Contraception Flashcards by Kisspeptin GnRH

What are the contraception methods that require ongoing action?

→ Oral contraception
→ barrier methods

→ Fertility awareness
→ Coitus interruptus
→ Oral emergency contraception

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What are the methods which prevent contraception by default?

→ IUD/IUI/IUS
→ Progestogen implants

→ progestogen injections
→ Sterilisation

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What are the risks of treatment?

→ Cardiovascular
→ Neoplastic

→ emotional
→ infection
→ allergy
→ iatrogenic

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What are the risks of no treatment ?

→ childbirth related
→ abortion related

→ Social and economic costs

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What is the latest progestogen?

→ Drospirenone

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What do estrogens act on?

→ Anterior pituitary and hypothalamus
→ directly on the ovary

→ on the endometrium

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Where do progestogens act on?

→ Anterior pituitary and hypothalamus
→ Directly on the ovary

→ On the endometrium
→ Fallopian tubes
→ cervical mucus

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How does the combined oral contraceptive work?

→ Supraphysiological levels of progestogens and estrogens are given because this creates negative feedback
→ gnRH is not produced so FSH and LH are not produced

→ no follicle development and no ovulation

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What happens if only estrogen is given?

→ Endometrium keeps proliferating

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Why is progesterone added to the COCP?

→ Endometrium becomes thin
→ Implantation would not occur

→ Fimbriae become very inactive and delays gamete transport

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What are the benefits of combined oral contraception?

→ reliable
→ Safe

→ Unrelated to coitus
→ rapidly reversible

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What cancers does the COCP prevent?

→ 1/2 risk of ovarian cancer

→ 1/2 risk of endometrial cance

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What conditions does the COCP help?

→ endometriosis
→ Menorrhagia

→ dysmenorrhoea

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What are the cardiovascular risks of the COCP?

→ Arterial - HBP, smoking

→ Venous - DVT, PE, migraine

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What are the neoplastic risks of the COCP?

→ breast
→ cervix

→ liver

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What are the 3 gastrointestinal risks of COCP?

→ COH/insulin metabolism
→ Weight gain

→ Crohns

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What are the 3 hepatic risks of COCP?

→ Hormone metabolisms
→ Congenital nonhemolytic jaundice

→ Gallstones

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What are the 3 dermatological risks of COCP?

→ Chloasma
→ Acne

→ erythema multiforme

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What are the 3 psychological changes that COCP can have?

→ Mood swings
→ Depression

→ Libido

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How do you take the COCP?

→1st packet the 1st day of period
→ 21 pills and stop for a 7 day break

→ restart each new packet on the 8th day
→ if missed pills then no pill free interval

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What medications can interact with the COCP?

→ liver enzyme inducing drugs
→ Rifampicin and anti-epileptics

→ Broad spectrum antibiotics

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What are the 2 progestogen only implants?

→ Nexplanon

→ Norplant

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What is the progestogen only IUD called?

→ mirena

Why is cerelle better than progesterone only pills?

→ As effective as the combined contraceptive
→ no estrogen - no effects on breastfeeding

→ bleeding is as predictable as the combined pill

How do you use the combined vaginal contraceptive (ring)?

→ Vaginal delivery for 21 days | → remove for 7 days

How do copper containing IUDs work?

→ Destroying spermatozoa → Preventing implantation - inflammatory reaction → Sterile endometrium due to a foreign body in the uterus

What are the 3 copper bearing IUDs called?

→ Ortho T380 → Multiload 275 → Multiload 250

What are the 2 progesterone IUDs called?

→ Mirena | → Jaydess

What are benefits of IUCDs?

→ Non user dependent → Immediately and retrospectively effective → reversible → longterm → reliable → unrelated to coitus

What are disadvantages of the IUCDs?

→ Fitted by trained medical personnel → Fitting can cause pain and discomfort → periods can become heavier and more painful → no protection against infection → threads can be felt

What are the risks of IUDs?

→ Miscarriage if pregnancy occurs → Ectopic → expelled if not deep enough → Uterus can be perforated

What are absolute contraindications of IUDs?

→ Pelvic inflammatory disease → Suspected pregnancy → Unexplained vaginal bleeding → Abnormalities of uterine cavity

What are relative contradindications of IUDs?

→ not mutually monogamous → Nulliparity → Menorrhagia/dysmenorrhea → Small uterine fibroids

What are advantages of the male condom?

→ Man in control → protects against STIs → no health risks

What are disadvantages of the male condom?

→ Last minute use → needs to be taught → Can cause allergies

What are advantages of the female condom?

→ Protects against STIs → Can be put in advance → not dependent on erection

What are disadvantages of the female condom?

→ Messy → Expensive → obtrusive

What must caps be used with?

Spermicide

What are advantages of diaphragm caps?

→ Can be put in advance | → protection against cervical dysplasias

What are advantages of suction caps?

→ Suitable for women with poor pelvic muscles | → unobtrusive

What are disadvantages of diaphragm caps?

→ needs to be taught → messy → higher UTI → higher candidiasis

What are disadvantages of suction caps?

→ Accessible and suitable cervix → not easy to find a teacher → higher failure rate than diaphragm

How long can sperm and egg survive?

→ egg 24 hrs | → sperm 5 days

How long does the egg take to reach the uterus and implant?

4 days

What are the advantages of the fertility awareness method?

→ Non medical → can be used in 3rd world → allowed by catholics → closeness between partners

What are disadvantages of the fertility method?

→ Failure rate is user dependent → requires skill → cooperation → limiting sexual activity

What are the 3 post coital pills?

→ EllaOne → Levonelle → Schering PC4

When can you take emergency contraception?

→ upto 72 hours after unprotected sex

When can you put an IUD in as emergency contraception?

→ upto 5 days after unprotected sex

What does Levonelle contain?

→ 750 mg of levonorgesterel

What is PC4 contraindicated in?

→ focal migraine attack

What is Levonelle contraindicated in?

→ Women taking potent liver enzyme medication

What is EllaOne?

→ selective progestagen receptor

What is the effectiveness of Levonelle upto 24hours?

→ 95%

How do PC4 and levonelle prevent pregnancy?

→ Postpone ovulation in 1st part of cycle

How do copper IUDs prevent pregnancy?

→ Copper kills sperm in 1st part of cycle | → prevents implantation in 2nd part of cycle

What are the efficacies of COCP, depo provera, IUCDs, IUS, implants and POP?

→ <1/100 woman will get pregnant