contraception?
80%
if male condom is used correctly and every time, what % will result in pregnancy?
2%
which method of contraception (except sterilisation + vasectomy) is most effective against pregnancy?
Implant
when is the highest chance of getting pregnant?
sex on days 8 - 19
how long does the egg survive?
24 hours
how long does sperm survive?
95 % - less than 4 days
5% - up to 7 days
what are the 3 types of combined hormonal contraceptions?
pill
patch
vaginal ring
which hormones are used in the combined hormonal contraception?
EE (ethinyl estradiol)
synthetic progesterone
what regime must combined hormonal contraception follow?
Standard regime = 21 days with a hormone free week
BUT
Can have tailored regimes - e.g. without having withdrawal bleeds
describe the combined pill - when should it be taken?
taken daily - anytime in 24 hours
give 2 disadvantages of the combined pill?
have to remember taking it every day
not suitable for those with GI upset
what is the combined patch called?
patch EVRA
how often is the patch EVRA changed?
weekly
name a possible side effect of patch EVRA?
skin reactions
what is the combined ring called?
Nuvaring
how often is Nuvaring changed?
every 3 weeks
when can Nuvaring be taken out and when might people choose to do so?
can be taken out for 3 hours/ 24 hours - might want to remove for sex
give 4 symptom-related benefits to combined methods of contraception?
Regulate/reduce bleeding
Improve acne
Improve hirsutism
improve PMS (by stopping ovulation)
give 7 more serious conditions which combined methods often reduce?
functional ovarian cysts
ovarian cancer
endometrial cancer
benign breast disease
rheumatoid arthritis
colon cancer
osteoporosis
give 6 common side effects of combined methods?
Breast tenderness
Nausea
Headache
Irregular bleeding first 3 months
Mood
Weight gain
give 4 examples of serious risks associated with combined contraception?
DVT/ PE
cervical cancer
breast cancer
MI
when does the POP (progesterone-only pill) need to be taken?
Take at the same time every day without a pill-free interval
describe 3 contraindications for POP?
frequent GI upset
current breast cancer
past/ present liver tumours
what is the name of the POP an what is its window period?
Desogestrel pill – 12 hour window period
why are contraindications less frequent in POP than combined?
oestrogen-free
describe 5 progestogenic side effects?
Appetite increase
Hair loss/gain
Mood change
Headache
Acne
what hormone is injected in ‘the jag’?
progesterone
what is the dose indicated in the jag?
150 mg 1ml deep
whereabouts is the jag given?
into the upper outer quadrant of the buttocks
how often is the jag given?
every 13 weeks
what type of injection is the jag?
intramuscular
describe the 3 actions of the jag?
1 - prevents ovulation
2 - alters cervical mucus therefore hostile to sperm
3 - endometrium is unsuitable for implantation
describe 3 advantages to the jag?
Only need to remember every 12-14 weeks
70% women amenorrhoeic after 3 doses
Oestrogen-free so few contraindications
describe 3 disadvantages to the jag?
delay in return to fertility
weight gain
Reversible reduction in bone density (risk of osteoporosis)
what is the ‘rod’ called?
Subdermal Progestogen implant Nexplanon
how much progesterone does the rod contain?
68 mg
describe the action of the progesterone implant?
inhibits ovulation
effects cervical mucus
describe 3 advantages of the implant?
Can last 3 years (or be removed at any time)
No user input needed
No causal effect on weight
describe 2 possible side effects of the implant?
prolonged/ frequent bleeding
mood changes
what is the intrauterine device AKA?
the coil
what type of contraception is intrauterine contraception?
LARC
how long does the coil last?
5 - 10 years use
describe 3 advantages for using the coil?
little user imput
fitted at any age/ parity
side effects stop as soon as it is removed
name 3 (small) risks when fitting the coil?
infection
perforation
expulsion
name 2 occasions in which the coil is not suitable?
untreated pelvic infection
distorted endometrial cavity
name 3 actions of the copper IUD?
toxic to sperm
stops sperm reaching egg
prevents implantation of fertilised egg
what hormones are present in copper IUD?
none
a possible side effect of Copper IUD?
make periods heavier/crampier
how long does copper IUD last?
5-10 years
is copper IUD contraindication to MRI?
No
action of levonogestrel IUS?
affects cervical mucus and endometrium
stops fertilisation of egg
initial side effect of levonogestrel IUS which eases within 4 months?
irregular bleeding
which contraception is also licensed to treat HMB and as the progestogenic part of HRT?
Mirena
describe 3 methods of emergency contraception?
copper IUD
levonorgestrel pill (Levonelle)
Ulipristal pill (ellaone)
which method of emergency contraception is most effective?
copper IUD
when can copper IUD be used as emergency contraception?
within 120 hours of UPSI/
day 19 of 28 day cycle
when does levonorgestrel pill need to be taken as emergency contraception?
within 72 hours
when does ulipristal pill need to be taken as an emergency contraception?
within 120 hours
which method of emergency contraception has contraindications?
ulipristal pill
when should contraception be started to ensure immediate cover?
first 5 days of cycle
when can a woman get pregnant after delivery?
21 days after delivery
when can woman get pregnant after miscarriage/ abortion?
5 days after
when is breast-feeding contraceptive and for how long?
only if feeding every 4 hours and amenorrhoeic - contraceptive for first 6 months
which type of contraception are breast-feeding women advised to use?
any
is female sterilisation reversible?
no
what is a positive side affect of female sterilisation?
reduced risk of ovarian cancer
how is vasectomy achieved?
Vas deferens divided and ends cauterised small incision midline scrotum
does vasectomy affect testosterone/ sexual function?
no
which act is there to offer protection around termination of pregnancy?
1967 UK Abortion Act
how many doctors need to sign off an abortion to support a woman’s request?
2
when can surgical TOP (STOP) be carried out?
5-12 weeks
when can medical TOP (MTOP) be carried out?
5-24 weeks
which 2 drugs are involved in MTOP?
mifepristone
misoprostol
which drugs are involved in home MTOP?
misoprostol
what is the major longterm effect of abortion?
emotional - depends on mother, reasons for abortion etc.
give 5 examples of barrier methods of contraception?
diaphragm
cervical cap
male condom
female condom
spermicidal foam
