Avoiding Pregnancy Contraception Flashcards
What is the definition of contraception
A method preventing pregnancy via interference with ovulation, fertilization or implantation
When do you get ovulation?
2 weeks before a period.
Day 14 in a 28 day cycle
Day 16 in a 30 day cycle
Day 12 in a 26 day cycle
What are contraceptives in new zealand?
Condoms Combined oral contraceptive pill Progesterone only pill Jadelle Depp provera Copper iud Mirena IUS
What is the UK MEC
MEK 1 -no restriction on use
MEK 2 - Advantages generally outway disadvantages
MEK 3 - oppoit to avove
MEK 4 - Don’t use
How does the combined contraceptive pill work?
It suppresses ovulation (most important method)
Thickens cervical mucus
Changes endometrium to make implantation difficult.
Reduces the rates of cervical and endometrial cancer because it stops ovulation.
Disadvantages - complicated (missed pill rules)
Typical use - 9% failure (0.3% perfect use).
Can’t take if obese because of risk of venous thrombosis
Can’t take if older <30
Pill-free interval - delays in restarting after this period
What is the tricyclic contraceptive pill?
Pill without a pill free interval. Don’t need to have a period. Avoids the accidental ovulation caused by forgetting to start again after the pill free interval.
Who should not take contraceptive pill?
Obese people
people with focal - rik of cardiovascular accidents migraines
Smokers
Poorly controlled diabetes
When are you protected after initiating the oral contraceptive pill?
D1-D5 of cycle - protected straight away.
Later i the cycle - (make sure not pregnant) protected after 7 days
How does the progesterone only pill work and why would you take this over the OCP?
Thickening of the cervical mucus (main way)
Effect maximal after 48 hours after taking.
The one funded in NZ you need to take with 3 hours of the same time each day.
Cerazette is much better (12 hour window) but unfuned
take for those who cant take OCP, e.g. obese patients or for breastfeeding
What is a LARC?
Long acting reversible contraception.
Requires taking less than once a month.
Cost effective
What is depo provera?
12 weekly injection Delays ovulation and thickens cervical mucus Progesterone Can cause weight gain Prolonged amenorrhoea Delayed return of fertility Oestrogen free
What is jadelle?
Rod inserted into the arm.
Progesterone release
Prevents ovulation and makes endometrium thin and thickens cervical mucus.
Can cause bleeding. Pre warning is important.
Can give the OCP to stoop bleeding
How does the copper iud work?
Inserted into the uterus
Non-hormonal.
Lasts 10 years.
Reversible
Effective
Can cause heavy and painful periods
Cheap
Copper on the arms and stem is spermiotoxic. If a sperm does get through it causes an inflammatory reaction in the endometrioum so that implantation can’t occur and this is how it works as an emergency contraceptive
Need to swab for infections in at risk patients when inserting and then treat if an infection is present. Does not cause infections.
If you do get pregnant then 50% chance it will be ectopic but still lower chance than not having it.
Can be expelled.
What does the mirena do?
Unfunded in NZ
Progesterone release into the uterus.
Prevents implantation in the endometrium by thinning it out.
Thickens cervical mucus.
Makes unfavorable environment for sperm in the uterus and fallopian tubes.
Prevents 20-30% of ovulation.
Risk of light bleeding.
Indications: contraception, heavy menstrual bleeding, endometrial protection
Also used for dysmenorrhoea, endometriosis, endometrial hyperplasia.
What are emergency contraceptives?
Copper IUD - most effective
Can be used 5 days after ovulation because it prevents implantation.
Patient weigh not a factor
Lack of access to the device no training
Emergency contraceptive pill. Contains a high dose of progstrogen
Up to 72 hours
Postpones or prevents ovulation for 5 days by which time no active sperm in the genital tract.
If patient as already ovulated then this pill does nothing.
