3. Contraception Flashcards
What is contraception
aims to prevent unplanned pregnancy by:
- Keeping egg and sperm apart
- Stopping egg production
- Stopping combined sperm and egg attaching to lining of uterus
Physical barriers contraception
Male condom
What is it?
- Thin latex rubber or non-latex polyisoprene covering for the penis (barrier) during sex
How does it work?
- Provides a barrier which collects semen (fluid containing sperm) and stops transfer of fluid to partner
How effective?
- 8% when used perfectly – use a new one every time!
- 82% with typical use (can break and not be used correctly)
- Up to 18 in 100 women who use condoms for a year may become pregnant
Benefits
- Cheap and very small – don’t need a prescription
- Protect against some STIs
Other barrier methods include:
- Female condoms (internal condoms) - worn inside the vagina to cover cervix, lines vagina and protect the vulva (entrance to vagina)
- Diaphragm - round silicone cup worn inside the vagina to cover the cervix
Contraception and STIs
- Barrier methods, such as condoms, are THE ONLY form of contraception that provides protection against both sexually transmitted infections (STIs) and unwanted pregnancy
- Barrier methods DO NOT stop the spread of pubic lice/crabs, active herpes, or genital warts (Human Papilloma Virus; HPV)
- HPV vaccine only prevents the most common cancer-causing strains of HPV – BUT STILL WORTH IT!
Combined Hormonal contraceptive
oral contraceptive pill (COCP)
What is it?
- Pills taken orally once a day containing two hormones – oestrogen and progestogen (sugar pills allow a period-like withdrawal bleed)
How does it work?
- Stops ovaries releasing an egg
- Thickens mucus at cervix (entrance to uterus) to stop movement of sperm up from vagina
How effective?
- 99.7% when used perfectly
- 91% with typical use – often forgotten!
Benefits
- Periods may become lighter, more regular, less painful – or skipped altogether
- Acne often improves; PMS may improve or vanish
Downsides
- Requires a prescription and can be expensive
- Several health contraindications: smoking, clotting disease, breast cancer, migraines, heart disease
- Does NOT protect against STIs
- Some women experience side effects
The vaginal ring (NuvaRing)
- is also a combined hormonal contraceptive
- Soft plastic ring of about 5 cm in diameter
- containing oestrogen and progestogen placed into vagina
- worn continuously for 3 weeks before removing, withdrawal bleed, and replacement with new
progestogen-only methods
Hormonal intrauterine device (IUD)
What is it?
- Small T-shaped plastic device placed inside uterus that releases small amounts of hormone – progestogen – for up to 5 years
How does it work?
- Thickens mucus at cervix to stop movement of sperm up from vagina
- Thins lining of uterus to stop fertilised egg implanting
- Sometimes stops ovaries from releasing an egg
How effective?
- 99.8% when used perfectly;
- Typical use related to timeliness of replacement
Benefits
- Periods become lighter or even stop - Reversible!
- Most women can use an IUD; safe to use when breastfeeding or oestrogen is contraindicated
- Inexpensive thanks to Medicare!
Downsides
- Some women have side effects; regular period patterns change/stop, which can result in spotting
- Does NOT protect against STIs
- Requires trained professional for insertion
Other progestogen-only methods: progestogen-only pill, the implant (Implanon)
copper IUD contraception
What is it?
- Small T-shaped plastic and the copper device placed inside the uterus for up to 5 or 10 years
How does it work?
- Affects sperm movement and survival so they can’t move through the uterus to reach and fertilise egg
- Stops fertilised egg from implanting in the uterus
How effective?
- 99.2% when used perfectly;
- Typical use related to timeliness of replacement
Benefits
- Does not contain hormones - Safe to use when breastfeeding or oestrogen is contraindicated
- It starts working right away – Immediately reversible upon removal
- Safe for most women – including young women
Downsides
- Some women experience side effects; periods can be heavier and last longer than before
- Does NOT protect against STIs
Requires trained professional for insertion
Sterilisation contraception
Male
- Permanent contraception (intended > can be reversed)
- 99.85% effective
- Blocks sperm from becoming part of the ejaculate
- Cut the vas deferens
Female
- Permanent contraception
- 99.5% effective
- Blocks fallopian tubes so sperm can’t reach egg
- Fallopian tubes are closed off by clips or rings
Fertility awarness method of contraception
What is it?
- Rely on avoiding sexual intercourse at times of the month when the woman is most fertile
How does it work?
- Cycle dates, vaginal mucus changes, cervix changes, and temperature changes are monitored and used as indicators of fertility
How effective?
- Perfect use of the ovulation method is 97% effective
- Perfect use of hypothermal method is 99.6% effective
- 76% when used typically
Other awareness methods
Withdrawal
- penis removed (pulled out) of vagina before ejaculation occurs
- Reduces the amount of sperm released into the vagina thereby decreasing the likelihood of sperm meeting the egg
- 78% effective with typical use
Emergency contraceptive
Emergency contraceptive pill (Morning after pill)
What is it?
- Single pill taken after unprotected sex to prevent pregnancy
- Works best if taken within 24 hours
How does it work?
- Stops or delays the release of an egg from the ovaries until sperm are no longer viable
- Won’t cause an abortion if already pregnant
How effective?
- 85% effective with perfect use
Benefits
- Available over the counter at a pharmacy
Other options
- Copper IUD inserted within 5 days of unprotected sex by a trained doctor or nurse (99% effective)
Long-acting reversible contraceptives
- Contraceptive administered less than once per cycle
- copper and progestogen-only IUDs
- progestogen subdermal implants and injections
- Widely recommended by professional bodies and World Health Organisation (WHO)
- Safe, effective reversible
- Should be offered to young women as part of a fully informed decision for their first form of contraception
- Low uptake in Australia may be related to:
- prevailing cultural norm of oral contraception
- practitioner and patient misperceptions of safety and efficacy of LARC…which have been dispelled in recent years
Global trends in contraceptive use: unmet needs
- 190 or 10% of women have an unmet need for contraception
- Unmet need: wanting to stop or delay pregnancy but are not using any method of contraception
- Contraception is overwhelmingly a woman’s responsibility because they have the biological burden of carrying the child
- Male sterilisation is more effective, less expensive, fewer complications, potentially reversible
