7. Contraception Flashcards
What are the categories of contraception?
Natural Barrier Hormonal control Prevention of implantation Sterilisation Emergency contraception
What is lactational amenorrhoea?
Breastfeeding after childbirth to avoid pregnancy
Delays return of ovulation by disrupting gonadotropin release
Can be send effective for up to 6 months postnatally provided exclusive breastfeeding, complete amenorrhoea
What are the different barrier methods?
Male/female condoms
Diaphragms/cervical caps
Spermicides
What are the types of hormonal control?
Combined oestrogen and progestogen - COCP, patch, ring
Progestogen-only pill (POP)
LARC - progestogen depot and implant
What is the role of progesterone?
High levels enhances negative feedback of oestrogen, therefore pre-ovulation - reduces FSH and LH secretion, inhibits positive feedback - no LH surge, no ovulation
Lower levels do not inhibit LH surge, can still ovulate, will thicken cervical mucus
What is the main action of COCP?
Prevent ovulation
What is the secondary action of COCP?
Reduces endometrial receptivity to implantation, thicken cervical mucus
What are the advantages of COCP?
Reliable up to 99%
Can relieve menstrual disorders
Lowers risk of ovarian and endometrial cancer
Decrease acne severity in some
What are the disadvantages of COCP?
User dependant
No STI protection
Medication interaction
Contraindications - raised BMI, migraine, breast cancer
Side effects - menstrual irregularities, breast tenderness, mood disturbances
Increased risk of CV disease, stroke, VTE, breast cancer, cervical cancer
What is the main action of POP?
Thicken cervical mucus
What is the other action of POP?
Reduced cilia activity in Fallopian tube
What are the advantages of POP?
Reliable up to 99%
Can be used if COCP contraindicated
What are the disadvantages of POP?
No STI protection
Strict timing
Menstrual irregularities
Increased risk of ectopic pregnancy
What are the main actions of progestogen injection?
Inhibit ovulation, thicken cervical mucus, thin endometrial lining
Given IM every 12 weeks
What are the advantages of progestogen injection?
Reliable
No known medication interactions
Can be used if oestrogen contraindicated and raised BMI
What are the disadvantages of progestogen injection?
No STI protection
Not rapidly reversible
Menstrual irregularities
What is the progestogen implant?
Small subcutaneous tube inserted in arm
High dose progestogen
What are the main actions of progestogen implant?
Inhibit ovulation, thicken cervical mucus, thin endometrial lining
What are the advantages of progestogen implant?
Reliable
Lasts for up to 3 years
Can be used if oestrogen contraindicated and raised BMI
Fertility returns faster than injection
What are the disadvantages of progestogen implant?
No STI protection
Menstrual irregularities
Complications with insertion and removal
What is the intrauterine system?
Progestogen releasing coil
Prevents implantation and reduces endometrial proliferation, thickens cervical mucus
Ovulation usually continues
What is the intrauterine device?
Copper-containing coil
What is the main action of IUD?
Copper toxic to ovum and sperm, preventing fertilisation
What are the secondary actions of IUD?
Cervical mucus changes, endometrial inflammatory reactions inhibit implantation
What are the advantages to the coil?
Convenient
Effective up to 99%
LARC from 3 to 10 years
IUS or treatment of menorrhagia
What are the disadvantages of the coil?
No STI protection
Complications with insertion
Menstrual irregularities
Displacement/expulsion may occur
What are the 3 types of emergency contraception?
Levonorgestrel - morning after pill, high dose progestogen, inhibits ovulation
Ulipristal acetate - selective progesterone receptor modulator, inhibits/delays ovulation
Copper IUD
