Contraception Flashcards by Rose Leckie

what are the three main mechanisms of action of contraception?

prevention of ovulation
prevention of fertilisation
prevention of implantation

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how do contraceptives prevent ovulation?

hormonal methods work by suppressing FSH and LH

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what is the main mechanism of moth hormonal methods of contraception?

prevention of ovulation

except hormone coil and traditional POPs

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what is the mechanism of action of emergency hormonal contraception?

temporarily delays ovulation

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how do some contraceptives prevent fertilisation?

creating a barrier

direct toxicity

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name some contraceptives that work by preventing fertilisation

condoms 
diaphragm + spermicide 
sterilisation 
IUDs 
hormonal methods

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name some contraceptives that prevent implantation

hormonal methods
IUDs - second mechanism of action
copper coil as emergency contraception

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how do some contraceptives prevent implantation?

create a hostile endometrium or cause direct toxicity

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what is a traditional POP?

progesterone only pill that contains levonorgestrel or norethisterone

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what is an IUD?

intrauterine device

aka the copper coil

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what is an IUS?

intrauterine system

aka hormone coil

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what is DMPA?

medroxyprogesterone acetate

aka depo provera

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what is LAM?

lactational amenorrhoea method

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what is SDI?

the subdermal implant

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what types of contraception fall under the classification of LARC?

IUD
implant
DMPA injections

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what does LARC stand for?

long acting reversible contraceptives

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how long does the copper IUD last?

up to 10 years

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what is the mechanism of action of hormone and copper coils?

mainly prevent fertilisation

also prevent implantation

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what are there small risks of with hormone and copper coils?

perforation
PID
malposition/expulsion

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when are hormone and copper coils unsuitable?

submucosal fibroids

uterine malformation

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when can the copper IUD be kept in til if inserted over the age of 40?

til the menopause

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is the copper IUD a hormonal method?

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when can the copper IUD be used as emergency contraception?

up to 5 days after sex
OR
5 days after the earliest estimated day of ovulation

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what is a common side effect of the copper IUD?

heavier, longer and more painful periods

especially in the first three months

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what can help with the side effects of the copper IUD?

NSAIDs

what is the main suitable and reliable method of contraception for women who have had breast cancer?

copper IUD

which is more effective - IUD or IUS?

IUS

what is the main IUS in use?

mirena coil

besides contraception, what else can the mirena IUS be used for?

treat heavy periods part of JRT endometriosis many other therapeutic uses

what are common side effects of IUS insertion?

irregular spotting PV bleeding in the first few months

what is the most effective of all contraceptive methods?

subdermal implant (SDI)

what is another name for SDI?

nexplanon

how long does the SDI last?

three years

what hormone is released by the SDI?

progestogen only

what is the main side effect of the SDI?

prolonged PV bleeding

what is CHC?

combined hormonal contraception

what is included under CHC?

combined pill patch ring

what is the mechanism of action of CHC?

stops ovulation

what is the COC?

combined oral contraceptive

when should the COC be started?

first 5 days of period OR at any time in the cycle, should also use condoms for 7 days

how is the COC taken usually?

daily for 21 days followed by a 7 day break

what are possible off licence ways to take the COC?

tricycling - three packs then a 7 day break continuous use

what advice is given if patients take the COC continuously?

if you bleed for four days or more, stop for four days then start again

what factors may affect the effectiveness of CHC?

impaired absorption increased metabolism forgetting to take it

what are three possible risks of CHC?

venous thrombosis arterial thrombosis adverse effects on some cancers

what should be done to minimise risk of VTE in patients using CHC?

prescribe the most effective option with the lowest risk discuss signs and symptoms with the patient

what possible circulatory effect can the COC have?

systemic hypertension small increase in BP in some patients

when should patients on the COC get their BP checked?

initially at three months then annually

what contraceptive is contraindicated in individuals with migraine with aura?

CHC

what cancers can CHC have unwanted effects on?

breast cancer | cervical cancer

what examination should be done before first prescription of CHC?

record BP and BMI | check smear status if relevant

what should be referred to if a patient with multiple risk factors wants to start contraception?

UKMEC

what cancers can CHC provide protection against?

ovarian cancer | endometrial cancer

what are some common side effects of CHC?

nausea spots bleeding breast tenderness

what is the POP?

progestogen only pill

name a POP commonly used

cerelle

what is the mode of action of desogestrel POP?

inhibits ovulation

what are the three progestogen only methods of contraception?

POP subdermal implant DMPA

how should progestogen only methods be started?

day 1-5 of period OR anytime if sure not pregnant + condoms for 7 days (2 for POP_)

what is the main contraindication to progestogen only methods?

current breast cancer

what are possible side effects of the POP?

nausea spots bleeding headaches

what are the two options for DMPA injections?

depo provera | sayana press

what is the mechanism of action of DMPA injections?

lower estradiol | supresses FSH

how are DMPA injections administered?

sayana press = self administered depo by doctor

what are possible side effects of DMPA injections?

``` nausea weight gain spots headaches bleeding ```

what is the most effective mechanism of emergency contraception?

copper IUD

what should be offered first line as emergency contraception?

copper IUD

what are the three possible options for emergency contraception?

copper IUD EllaOne levonelle

what does EllaOne contain and how does this work?

ulapristal acetate progestogen receptor modulator

when can EllaOne be used?

up to 5 days after sex

how does EllaOne work?

stops the LH surge and delays ovulation

what makes EllaOne more effective?

taking it earlier

what is levonelle?

essentially a big dose of progestogen

when can levonelle be used?

best up to 72 hours after sex can be used later if needed

how does levonelle work?

inhibits ovulation

when does a double dose of levonelle need to be taken?

body weight > 70kg