Basics of contraception Flashcards
CHC
Combined hormonal contraceptive
COC
Combined oral contraceptive (Pill)
CTP
Combined transdermal patch (Evra)
CVR
Combined vaginal ring (NuvaRing)
Cu-IUD
Copper Intra-uterine device (Copper coil)
DMPA
Depot Medroxyprogesterone Acetate
LAM
Lactational Amenorrhoea Method
LNG-IUD
Levonorgestrel Intra-Uterine Device
NPF
Natural Family Planning
POP
Progesterone Only Pill (MiniPill)
SDI
Sub-Dermal Implant (Nexplanon)
What are some reasons people have sex?
- Physical reasons - Pleasure, release of sexual tension, attraction, stress relief and mood boosting
- Emotional reasons - Love, commitment, curiosity, gratitude, need for affection
- Insecurity reasons - Self-esteem, sense of duty, internal and external pressures
- Goal-based reasons - Improve social status, seek revenge, power, make a baby
What are some outcomes of unwanted pregnancy
- Have and keep the baby
- Termination of pregnancy
- Have the baby and put it up for adoption
What is the pregnancy rate of unprotected sex?
85%
What are the 3 mechanisms of contraception
- Prevent ovulation
- Prevent fertilisation
- Prevent implantation
How do most hormonal contraceptives work to prevent ovulation?
Suppressing FSH and LH via negative feedback in the HPO axis
What are some methods of preventing fertilisation?
Barrier (E.g. condoms, sterilisation, mucus thickening)
Sperm toxicity
Ovum toxicity (IUDs)
Decreased tubal motility (POP, CHC)
What are some methods of preventing implantation
Create a histile endometrium (Thin)
Inflammatory endometrium
Toxic environment
What are some categories of contraceptives?
- Hormonal
- Barrier
- Intrauterine
- Permanent
- Fertility awareness
- Emergency
What is LARC?
Long-Acting Reversible Contraception
Def: Method failure rate
Failure rate with perfect use
Def: User failure rare
Failure rate at typical use
In LARC, User failure rate is equal to …
Method failure rate
What is the most effective form of contraception?
Sub-dermal implant
What are some reasons for failure in condoms?
Used too late, wrong lube (Oil-based), wrong technique, wrong size, inconsistent use, wrong storage, damage, expired
What are some reason for failure in diaphragms?
Used too late, removed too early, wrong technique, inconsistent use
What are some reasons for failure in CHC, POP and DMPA?
Inconsistent use, poor complience, wrong use, drug interactions (St John’s Wort)
What are some causes of iatrogenic contraceptive failure
Poor counselling, poor or wrong instructions, no extra-precautions recommended when quick-starting, drug interactions, incorrect insertion
What are some common concerns that play a role in choosing contraception
- Pleasure
- Fertility
- Weight
- Bleeding and menstruation
- Mood
What are some factors to consider when prescribing contraception
- Personal preference
- Age
- Mental capacity
- Child protection or wellbeing concerns
- Partner(s)
- Drug or alcohol use
- Consent
- Type of sex
- Pregnancy risk
- STI risk
- Previous experiences with contraception
- Future pregnancy plans
- Practical issues (E.g. secrecy, storage, manual dexterity, time off school or work for LARC insertion)
- Lifestyle and situation
- Allergies and medications
- Weight, BMI, blood pressure
- PMH
- Family history
- Socio-cultural and religious aspects
- Acceptability of:
- Hormonal methods
- Amenorrhoea and irregular bleeding
- Side effects
- Invasive procedures
What are some benefits of hormonal contraception?
- Decreased period pain
- Decreased heavy menstrual bleeding
- Decreased ovulation pain (Mittelschmerz) (If ovulation is suppressed)
- Decreased PMS (mainly CHC)
- Decreased cyclical breast tenderness
- Decreased risk of ovarian cysts (If ovulation is suppressed)
- Decreased risk of ovarian cancer (If ovulation is suppressed)
- Decreased acne or hirsutism (CHC only)
- Decreased perimenopausal symptoms (CHC only)
What is important when counselling about LARCs
- Establish rapport, listen and try to understand
- Establish contraceptive needs
- Do you have any plans to get preganncy
- How important is it for you not to get pregnant
- Understand previous experiences
- Understand important factors
- Give information
What is UKMEC?
UK Medical Eligibility Criteria (UKMEC)
What is UKMEC category 1
A - Always use - No restriction for use of contraceptive method
What is UKMEC category 2
B - Broadly useable - Advantages outweigh risks
What is UKMEC category 3
C - Counsel/Caution - Risks outweigh advantages - Expert opinion required
What is UKMEC category 4
D - Do not use - Method strongly contraindicated due to condition or characteristics
