9- Contraception Flashcards
What are the two types of contraceptive methods?
- Methods which require ongoing action by the individual
- Methods which prevent conception by default
What are some examples of contraceptive methods that require ongoing action by the individual?
Oral contraceptions
Barrier methods
Fertility awareness
Coitus interruptus
Oral emergency contraception
What are some contraceptive methods which prevent conception by default?
IUCD/IUI/IUS
Progesterone implants
Progesterone injections
Sterilisation
What makes the perfect contraceptive?
100% reliable
100% safe
Non user dependent
Unrelated to coitus
Visible to the woman
Non ongoing medical imput
Completely reversible within 24hrs
No discomfort
What are the risks of contraception?
Cardiovascular
Neoplastic
Emotional
Infection related
Allergic
Iatrogenic
What are the risks of not using contraception?
Childbirth related
Abprtion related
Social and economic costs
What the benefits of using contraception?
Non contraceptive
Psychosexual
Choice
Sexual health
Cost savings
Female equality
What are the benefits of not using contraception?
Non interference
Population growth
Control of women
What is the combined oral contraception?
Oestrogen ( ethinyloestrodiol) and progestogens
Where does the combined oral contraceptive pill act? (Oestrogen)
Oestrogen:
Acts on the anterior pituitary and hypothalamus - negative feedback shuts down the HPG axis
Directly on the ovary - prevents ovulation
On the endometrium- proliferation of the endometrium
Where does the combined oral contraceptive pill act? (Progestogens)
On the anterior pituitary and the hypothalamus- negative feedback
Directly on the ovary- stops ovulation
On the Fallopian tubes- causes smooth muscle dilation , gametes transport is reduced
On the cervical mucus- causes it to thicken to prevent sperm from entering the cervix
What are the benefits of the combined oral contraception?
Contraceptive-
- reliable
- safe
- unrelated to coitus
- woman in control
- rapidly reversible
Non contraceptive-
-halve chances of ovarian cancer
-halve chances of endometrium cancer
-helps endometriosis,menorrhagia,dysmenorrhea
What are the risks of combined oral contraception?
Cardiovascular- can be arterial or venous
- arterial: can cause high blood pressure (associated with progesogen)
- venous: can induce production of clotting factors in the liver (associated with oestrogen)
Neoplastic- breast, cervix, liver
Gastrointestinal- COG/ insulin metabolism, weight gain and Crohn’s disease
Hepatic
Dermatological- chloasma, acne, erthythema multiforme
Psychological- mood swings, depression, libido
How is the combined oral contraceptive pill taken?
Start 1st packet on the 1st day of a menstrual period
Take 21 pills and strop for 7 days
Restart new pack on the 8th day of the break
Do not start the new packet late
During the 7day break there is a withdrawal bleed (similar to a period but not a period)
What medications can interact with COCP and reduce its effect?
Liver enzyme inducing drugs- (e.g. rifampicin and anti-epileptics)
- affect metabolising of both oestrogen and progestogen
Broad spectrum antibiotics-
- affect enterohepatic circulation of oestrogen only
What is another example of a combined contraceptive?
The combined vaginal contraceptive
Similar to the COCP expect vaginal delivery
Ring is in vagina for 21 days and releases oestrogen and progestogen
Ring is then removed for 7 days
The advantage is you don’t have to take it every day
What are some examples of progesterone only methods of contraception?
The default methods are:
IMPLANTS:
- nexoplanon
- norplant (LNG)
HORMONE_RELEASING IUCD:
- mirena IUS (LNG)
The user-dependent methods are:
POPs (pills)
- Desogestrelle (Cerelle)
- norethisterone
- ethynodiol diacetate
- levonorgestrel
- norgestrel
INJECTIBLES:
- depo provera (MPA) (12-weekly)
- noristerat (NET)
Why is Cerelle better than older POPs?
It’s as effective as COCP
No oestrogen
Favourable side effect profile vs older POPs
Bleeding as predictable as COCP
12 hour window if missed
What are IUCDs and how do they act?
They are intrauterine contraceptive devices, they are inserted into the uterus by trained professionals and may be left in situ long term.
They act by destroying spermatozoa and preventing implantation by inflammatory reactions and prostaglandin secretion as well as a mechanical effect
What are the two types of IUCDs?
Copper bearing and hormone bearing
What are the benefits of IUCDs?
Non user dependent
Immediately and retrospectively effective
Immediately reversible
Can be used long term
Extremely reliable
Unrelated to coitus
What are the disadvantages of IUCDs?
Has to be fitted by a trained medical personnel
Fitting may cause pain or discomfort
Periods may become heavier and painful
It does not offer protection against infection
Threads may be felt by the male
What are the risks of IUCDs?
Miscarriage if left in situ if a pregnancy
Ectopic pregnancy
MY be expelled
The uterus may be perforated
What are some absolute contradictions of IUCDs?
Current pelvic inflammatory disease
Suspected or known pregnancy
Unexplained vaginal bleeding
Abnormalities of the uterine cavity