CONTRACEPTION Flashcards
what is UKMEC?
a set of guidelines for contraception
what types of contraception are there?
natural methods combined hormonal contraception progesterone only contraception intrauterine contraception emergency contraception barrier methods surgical sterilisation
what are the 3 natural methods of contraception?
fertility awareness method
lactational amenorrhea method
coitus interruptus
when is ovulation within the menstrual cycle?
14 days before the END
how long can sperm survive for?
7 days
how long can eggs survive for?
24 hours
how long is the fertile window in each menstrual cycle?
8-9 days
when in the menstrual cycle is conception most likely to occur?
on day of ovulation or in the preceding 24 hours
describe the fertility awareness method?
when women are aware of when in their cycle they are most and least fertile using temperature, cervical secretions and standard days methods
how do you get the best efficacy out of the fertility awareness method?
using the symptothermal method (calender, cervical secretions and temperature)
what are the advantages of the fertility awareness method?
no hormones, no alterations to menstrual cycle, helps with conception in the future, no intercourse for 8-9 days per cycle, user dependant
what are the disadvantages of the fertility awareness method?
less effective than other methods, no intercourse for 8-9 days per cycle, requires motivation, user dependant, no protection from STIs.
what is the lactose amenorrhoea method?
when a woman is fully breastfeeding, has amenorrheas and is less than 6/12 post partem then ovulation is supressed
why is ovulation suppressed in the lactational amenorrhea method?
Increased production of prolactin suppresses release of GnRH from hypothalamus. This interrupts release of FSH/LH from anterior pituitary- leading to suppression of ovulation
how reliable is the lactational amenorrhoea?
98% effective if all criteria are there
what is coitus interruptus?
the withdrawal method
What’s a problem with using coitus interruptus as your contraceptive method?
pre-ejaculate contains sperm (only 78% effective with standard use)
what are the combined contraception options?
the pill, patch or ring
what is the combined contraception’s mode of action?
inhibition of ovulation via action on the hypothalamo-pituitary-ovarian axis to reduce luteinising hormone and follicle-stimulating hormone.
this leads to increases in cervical mucus and it makes the endometrium less suitable for implantation.
what do the combined contraceptions contain?
ethinylestradiol and progestogen
what is progestogen?
the synthetic form of progesterone
describe what the 21 pills in a combined contraception pill pack do?
the first 7 inhibit ovulation and the other 14 maintain anovulation
what is the bleed when on combined contraception?
A WITHDRAWAL BLEED RATHER THAN A MENSTRUAL BLEED
describe how to use the combined patch?
for 3 weeks place a new patch on once a week and then in the 4th week you don’t apply a patch
describe how to use the combined ring?
insert the plastic ring into the vagina and leave for 21 days. after this remove the ring and you will have a withdrawal bleed for 7 days. then reinsert a new ring
what are some contraindications for the combined contraception?
migraines with aura, smoking over 35, previous history of blood clots, family history of blood clots, Bp> 140/90, BMI>35, 0-6 weeks postpartum, major surgery with prolonged immobilization, breast cancer, liver disease
why would the pill potentially not work when on antibiotics?
due to the side effects of diarrhoea and vomiting from the antibiotics
which medications should you not take when on combined contraception?
`liver enzyme inducers e.g. antiepileptics, antibacterials, antiretrovirals, antidepressants, Ulipristal (EllaOne- the morning after pill)
what are advantages to combined contraception?
Regulates menstruation Reduces heavy bleeding and pain Decreased risk of endometrial and ovarian cancer Decreased risk of colorectal cancer Improves Acne May help PMS
what are disadvantaged to the combined contraception?
Increased risk of venous thromboembolism x 2
Increased risk of stroke and MI
Small increased risk of breast cancer (decreases after stopping)
Relies on user to take effectively
Increased risk of cervical Cancer (risk reduces after stopping)
what are the progesterone-only contraception options?
the pill, injection and implant
Is the progesterone-only pill safe? What are some cautions?
yes- the safest contraception
it may cause cardiovascular disease and unexplained vaginal bleeding
what are the contraindications of the progesterone only pill?
Breast cancer and liver disease
what are the 2 types of progestogens?
traditional and desogestrel
whats the benefits of having the newer progestrogen?
Increase volume and viscosity of cervical mucus preventing sperm penetration. has a more reliable effect on ovulation ~97% of cycles are anovulatory. Has a 12 hour window to take the pill.
how do you take the progestogen pills?
Start day 1 – 5 with immediate protection
Can start any other time so long as reasonably sure not pregnant
Take one pill at the same time every day and continue
what are some potential drug interactions for the progesterone-only pill?
Liver enzyme inducers, Ulipristal, EllaOne
what are the advantages of the progesterone only pill?
Works quickly (48 hours) Easy to take 12 hr window with desogestrel Very safe May help dysmenorrhoea No delay in return to fertility Can be used until age 55
what are the disadvantages of the progesterone only pill?
Hormonal side effects in some e.g.
Irregular bleeding pattern
what are the 2 types of progesterone-only injection?
depo provera and sayana press
what is the risk of pregnancy with the progesterone-only injection and how does it work?
4/1000
works by inhibiting ovulation
what are some concerns for the progesterone-only injection?
there’s a potential to reduce bone mineral density so should watch out for osteoporosis and cardiovascular disease
has a drug interaction with EllaOne
what are the advantages of progesterone-only injection?
most are amenorrhoeic by 12 months
can reduce pain with endometriosis
long acting
what are some disadvantages of the progesterone only injection?
not possible to remove once given if adverse side effects
can cause weight gain
delay in return of fertility for up to a year
can cause loss in bone mineral density
weak associations with breast and cervical cancer
what is the progesterone only implant called? how does it work?
What’s the risk of pregnancy?
nexplanon
inhibition of ovulation
1/1000
what are the drug interactions with the progesterone only implant?
liver enzyme inducers and Ulipristal
what are some side effects of the progesterone only implant?
irregular bleeding that is likely to stay that way
what are the advantages of the progesterone only implant?
Very safe LARC 3 years Fit and forget Rapid return to fertility after removal May help dysmenorrhoea
what are the disadvantages of the progesterone only implant?
Irregular bleeding patterns
Relies on health professional to fit and remove
Some experience weight gain (no evidence)
Risks of fitting – infection, expulsion, non-insertion, nerve damage (rare)
what are the 2 types of intrauterine contraception?
IUS- levonorgestrel
IUD- copper
what are the contraindications of intrauterine contraceptions?
cardiac disease pelvic infection unexplained vaginal bleeding gestational trophoblastic disease cervical or endometrial cancer fibroids
who is at risk of STIs?
under 25s
anyone whos had a new sexual partner in the last 3 months or more than one in the last year
if your partner has other partners
if you have been in contact with someone who has one
if you use alcohol or drugs as you take more risks
how does an IUS work?
it increases cervical mucus and reduces sperm penetration
what are the 3 types of IUS?
MIRENA/JAYDESS/KYLEENA
what are the advantages of IUS?
LARC Fit and forget Reduction of bleeding and pain 5 or 3 years Immediate return to fertility
what are the disadvantages of IUS?
Risks with fitting
Perforation 2/1000 (risk depends on experience of putting them in)
Expulsion 1/20
Infection 1/100
Ectopic (low)
Relies on health professional to fit and remove
how does an IUD work?
Copper toxic to ovum and sperm - affects fertilisation
what’s a disadvantage of an IUD?
endometrial inflammatory reaction- can cause periods to be more painful and heavier
what are the 3 types of emergency contraception?
IUD
Ulipristal (EllaOne)
Levonorgestrel
why is emergency contraception deemed as ok?
because a judicial review in 2002 concluded that pregnancy begins at implantation rather than at fertilisation
what should you offer, aswell as the contraception, to someone who needs emergency contraception
ongoing contraception to prevent it from happening again
What can reduce the effectiveness of oral contraceptives?
high BMI
which drugs can interact with emergency contraception?
liver enzyme reducers
EllaOne effectiveness can be reduced if progesterone has been taken for the previous 7 days or the following 5 days
whats the risk with emergency contraception and breast feeding?
you must throw away breast milk after for 7 days
how does the emergency IUD work?
it inhibits fertilisation as its toxic to the sperm and ovum
it causes endometrial inflammation which prevents implantation
it can be inserted up to 5 days after unprotected sexual intercourse or 5 days after the predicted date of ovulation
how does levonorgestrel work? (emergency contraception)
it inhibits ovulation by delaying or preventing follicular rupture and causing luteal dysfunction
can be used up to 3 days after the unprotected intercourse
what are the types of barrier methods?
male and female condoms
diaphragms
what are some cautions around using barrier methods of contraception?
sensitivity to latex
if you have a history of toxic shock syndrome then you shouldn’t use a diaphragm
how effective are male condoms with typical use?
82%
how effective are female condoms with typical use?
79%
how effective are diaphragms with typical use?
88%
how do you use a diaphragm?
it is inserted into the vagina along with spermicide any time before intercourse
reapply spermicide if in situ for over 3 hours
do not remove for 6 hours after intercourse
describe male sterilisation?
its called a vasectomy- it involves snipping the vas deferens under local anaesthetic
describe female sterilisation?
tubal occlusion is when the fallopian tubes are clipped or cut using a laparoscopy
a salpingectomy is when you remove the fallopian tubes
what are some risks of a vasectomy?
bleeding, pain, infections, failure, chronic pain
what are some risks of female sterilisation?
bowel perforation, bleeding, infection, failure, ectopic pregnancy, post-op pain
what are some considerations for someone who wants sterilisation?
are they eligible
have they given consent
have they have counselling because it’s irreversible
do they have the mental capacity
