conntraception Flashcards
what are the different modes of action of contraception ?
prevention of ovulation
prevention of fertilization
prevention of implantation
thickening of cervical mucus
what is the lactational amenorrhea method of contraception ?
allow women to safely rely on breastfeeding as a family planning method and this can be used as long as the woman is:
fully breast feeding ( baby fully dependent )
no periods
less than 6 months postpartum
what is the “safe period” method based upon ?
based on the assumption that :
the ovum life span os 24 hours post ovulation
spermatozoa are capable of fertilization for 4 days
ovulation occurs 12-16 days before the onset of the next menses
- safe period is not safe
what are the barrier methods of contraception ?
condom
diaphragm
how is the diaphragm used ?
- before intercourse a spermicide gel is applied over the diaphragm and all around the ring , and is inserted in the vault
- should be left for 8 hours after intercourse
- diaphragm can be washed and reused
what chemical methods are available ?
spermicides
what is the active chemical in spermicides ?
nonoxynol-9 , used alone or usually with a barrier method
what important instruction must the female be aware of when using spermicides ?
no douching for 6 hours after intercourse
when should we avoid using spermicides ?
in young age
frequent intercourse
STDs
what are the hormonal methods of contraception?
combined OCPs
Hormone releasing vaginal rings
contraceptive patches
monthly combined injectables
what is the mode of action in combined hormonal contraception ?
- estrogen is given in certain doses and causes the inhibition of ovulation through suppression of the hypothalamo-pituitary-ovarian axis
- progesterone is given simultaneously to avoid the unopposed effect of oestrogen on the endometrium
how long are combined pills supposed to be taken ?
they are taken for 21 days then stopped for a week
when does withdrawal bleeding happen when using combined pills?
2-3 days after stoppage
when should the new course for OCPs be started ?
5th day of menstruation
what is the mode of action of OCPs ?
inhibition of ovulation
interference with fertilization
effect on the endometrium ( edema of the stroma and atrophy of the glands)
what is used to delay menstruation ?
progesterones more than OCPs
what are the side effects of OCPs?
thrombo-embolic disorders
slight transient liver impairment
decreased milk production
menstrual disturbances ( spotting , breakthrough bleeding, hypomenorrhea, amenorrhea)
when is post pill amenorrhea diagnosed ?
after 3 months after stoppage of pills and is related to prolonged suppression of the hypothalamus
how do you manage in a case of break through bleeding with a patient on OCP?
increase the dose of OCP on the 5th day of menstruation
inn what conditions are OCPs contraindicated ?
In CVD inn VTE breast cancers liver cancers migranes with auras immobilization breast feeding above 35 y/o and a smoker above 35 BMI SLE APS ( anti-phospholipid)
what is a vaginal contraceptive ring ?
ring that releases progesterone and oestrogen and has a similar effect to OCP but bypasses the first pass metabolism by the liver
how is a vaginal contraceptive ring used ?
to be left inn for 21 days and may be removed during intercourse
what is a contraceptive patch ?
same idea as vaginal rings, avoid the first pass metabolism by the liver
how is a contraceptive patch used ?
replaced every 3 weeks with a one week interval
what are the two types of progesterone only pills ?
traditional
desogestrel- containing
what is the mechanism of action of POP ?
makes the cervical mucus impenetrable for sperm
what are the disadvantages of POP ?
menstrual irregularities
must continuously take pill no pill free week
what are the advantages of POP ?
avoids the side effects of oestrogen
no inhibition of lactation
If a patient forgets to take her POP pill what must she be instructed ?
to take it as soon as she remembers and to take thew next one as well
what instruction must be given regarding sexual intercourse if the POP pill was missed ?
a condom must be used for 2 days after a missed POP
when would EC be needed in the case of a missed POP pull ?
if unprotected sex has happened within two days of a missed POP
what emergency contraception can be used if required when a POP pill is missed ?
levonorgestrel IUD offered up to 72 hours
UPA offered up to 120 hours
what are the two types of progesterone only injection ?
depo-provera ( intra muscular injection) sayana press ( subcutaneous)
what other type of progesterone only methods are available ?
subdermal implants ( same effect as the injectables)
what are the types of IUDs ?
copper intrauterine device (IUD)
progesterone intrauterine system (IUS)
what are the types of progesterone intrauterine system ?
MIrena ( 5 years)
Jaydess ( 3 years)
when should intrauterine contraception be inserted ?
post-menstrual
after pregnancy within the first 48 hours after delivery or 4 weeks after delivery
what are the risk of intrauterine contraception ?
ectopic pregnancy
expulsion
infection
what are the contraindications to using intrauterine contraception ?
Pelvic inflammatory disease
pregnancy
abnormal shape of uterine cavity
what are the medical indications of sterilization ?
failure of other methods of contraception with a complete family
medical or surgical condition that may threaten the patient’s life if pregnancy occurs
how is male sterilization done ?
bilateral ligation and excision of a segment of the vas
what investigation should be done for follow up after male sterilization ?
a semen analysis needs to be done after 6 months to confirm success of the operation
how is female sterilization done
bilateral ligation of the tubes
