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
What are the advantages of using condoms?
Male:
- male in control
- protects against STIs
- no serious health risks
- easily available
Female:
- woman in control
- protects against STIs
- can be put in advance and left inside after erection is lost
Not dependent on male erection to work
What are the disadvantages of using condoms?
Male:
- Last minute use
- Needs to be taught
- May cause allergies
- May cause psycho sexual
difficulties
- Higher failure rate among
some couples
- Oily preparations rot rubber
Female:
- Obtrusive
- Expensive
- Messy
- Rustles during sex
- Uncertain failure rate
Describe caps as a method of contraception
Diaphragm Caps:
* Made of latex
* Fit across vagina
* Sizes 55 – 95mm in
5cm jumps
* Must be used with
spermicide and left in
at least 6 hours after
sexual intercourse
Suction (cervical)
Caps:
* Made of plastic
* Suction to cervix or
vaginal vault
* Different sizes
* Must be used with
spermicide and left in
6 hours or more.
What are the advantages of using caps as a method of contraception?
Diaphragm Caps:
* Woman in Control
* Can be put in in
advance
* Offers protection
against cervical
dysplasia
* Perceived as “natural”
Suction Caps:
* Suitable for women
with poor pelvic
muscles
* No problems with
rubber allergies
* Very unobtrusive
* Woman in control
What are the disadvantages of using caps as a method of contraception?
DIAPHRAGM CAPS:
- needs to be taught
- messy
- higher failure rate than most other methods
- higher UTI chance
- higher candiasis chance
SUCTION CAPS:
- needs an accessible and suitable cervix
- higher failure rate than the diaphragm cap
- not easy to find experienced teacher
Describe fertility awareness as a method of contraception
It uses the prediction of ovulation, and several facts surrounding fertilisation:
- sperm can survive 5 days in the female tract
- the ova can survive 24 hours
- ova are fertilised in the fallopian tube and take 4 days to reach the uterus and implant
- cervical mucus is receptive to sperm around the time of ovulation
They use periodic abstinence/alternative contraception to avoid pregnancy. They also time intercourse to the pre-ovulatory phase to conceive.
What factors are considered during natural family planning?
- temperature
- rhythm
- cervix position
- cervical mucus
- persona
- lactational amenorrhoea (LAM)
What are the advantages of using fertility awareness as a method of contraception?
- non-medical
- can be used in 3rd world countries
- allowed by Catholic church
- can result in closeness of understanding between partners
What are the disadvantages of using fertility awareness as a contraceptive method?
- failure rate is heavily user dependant
- requires skilled teaching
- require cooperation between partners
- may involve limiting sexual activity
- can cause strain
What are some methods of emergency contraception?
POSTCOITAL PILLS:
- can work up to 72 hours after unprotected sexual intercourse (UPSI)
- Schering PC4 - prevents 3 out of 4 pregnancies which would have occurred
- Levonelle - (oestrogen based) prevents 7 of 8 pregnancies
- ellaOne - selective progestogen modulator
COPPER- BEARING IUCDs:
- up to 5 days after presumed ovulation OR 5 days after one single episode of UPSI at any time of the cycle
- failure rate is extremely rare
What does Levonelle 2 consist of?
- Levonelle 2 consists of 2 tablets each containing 750 micrograms of Levonorgestrel
- 1.5mg one dose
What does Levonelle 2 consist of?
- Levonelle 2 consists of 2 tablets each containing 750 micrograms of Levonorgestrel
- 1.5mg one dose
Compare PC4 and Levonelle 2 as postcoital pills
PC4:
- lower failure rate in the first 24 hours
- causes nausea and vomiting in many women
- contraindicated during a focal migraine attack
LEVONELLE 2:
- higher failure rate in the first 24 hours
- very little nausea
- only contraindicated in women taking very potent liver enzyme medication (eg. anti-TB)
Describe ellaOne as a postcoital pill
- it’s a new selective progesteragen receptor modulator (SPeRM)
- up to 120 hours
- RR 0.58 pregnancy vs. Levonelle
- possibly slightly higher side effect profile - GI symptoms mostly
Compare the effectiveness of Levonelle 2 and Schering PC4 as postcoital pills
LEVONELLE 2:
up to 24 hours - 95%
25-48 hours - 85%
49-72 hours - 58%
SCHERING PC4:
up to 24 hours - 77%
25-48 hours - 36%
49-72 hours - 31%
How does PC4 and Levonelle 2 act as postcoital pills
- Act by postponing ovulation in 1st part of the cycle – So beware!
- Act by preventing implantation in 2nd part of the cycle
How do Copper IUCDs work as a method of contraception?
- Copper kills sperm in 1st part of the cycle
- Device prevents implantation in 2nd part of the cycle
