Contraception Flashcards
What are the components of the COCP?
The COCP has two active ingredients:
- ethinyloestrodial (synthetic estrogen)
- levonorgestrel (synthetic progestin)
The MoA is:
✔️ inhibition of ovulation
✔️ thinning of the endometrium
✔️ thickening of the cervical mucus plug, to prevent passage of sperm
There are two formulations:
- 21 active days + 7 inactive days
- 24 active days + 4 inactive days
Identify indications for the COCP?
✔️ contraception (91 to 99% effective) ✔️ acne ✔️ abnormal uterine bleeding (e.g. dysmenorrhea, menorrhagia) ✔️ PCOS ✔️ endometriosis ✔️ PMS
Identify some CONTRAINDICATIONS for the COCP?
✔️ personal or family history of breast cancer
✔️ personal or family history of DVT or PE
✔️ obesity
✔️ 35 years + active smoking
✔️ 35 years + migraine with aura
✔️ impaired liver function
✔️ unexplained vaginal bleeding
What are some common side effects of the COCP?
✔️ nausea + vomiting ✔️ weight gain ✔️ headaches and migraine ✔️ depression / low mood ✔️ breakthrough bleeding ✔️ can take up to 12 months for fertility to return
Explain how the COCP should be implemented?
- It is best to begin the COCP whilst bleeding (days 1 to 5 of cycle).
- Take one pill every day (every 24 hours).
- If a pill is skipped but within 24 hours, take the pill as soon as remembered.
- If a pill is skipped but is greater than 24 hours, take the skipped pill PLUS the required pill (two pills in one day) and use alternative form of contraception for 7 days.
✔️ if < 7 days since most recent inactive pill, EMERGENCY CONTRACEPTION
✔️ if < 7 days since next inactive pill, continue the pack, do NOT take inactive pill - It is possible to run pill packets without a break –> this may cause breakthrough bleeding.
- Seek medical attention if headaches, migraines or visual disturbances occur.
What are the components of the MINI PILL?
Levonorgestrel (synthetic progesterone).
Mechanism of action is NOT inhibition / suppression of ovulation –> very unreliable in doing this. Main MoA is thinning of endometrial lining to prevent implantation of a fertilised egg.
Identify the indications and contraindications for the mini pill.
INDICATIONS
✔️ breast feeding
✔️ post partum
✔️ contraindications to COCP
CONTRAINDICATIONS ✔️ active breast cancer within last five years ✔️ SLE ✔️ unexplained vaginal bleeding ✔️ hepatocellular carcinoma
Explain the implementation of the MINI PILL.
The mini pill has a MoA that lasts ~21 hours. It should be taken within three hours each day.
If missed, alternative contraception should be used for 48 hours.
Identify some common side effects of the MINI PILL.
✔️ irregular menstrual periods ✔️ acne ✔️ weight gain ✔️ mood changes ✔️ breast tenderness
Describe the use of the IMPLANON.
Implanon is a subnormal device that contains a long-acting / slow-releasing synthetic progesterone.
It is inserted using a local anasthetic. The bar can be left in place for 3 years.
Advantages:
✔️ long acting contraception
✔️ 99% effective
✔️ do not need to remember to take every day; good for younger women / girls
✔️ fertility returns immediately after removal
Disadvantages:
✔️ irregular periods (amenorrhea, menorrhagia or light spotting / breakthrough bleeding)
✔️ must be replaced every three years
Compare the COPPER versus PROGESTERONE (MIRENA) IUD.
COPPER IUD
✔️ may be used / inserted as emergency contraception
✔️ left in place for 10 years
✔️ associated with heavier bleeding and cramping
✔️ spermidocidal
MIRENA
✔️ cannot be used as emergency contraception; placed during laparoscopic exploration / caesarian section etc.
✔️ left in place for 5 years
✔️ associated with lighter bleeding, amenorrhea and less cramping
✔️ also indicated in dysmenorrhea or menorrhagia
What are some contraindications to the IUD?
✔️ recent STI / PID
✔️ recent septic ectopic pregnancy / abortion
✔️ gyancaelogical malignancy
✔️ uterine anomaly
Identify some risks of the IUD.
✔️ 99% effective; still a small risk of pregnancy
✔️ perforation
✔️ spontaneous expulsion
✔️ ectopic pregnancy (if pregnancy does occur)
✔️ long-term irregular bleeding
✔️ PID (within first few months)
Describe how the IUD should be inserted.
- The IUD is best inserted during Days 1 to 5 of a woman’s cycle.
- Perform a high cervical / vaginal swab for STIs prior to insertion.
- If screen comes back positive, leave the IUD in place and treat aggressively with antibiotics.
- Review in 4 to 6 weeks for PID / STIs and to check the strings are still in place.
- Annual review after that.
EMERGENCY CONTRACEPTION ✔️active ingredients ✔️ implementation ✔️ mechanism ✔️ risks / disadvantages ✔️ alternatives
ACTIVE INGREDIENTS
Levonorgestrel 1.5g (synthetic progesterone)
This medication can be taken orally within 72 hours of unprotected sexual intercourse –> 99% effective if taken during this time.
IMPLEMENTATION
Oral pill; taken once.
May be prescribe with an anti-emetic to reduce N+V.
Vomiting and diarrhoea reduce effectiveness.
MECHANISM
Levonorgestrel delays ovulation.
Does NOT prevent implantation of an already fertilised egg.
RISKS / DISADVANTAGES ✔️significant nausea and vomiting ✔️ breast tenderness ✔️ may delay next period ✔️ next period may be heavy ✔️ not a sustainable means of ongoing contraception
ALTERNATIVES
The Copper IUD may also be used as a form of emergency contraception.
This can be placed within 5 days of unprotected intercourse and is 99% effective.
It can also be left in for 10 years for ongoing contraception.
FEMALE STERILISATION ✔️ description ✔️ benefits ✔️ risks ✔️ indications and contraindications ✔️ alternatives ✔️ after the procedure
DESCRIPTION
Female sterilisation is achieved by a process known as tubal ligation. This involves clipping the fallopian tube to prevent passage of the ovum from the ovary to the uterus.
The procedure is performed under general anasthetic.
There are three ways in which it can be performed:
- hysteroscopy
- laparoscopy
- laparotomy
BENEFITS
Tubal ligation is 99.5% effective in achieving permanent infertility / sterility.
RISKS ✔️ risk of unplanned pregnancy --> must check LMP, unprotected sex within 72 hours and serum hCG levels ✔️ profound regret ✔️ anaesthetic risks ✔️ intra-operative risks ✔️ early and late post-operative risks
INDICATIONS AND CONTRAINDICATIONS
Indications include:
✔️ completion of child rearing
✔️ desire for permanent sterilisation
Contraindications include: ✔️ hesitancy / doubt about the procedure ✔️ coercion ✔️ recent STI / PID ✔️ unprotected sex within last 72 hours ✔️ positive pregnancy test ✔️ gynaecological malignancy
ALTERNATIVES
✔️ long-active reversible contraception (LARC)
✔️ male sterilisation –> reversible, less risks, no GA required
AFTER THE PROCEDURE
✔️ usually can return home the day of the procedure, given patient is able to eat and drink appropriately and pain is well controlled
✔️ able to drive once can operate an emergency brake pain-free
✔️ return to full actives within 1 week
✔️ if on COCP prior to procedure, continue to take for 7 days
✔️ if using a Mirena prior to the procedure, continue to use for 7 days prior to removal
MALE STERILISATION ✔️ description ✔️ benefits ✔️ risks ✔️ indications and contraindications ✔️ alternatives ✔️ after the procedure
DESCRIPTION
Male sterilisation is achieved via a procedure known as a vasectomy.
There are two ways to perform this, both of which can be done under local anaesthetic:
- scalpel method
- non-scalpel method
BENEFITS
✔️ 99.8% effective (more effective than female sterilisation)
✔️ fully reversible in 60 to 70% of cases
✔️ does not require general anaesthetic
✔️ return to normal activity is quick
RISKS
✔️ not 100% effective against unplanned pregnancy
✔️ sperm can remain viable for 6 to 8 weeks
✔️ bruising, slight bleeding and pain in the area may persist for a few days to weeks
INDICATIONS AND CONTRAINDICATIONS
Indications
✔️ completion of child rearing
✔️ desire for permanent contraception
Contraindications
✔️ allergy to equipment used
✔️ hesitant about procedure
✔️ coercion
ALTERANTIVES
✔️ female sterilisation –> less effective, more risks associated with GA
✔️ female LARCs
AFTER THE PROCEDURE
✔️ avoid high physical exertion for 2 to 5 days afterwards
✔️ avoid ejaculation for 7 to 10 days afterwards
✔️ use alternative form of contraception for 6 to 8 weeks
✔️ follow up is required in 6 to 10 weeks with full semen analysis
