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PHYS - REPRO > 9. CONTRACEPTION > Flashcards

9. CONTRACEPTION Flashcards

1
Q

What are the contraception methods that require ongoing action?

A
  1. Oral contraceptives
  2. Barrier methods
  3. Fertility awareness
  4. Coitus interruptus
  5. oral emergency contraception
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2
Q

What are the methods which prevent contraception by default?

A
  1. IUD/IUI/IUS
  2. Progestogen implants
  3. Progestogen injection
  4. Sterilisation
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3
Q

What are the risks of contraceptive treatment?

A
  • Cardiovascular
  • Neoplastic
  • Emotional
  • Allergies
  • Not all methods of contraception prevent against STIs
  • Iatrogenic
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4
Q

What are the risks of not taking contraception?

A
  • Childbirth related risks
  • Abortion related risks
  • Social & economic costs
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5
Q

What is the combined oral contraceptive pill & how does it work?

A
  • Combined oral contraceptive pill has both oestrogen & progestogens
  • Supraphysiologic levels of oestrogen & progestogens are given to cause negative feedback to the hypothalamus & pituitary, preventing the release of FSH & LH
  • No ovulation & no follicle development
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6
Q

What does oestrogen in the COCP work on?

A
  • Anterior pituitary & hypothalamus - switch off HPG axis
  • Directly on the ovary to prevent ovulation
  • On the endometrium
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7
Q

What does progestogens in the COCP act on?

A
  • Anterior pituitary & hypothalamus - shut off HPG axis
  • Directly on ovary - stop ovulation
  • Endometrium - combined effect of progestogen & oestrogen thins the endometrium
  • Fallopian tubes - smooth muscle is dilated which reduces gamete transport
  • Cervical mucus - thick, reduces movement of sperm
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8
Q

Why isn’t oestrogen only contraception given?

A
  • The endometrium will continue to proliferate
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9
Q

What are the 4 sites of action for COCP?

A
  1. OVARY - prevent ovulation
  2. FALLOPIAN TUBE - smooth muscle becomes dilated to reduce oocyte transport
  3. ENDOMETRIUM - becomes thin due to both oestrogen & progestogen
  4. CERVIX - thickens the cervical mucus
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10
Q

What are some examples of COCP?

A
  • Ethinyl estradiol is synthetic oestrogen, it is taken in combination with progestogens
  • Progestogens include:
  • Norethisterone & Levonorgestrel (Older - 2nd generation)
  • Desogestrel, Gestodene & Norgestimate (Newer - 3rd generation)
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11
Q

What is the latest progestogen?

A
  • Drospirenone
  • Derived from spironolactone
  • Can be combined with synthetic oestrogen
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12
Q

What are the benefits of taking COCP?

A
  • reliable
  • safe
  • unrelated to coitus
  • rapidly reversible
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13
Q

Which cancers does the COCP prevent?

A
  • Halves the risk for:
  • Ovarian cancer
  • Endometrial cancer
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14
Q

What conditions can COCP be helpful for?

A
  • Endometriosis
  • Menorrhagia (prolonged or heavy bleeding)
  • Dysmenorrhea (severe & frequent menstrual cramps or pain)
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15
Q

What are the cardiovascular risks of COCP?

A
  • Arterial - High blood pressure (progestogen)

- Venous - DVT, PE, migraine (oestrogen)

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16
Q

What are the neoplastic risks of COCP?

A
  • Can cause cancers of the:
  • Liver
  • Breast
  • Cervix
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17
Q

What are the gastrointestinal risks of COCP?

A
  • Carbohydrate & insulin metabolism
  • Weight gain
  • Crohn’s disease
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18
Q

What are the hepatic risks of COCP?

A
  • Hormone metabolism
  • Congenital nonhemolytic jaundice
  • Gall stones
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19
Q

What are the dermatological risks of COCP?

A
  • Acne

- Chloasma

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20
Q

What are the emotional effects of COCP?

A
  • Depression
  • Mood swings
  • Changes in libido
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21
Q

What are the rules for taking COCP?

A
  • 1st packet on Day 1 of cycle
  • 1 packet everyday for 21 days
  • Stop for 7 days to allow for a withdrawal bleed (PFI) where hormones naturally decline
  • Restart each new packet on 8th day after interval period
  • Missed pills = no pill free interval
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22
Q

What other medications can affect COCP?

A
  • Liver enzyme inducing drugs - can affect metabolism of hormones
  • Rifampicin & anti-epileptics
  • Broad spectrum antibiotics - affects gut microbiome & the oestrogen circulation
23
Q

What is the combined vaginal contraceptive?

A
  • Same as the COCP but it’s inserted vaginally

- Vaginal ring inserted for 21 days, removed for 7 days to allow PFI

24
Q

What are the two types of progestogen only methods?

A
  1. Default methods

2. User dependent methods

25
Q

What are the two types of progestogen implants?

A
  • Nexplanon
  • Norplant
  • Default methods
26
Q

What is the hormonal progestogen only IUCD?

A
  • Mirena
27
Q

What are examples of POPs?

A
  • Progesterone only pills:
  • Desogestrel (Cerelle)
  • Norethisterone
  • Levonorgestrel
  • Norgestrel
28
Q

What are the two progesterone only injectables?

A
  • Depo Provera (MPA) - every 12 weeks

- Noristerat (NET)

29
Q

Why is Cerelle better than older POPs?

A
  1. Cerelle is just as effective as COCPs
  2. POPs can be good for individuals who shouldn’t take oestrogen e.g breast feeding
  3. The bleeding interval with Cerelle is more predictable, older POPs have lots of spotting
  4. The window for a late pill is 3 hours with older POPs but it’s 12 hours for Cerelle
30
Q

What are the two types of IUCDs?

A
  1. Copper Bearing

2. Hormone Bearing

31
Q

Give examples of copper bearing IUCDs

A
  • Ortho T (8-12 yrs)
  • Multiload 375 or 250 - 5 yrs - standard
  • Nova T 380 or 200 - 5 yrs
  • Gyne Fix - 5 yrs
32
Q

How long to the hormone bearing IUD Mirena last?

A
  • 5 years
33
Q

How do copper bearing IUCDs work?

A
  • Copper bearing IUCDs are inserted into the uterus by trained professionals
    1. Destroys the spermatazoa - copper is sperm soluble
    2. Prevents implantation - local inflammatory response & release of prostaglandins. Causes sterile endometriosis preventing implantation
  • Implantation won’t occur even if fertilisation does occur, issues for those with religious beliefs
34
Q

What are the benefits of IUCDs?

A
  • Non-user dependent - no failure rate
  • Immediately effective
  • Retrospectively effective (post coital)
  • Unrelated to coitus
  • Reliable
  • Can be used long term
  • Reversible once removed
35
Q

What are the disadvantages of IUCDs?

A
  • Requires trained individual for fitting
  • Fitting can cause pain or discomfort
  • Threads aren’t cut short enough & may be felt by male
  • Doesn’t protect against STIs
  • Periods can become heavier, possible due to switch in contraception
36
Q

What are the risks of IUCDs?

A
  1. Miscarriages - IUCD left in situ for too long
  2. Ectopic pregnancy- IUCDs prevent implantation in uterus
    - IUCDs can be expelled if it’s not pushed far enough due to irritation
    - Can perforate the uterus if it’s pushed too far up
37
Q

Who shouldn’t use IUCDs?

A
  • Suspected or known pregnancy
  • Current pelvic inflammatory disease e.g chlamydia
  • Unexplained vaginal bleeding
  • Abnormalities of uterine cavity
  • Fibroids in uterine cavity
38
Q

What are the advantages of male & female condoms?

A
  • User in control
  • Protects against STIs
  • Easily available
39
Q

What are the disadvantages of male & female condoms?

A
  • Can be messy or obtrustive
  • May cause allergies
  • Oily preparations can rot rubber
  • Higher rate of failure in some e.g misuse
40
Q

What are the two types of caps?

A
  1. Diaphragm caps

2. Suction caps

41
Q

What are diaphragm caps?

A
  • Diaphragm caps are made of latex & are fitted across the vagina
  • Must be used with spermicide & left for six hours post intercourse
42
Q

What are the adavntages & disadvantages of a diaphragm cap?

A 
\+ Woman in control
\+ Can be put on in advance
\+ Protection against cervical dysplasias
- Needs to be taught
- Messy
- Higher rate of failure
- Can cause thrush/candiasis or UTI
43
Q

What is a suction cap?

A
  • Suction cap is made of plastic which suctions to cervical vault
  • Must be used with spermicide for 6 hours after intercourse
44
Q

What are the advantages & disadvantages of a suction cap?

A 
\+ Suitable for women with poor pelvic floor muscles
\+ No issues with allergies
\+ Woman in control
- Needs an accessible & suitable cervix
- Higher risk of failure than diaphragm
45
Q

How is fertility awareness used as a method of contraception?

A
  • Fertility awareness predicts ovulation by looking at factors such as cervical mucus, body temperature
    + Doesn’t involve hormones
  • Failure rate depends on individual
46
Q

What are the two types of emergency contraception?

A
  1. POST-COITAL

2. COPPER BEARING IUDS

47
Q

How can copper bearing IUDs be used as emergency contraception?

A
  • Up to 5 days after presumed ovulation or up to 5 days after SINGLE episode of unprotected intercourse
  • Coper kills sperm in 1st part of cycle & device prevents implantation in second part
48
Q

When can post-coital pills be taken?

A
  • Up to 72 hours after unprotected sex, but rate of efficacy decreases with time
  • Act by delaying ovulation in first part
49
Q

What are the three types of post-coital pills?

A
  1. Levonelle
  2. ellaONE
  3. Schering PC4
50
Q

What does Levonelle contain?

A
  • 1.5mg dose

- 2 tablets - each containing 750 mg of Levonorgestrel

51
Q

What does ellaONE contain?

A
  • ulipristal acetate
  • Selective progestogen receptor modulator (SpeRM)
  • Up to 120 hours
52
Q

What are the contraindications for Levonelle?

A
  • Potent liver enzyme medication

e. g anti TB

53
Q

How do PC4 & Levonelle work?

A
  • Postpone ovulation in 1st part of cycle

- Prevent implantation in second part of cycle

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