Contraception Flashcards
How many sexually active people who aren’t planning pregnancy don’t use contraception?
12%
Which contraceptives are irreversible?
Sterilisation
Which contraception is most effective?
vasectomy followed by implant
Which contraceptions are there for males?
Vasectomy or condoms
What is the pearl index?
The number of contraceptive failures per 100 women-years of exposure.
What is L.A.R.C
Long-acting reversible contraception:
IUD
Implant
Injections
what is method failure?
Pregnancy despite correct use of method
What is user failure?
pregnancy because the contraceptive method isn’t used correctly
How many women will become pregnant when using NO contraception?
80 women per 100.
Which days are ovulation most likely to occur?
Day 12-18 of cycle
How long does the egg survive?
24hrs
How long does sperm survive?
most <4 days
some >7 days
Which days have the highest chance of pregnancy?
days 8-19 of menstrual cycle
What are the options for combined hormonal contraception?
BOTH progesterone and oestrogen:
- pill (1 week break)
- patch (changed weekly)
- ring (21/24hrs daily)
What are the benefits of combined hormonal contraception?
- regulate/reduce periods
- stop ovulation
- reduce ovarian cysts
- 50% reduction in ovarian and endometrial cancer
- improves acne/hirsutism (decreased androgen)
- reduced benign breast disease
- reduced rheumatoid arthritis
- reduced colon cancer
- recused osteoporosis
What are the MINIMAL side effects of combined hormonal contraception?
- breast tenderness
- nausea
- headache
- irregular breakthrough bleeding (1st 3 months)
- mood
- weight (unknown)
What are the SERIOUS side effects of combined hormonal contraception?
- Increased risk of venous thrombosis (DVT, PE)
- increased risk of arterial thrombosis (MI, stroke)
- increased risk of cerical cancer
- increased risk of breast cancer (only for 10 years)
What are contraindications of the combined hormonal contraception?
- BMI >34
- reduced mobility
- Family history of VTE
- smokers >35
- history of arterial thrombosis or focal migraine
- > 50yrs
- Hypertension >140/90
- previous breast cancer
What are the options for the progesterone only hormonal contraception?
- pill (desogestrel 12 hr window or traditional 3hr window)
- IUD
- jab (every 13 weeks)
- rod
What are the contraindications of the progesterone only contraception?
- GI upset
- personal history of breast cancer
- benign/malignant past/present liver tumours
What are the side effects of the progesterone only contraception?
- increased appetite
- hair loss/gain
- mood change
- bloating/fluid retention
- headache
- acne - worsen or improve
What are the benefits of the progesterone only contraception?
- no increased risk of venous or arterial thrombosis
- very little contraindications
What are the side effects of the progesterone only PILL?
- increased appetite
- hair loss/gain
- mood change
- bloating/fluid retention
- headache
- acne - worsen or improve
What are the benefits of the progesterone only PILL?
- no increased risk of venous or arterial thrombosis
- very little contraindications
- most users bleed free after 4 months
What are the problems involved with the INJECTABLE progesterone?
- fertility delay - average delay of 9 months
- weight gain
- affects bone density
- 1st 2 doses give problematic bleeding
What are the benefits of the progesterone ROD?
- inhibits ovulation
- can last 3 years
- no weight change
- 60% beed free
What are the disadvantages of the progesterone ROD?
- 30% prolonged bleeding
- more mood changes than other progesterone only methods
What are the types of IUD?
- Progesterone only
- Copper coil
What are the benefits of IUD (progesterone and copper)?
- no input from user
- can be fitted at any age
- effects and side effects immediately leave when taken out
What are the disadvantages of the IUD (progesterone and copper)?
- infection risk
- perforation risk
- expulsion risk
- conceiving might be ectopic (but still less than condom)
- not suitable for pelvic infection, sub mucous fibroids
What are the advantages of the copper IUD?
- hormone free
- last 5-10 yrs
- no contraindication to MRI
- toxic to sperm (also prevent implantation of fertilised egg)
What are the advantages of the progesterone IUD?
- most women still ovulate but affects cervical mucus and endometrium
- low circulating progesterone
- reduces menstrual bleeding after initial 4 months irregular bleeding
What are the types of progesterone IUD?
- Mirena: can treat heavy menstrual bleeding and can act as progesterone part of HRT for 5 yrs
- Kyleena: contraception only, smaller frame and insertion tube
What are the types of emergency contraception?
- Copper IUD
- Levonorgestrel pill
- Ulipristal pill
When should you start contraception?
in the first 5 days of your cycle - immediate cover
If after - use condoms/ abstain for next 7 days
When can you get pregnant after birth?
- 21 days after delivery
- 5 days after miscarriage or abortion
When is breastfeeding classed as contraception?
- first 6 months
- when feeding every 4 hrs
- when amenorrhoeic
*Breast feeding women can use any contraception, must wait 6 weeks after childbirth before using combined oral contraception)
Which drugs do the pill, patch, ring and implant interact with?
Enzyme inducing drugs - rifampicin, topiramate, carbamazepine
What is female sterilisation?
filthiest clips are applied across the Fallopian tube to block the lumen
- failure rate of 1 in 200
- reduces ovarian cancer risk
- no effect on periods or hormones
What is male sterilisation?
Vasectomy - the vas deferent is divided and the ends cauterised.
- takes 4-5 months to be effective
- failure rate of 1 in 2000
- <1:100 long term testicular pain
What is the procedure for the termination of pregnancy?
- Surgical (5-12 weeks)
- Oral - mifepristone and misoprostol
When can abortion be done at home?
- when under 10 weeks gestation
What should you consider when giving ellaone for emergency contraception?
It contains uripristal acetate.
DONT use hormonal contraception for the following 5 days.
If having sex, use a barrier method.
Levonelle - theres no interaction with this medication so you can begin hormonal contraception immediately.
