2.2 Contraception Flashcards
what kind of reversible contraceptions require action around time of sex?
abstinence, male condom, female condom, diaphragms/ caps
what kinds of reversible contraceptions require regular actions?
progesterone only pill, combined pill, combined transdermal patch, combined vaginal ring, fertility awareness
what are long acting reversible contraception?
injectable contraceptives, subdermal implants, copper IUD, progesterone only IUS
what are permanent contraception?
Vasectomy (male), fallopian tube occlusion (females)
Fertility awareness is a contraceptive method which relies on accurate identification of fertile days of a woman’s menstrual cycle and the modification of sexual behaviour:
• Abstinence or use of barrier methods during the fertile time prevents pregnancy
• Fertile time: earliest point at which sperm deposited in the female genital tract can survive long enough to fertilise the egg – latest time egg can be fertilised
o Corresponds to ______________ → 5 – 7 day period when intercourse can lead to pregnancy each cycle
o Timing of ovulation may vary (follicular phase is highly variable from __________; luteal phase is more stable at _________-)
• Indications of fertility: increased waking temperature (responds to ____________ after ovulation), changes in cervical secretions (white/sticky in follicular phase → clear/wet/slippery in ovulation → white/thick in luteal phase)
5 days pre-ovulation to 2 days post ovulation;
7 – 21 days;
12 – 14 days;
progesterone;
What are the advantages of fertility awareness?
- natural method involving no chemicals or physical devices
- has no side effects
- very effective when user is well taught and motivated
- promotes a better understanding of the female reproductive system and fertility
- acceptable to most religious groups
What are the disadvantages of fertility awareness?
- takes time to learn the method
- it is complicated to chart accurately
- couples may find it difficult to abstain or use extra precautions during fertile time
- harder to identify the fertile time during times of stress or hormonal change
- can lead to higher failure rate if not used consistently or correctly
Lactational amenorrhoea is the period of temporary postnatal infertility which occurs when a woman is amenorrhoeic and fully breastfeeding:
• Breastfeeding delays the resumption of normal ovarian cycles by disrupting the pattern of ______________ → inadequate LH → reduced oestradiol
• Normal ovarian cycles only resume when breastfeeding decreases to a level to allow generation of a _____________
• 98% effective with the following: _______, __________, _________
pulsatile GnRH release;
normal pre-ovulatory LH surge;
amenorrhoea, full/nearly full breastfeeding, child is less than 6 months old (phenomenon usually lasts about 6 months)
Male and female condoms are essentially sheaths which contain and prevent the sperm from reaching the uterus and protect against STIs (forms barrier to blood and vaginal fluid):
• Can be used independently without additional spermicide
• ______________ should be used instead of petroleum jelly or other oil-based products (may damage the condom and cause breakage)
Water-based lubricants (e.g. KY jelly)
What are the advantages of condoms?
- only need to use during sex
- protects against STIs
- no medical side effects (unless latex allergy)
- easily availabe
- does not interfere with woman’s menstrual cycle
What are the disadvantages of condoms?
- interrupts sex
- less effective than other contraceptive methods as they require consistent or correct use
- both partners need to be motivated
what is a diahragm?
soft latex or silicone dome that sits in the vagina to create a seal against the walls of the vagina
what is caps?
smaller than diaphragms and fits neatly over the cervix
what are advantages of diaphragms/ caps?
- offer a hormone free method and only need to be used around the time of sexual activity
- unlike candoms, they are reusable
- can be inserted prior to sex
what are disadvantages of diaphragms/ caps?
- does not prevent conntact of vaginal mucosa to semen or exposure of penis to cervicovaginal secretions, therefore they do not protect against STIs
- there is a need for inserting and removing at the correct time, messiness of spermicide and an increased risk of cystitis with diaphragms
- some users report pain during sexual activity with caps and diaphragms
How does combined hormonal contraception work?
Combined hormonal contraception contains analogues of oestrogen and progesterone which exerts its effects via the following mechanisms:
- Suppression of ovulation (progesterone causes negative feedback on hypothalamic GnRH release and consequently FSH/LH release → prevents LH surge)
- Thickening the cervical mucus (via decreasing water content and increasing viscosity) to prevent sperm penetration through the cervix
- Endometrial atrophy (progesterone maintains the endometrial lining at a thinner level while oestrogen exerts its effects)
what are the advantages of combined hormonal contraceptive methods?
- Regulation of menstruation and reduced menstrual blood loss
- reduced incidence of benign ovarian cyst and functional ovarian tumours
- reduced risk of ovarian, endometrial and colorectal cancer
- treats the symptoms of endometriosis
- possible improvement in pre menstrual stress
- alleviation of dysmenorrhea
what are the disadvantages of combined hormonal contraceptive methods?
- breakthrough bleeding (most common, most frequent in 1st 3 months, can last up to 6 months due to insufficient oestrogen concentration).
- breast tenderness/ enlargement
- abbdominal bloating
- nausea
- headache
- depression
- loss of libido
What are the contraindications to combined hormone contraception use?
Cardiovascular
- Elevated blood pressure (hypertension)
- Presence/risk of VTE (oestrogen is a thrombotic source):
• Current VTE (on anticoagulants) or history of DVT/PE
• Known hereditary/acquired predisposition for VTEs (e.g. APC-resistance including Factor V Leiden, AT-III deficiency, protein C/S deficiency)
• Major surgery with prolonged immobilisation
• Presence of multiple risk factors for VTEs
- Severe hypercholesterolaemia/hypertriglyceridaemia
- Smokers over the age of 35
Hepatic
- Markedly impaired liver function (risk of liver cancer)
Neoplastic
- Known/suspected breast cancer (esp. oestrogen-dependent forms)
Reproductive
- Undiagnosed abnormal vaginal bleeding - Known/suspected pregnancy (will cause miscarriage
What is the risk of getting venous thromboembolism (VTE) when on COCP?
Background risk: 5 in 100,000 chance of developing VTEs (generally)
• Risk with COCP use: increase up to 5-fold (depending on progestogen) but low risk in absolute terms
• Risk is the highest in first year of use → returns to normal within weeks of discontinuation
• Risk is lower than during pregnancy and postpartum period
