Contraception Flashcards
When in the menstrual cycle is there the highest chance of pregnancy from sex?
Day 8-19 of a normal 26-32 day cycle. Egg survives 24 hrs. Most sperm survive less than 4 days.
What would be factors of an ideal contraception?
100% reversible. 100% effective (none). 100% unrelated to intercourse. 100% free of adverse side effects. 100% protective against STIs. Has non-contraceptive benefits. Low maintenance, no ongoing medical input. Male and female options.
What methods of contraception use a combination of hormones?
Combined oral contraceptive pill.
Patch
Vaginal ring
What hormones are used in combined hormonal contraceptive methods and what do these hormones cause?
Ethinyl estradiol and synthetic progesterone.
Stop ovulation. Affect cervical mucus and endometrium.
Standard regime: 21 days with a hormone free week.
How often is the combined hormonal patch (EVRA) changed?
Weekly
How often is the combined hormonal vaginal ring changed?
Every 3 weeks. (Can be taken out for 3hrs in every 24hrs so may prefer to take it out for sex)
What are the non-contraceptive benefits of combined hormonal methods of contraception?
Regulate/ reduce bleeding: helps heavy periods.
Stops ovulation: may help premenstrual syndrome.
Reduction in function of ovarian cysts.
50% reduction in ovarian and endometrial cancer.
Improves acne/ hirsutism
Reduction in benign breast disease, rheumatoid arthritis colon cancer and osteoporosis.
What are the possible side effects for combined hormonal methods of contraception?
Breast tenderness. Nausea Headache Irregular bleeding for first 3 months Weight gain: not causal
What are the serious risks of combined hormonal methods of contraception?
Increased risk of: - DVT,PE - arterial thrombosis Cervical cancer Breast cancer
What type of contraception is the Desogestrel pill?
Progesterone only pill (mini-pill)
When should the progesterone only pill be taken?
Same time every day
What are the possible side effects of the progesterone only pill?
Appetite increase Hair loss/ gain Mood change Bloating/ fluid retention Headache Acne
What does the injectable progesterone jag contain?
Solution of medroxyprogesteorne acetate.
How often is the progesterone jag administered?
Every 13 weeks
What is Depoprovera?
The progesterone jag
Where is Depoprovera administered?
1ml deep intramuscular injection into the upper outer quadrant of the buttock
Where is Sayana press injected?
0.6ml subcutaneous injection in abdomen/ thigh
What is the role of the progesterone jag?
- Prevents ovulation
- Alters cervical mucus making it hostile to sperm
- Makes endometrium unsuitable for implantation
What are the side effects of the progesterone jag.
Delay in return to fertility: average 9 months
Reversible reduction in bone density
Problematic bleeding especially first 2 doses
Weight gain: 2/3 of women gain 2-3 kg
What is the subdermal progesterone implant comprised of?
Core: 68mg etonogestrel
Membrane: ethinyl vinyl acetate (EVA)
What is Nexplanon?
The progesterone implant
What is the role of the progesterone implant?
Inhibitor of ovulation and effect on cervical mucus
How often must the progesterone implant be changed?
Every 3 years
What type of contraception is the coil?
Long Acting Reversible Contraception
What are the two types of coil?
Copper IUD
Mirena IUS
What is the mode of action of the copper IUD?
Toxic to sperm: stops sperm reaching egg.
May sometimes work by preventing implantation of fertilised egg.
Hormone free.
How long can a copper IUD last?
5-10 years depending on type
What is the mode of action of the Mirena (Levonorgestrel) IUS?
Affects cervical mucus and endometrium
Stopes fertilisation of egg
May prevent implantation of fertilised egg.
Slow release progesterone on stem
85% of women almost bleed free by 12 months
When does the Mirena IUD need to be changed?
Every 5 years
What are the options of emergency contraception?
Copper IUD: most effective (fit before implantation, within 120 hrs)
Levonorgestrel pill: take within 72hrs
Ulipristal pill (Ellaone): take within 120hrs
What drugs reduce the effectiveness of combined pill, patch, ring, POP and implant? Why is this?
Enzyme inducing drugs: carbamazepine, topiramate, rifampicin
These increase the metabolism of progesterone and oestrogen
Progesterone injections and Copper IUD or morning after pill are not affected.
Describe the process of female sterilisation.
Laparoscopic. Filshie clips applied across tube to block lumen.
Irreversible
No effect on period/ hormones.
May do salpingectomy at planned Caesarean section if baby seems well and discussed in advance.
Describe the process of a vasectomy.
Vas deferens divided and ends cauterised. Small incision midline of scrotum.
Local anaesthetic
Takes 4-5 months to be effective.
What proportion of women in the UK will have an abortion?
1 in 3 women
In what age group to abortions most commonly occur?
20-24 age group
Describe the procedure for a surgical termination of pregnancy (STOP).
Cervical priming: misoprostol 3 hrs preop. Helps dilation and reduces risk of perforation/ haemorrhage.
Transcervical: 6-10mm suction catheter
<10 mins
What is used in a medical termination of pregnancy (MTOP)?
Mifepristone oral antiprogesterone tablet.
36-48hrs later, uterine contraction which opens cervix and expels pregnancy
What is a diaphragm?
Barrier method of contraception. Fits inside vagina and prevents sperm passing through the cervix.
Inserted before sex
Works better when used with a spermicide
What is a cervical cap?
Barrier method of contraception. Fits over the cervix and blocks sperm from entering through os.
What are the failure rates for perfect and typical use of condoms?
Perfect use: 3%
Typical use: 12%
