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Repro Phys > Contraception > Flashcards

Contraception Flashcards

1
Q

Combined oral contraceptives

A

This form of birth control suppresses ovulation (the monthly release of an egg from the ovaries) by the combined actions of the hormones oestrogen and progestogen.

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2
Q

Progestogen only methods

A

Progestogen-only pill; Progestogen-only implant; Progestogen-only injectables. Progestin-only methods have several effects in the body that help prevent pregnancy: The mucus in the cervix thickens, making it difficult for sperm to enter the uterus and fertilize an egg; they stop ovulation, but they do not do so consistently.

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3
Q

Emergency contraception

A

Forms of contraception, especially contraceptive pills, that are effective if administered within a specified period of time after sexual intercourse.

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4
Q

Intra-uterine devices

A

A contraceptive device fitted inside the uterus and physically preventing the implantation of fertilized ova.

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5
Q

Pearl index

A

The number of contraceptive failures per 100 women-years of exposure, and uses as the denominator the total months or cycles of exposure from the initiation of the product to the end of the study or the discontinuation of the product.

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6
Q

The Perfect Contraceptive

A
  • 100% Reliable
  • 100% Safe
  • Non User Dependent
  • Unrelated to Coitus
  • Visible to the Woman
  • No ongoing Medical Input
  • Completely reversible within 24 hours
  • No Discomfort
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7
Q

Risks

A 
Risks of Treatment
• Cardiovascular
• Neoplastic
• Emotional
• Infection related
• Allergic
• Iatrogenic
Risks of no treatment
• Childbirth related
• Abortion related
• Social costs
• Economic costs
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8
Q

Benefits

A 
Benefits of Treatment
• Non Contraceptive 
• Psychosexual
• Choice
• Sexual Health
• Cost savings
• Female equality

Benefits of no Treatment
• Non interference
• Population growth
• Control of women

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9
Q

Combined Oral Contraception

A
  • Oestrogen EthinylOestradiol - 20,30,35,50 micrograms
  • Progestogens
  • Older (2nd generation) – Norethisterone (Norethindrone) & Levonorgestrel
  • Newer(3rd generation) – Desogestrel, Gestodene & Norgestimate (Noregestromin)
  • Latest (derived from Spironolactone) - Drospirenone
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10
Q

Combined Oral Contraception explained

A

Oestrogens act
• On anterior pituitary & hypothalamus
• Directly on the ovary
• On the Endometrium

Progestogens act
• On anterior pituitary & hypothalamus
• Directly on the ovary
• On the Endometrium
• On the fallopian tubes
• On cervical mucus

sites of action diagram

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11
Q

Combined Oral Contraception-

Benefits

A 
1. Contraceptive
• Reliable
• Safe
• Unrelated to coitus
• Woman in control
• Rapidly reversible
  1. Non contraceptive
    • Halve ca ovary
    • Halve ca endometrium
    • Helps endometriosis, menorrhagia, dysmenorrhoea,
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12
Q

Combined Oral Contraception

Risks

A
  • Cardiovascular - Arterial – Progestogen , HBP, smoking - Venous – Oestrogen-VTE-clotting disorders (DVT, PE, Migraine)
  • Neoplastic- Breast, Cervix, Liver
  • Gastrointestinal– COH/insulin metabolism, Weight gain,Crohns disease
  • Hepatic – hormone metabolisms, congenital nonhaemolytic, jaundices, gall stones
  • Dermatological – Chloasma, acne, erythema multiforme
  • Psychological – Mood swings, depression, Libido
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13
Q

Combined Oral Contraception

Pill Rules

A

Start 1st packet 1st day of a menstrual period
• Take 21 pills and stop for 7 day break (PFI)
• Restart each new packet on 8th day (same)
• Do not start new packets late
• If late or missed pills in 1st 7 days, condoms
• If missed pills in last 7 days no PFI

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14
Q

Combined Oral Contraception

Interacting Medication

A
  1. Liver enzyme inducing drugs - see list/MIMS
    • Affect metabolising of both oestrogen and progestogen
    • Beware rifampicin and anti-epileptics
    • 2. Broad spectrum antibiotics
    • Affect enterohepatic circulation of oestrogen
    only (40%)
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15
Q

Combined vaginal contraceptive

A 
Same as COCP except vaginal delivery 
(ring) for 21 days
• Remove for 7 days
• Adv – don’t have to take every day
• Disadv - don’t have to take every day!!
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16
Q

Progestogen Only Methods

A 
Default Methods
• Implants:  Nexplanon
Norplant (LNG)
• Hormone releasing IUCD:
Mirena IUS (LNG)
 User Dependent Methods
• POPs
- Desogestrel (Cerelle)
- Norethisterone 
- Ethynodiol diacetate
- Levonorgestrel
- Norgestrel

Injectables

  • Depo Provera (MPA) (12weekly)
  • Noristerat (NET)
17
Q

Why Cerelle is better than older POPs…

A 
• As effective as COCP
• No oestrogen – CIs e.g. breastfeeding
• Favourable side effect profile vs older 
POPS
• Bleeding as predictable as COCP
• 12 hour window
18
Q

IUCDs

A

Copper bearing intrauterine contraceptive
devices are inserted into the uterus by
suitably trained practitioners and may be
left in situ long term and act by
• 1. Destroying spermatozoa
• 2. Preventing implantation – Inflammatory
reaction and prostaglandin secretion as well
as a mechanical effect.

19
Q

IUCDs types

A 
. Copper bearing Ortho T 380 – 8 -12yr
• Multiload 375 – 5yr
• Multiload 250 – 5yr (Standard 
• & Short)
Nova T 380 – 5yr
• Nova T 200 – 5yr
• GyneFix  (IUI) – 5yr
• 2.  Hormone bearing – Mirena (IUS) – 5yr
20
Q

IUCDs Benefits

A 
Non user dependent
• Immediately and retrospectively effective
• Immediately reversible
• Can be used long term
• Extremely reliable
• Unrelated to coitus
• Free from serious medical dangers
21
Q

IUCDs Disadvantages

A 
• Has to be fitted by trained medical 
personnel
• Fitting may cause pain or discomfort
• Periods may become heavier & painful
• It does not offer protection against infection
• Threads may be felt by the male
22
Q

IUCDs Risks

A
  • Miscarriage if left in situ if a pregnancy
  • ?ectopics
  • May be expelled
  • The uterus may be perforated
23
Q

IUCDs Absolute contraindications

A
  • Current pelvic inflammatory disease
  • Suspected or known pregnancy
  • Unexplained vaginal bleeding
  • Abnormalities of the uterine cavity
24
Q

IUCDs- Relative contraindications?

A
  • Nulliparity
  • Past history of pelvic inflammatory disease
  • Not in mutually monogamous relationship
  • Menorrhagia / Dysmenorrhoea
  • Small uterine fibroids
  • NO!!!
25
Q

Condoms- Advantages

A 
Male
• Man in control
• Protects against STIs
• No serious health risks
• Easily available (free 
at Family Planning 
clinics)
 Female
• Woman in control
• Protects against STIs
• Can be put in in 
advance and left inside 
after erection lost
• Not dependent on 
male erection to work
26
Q

Condoms Disadvantages

A 
Male
• Last minute use
• Needs to be taught
• May cause allergies
• May cause psycho sexual 
difficulties
• Higher failure rate among 
some couples
• Oily preparations rot 
rubber
 Female
• Obtrusive
• Expensive
• Messy
• Rustles during sex
• Uncertain failure rate
27
Q

Caps

A 
Diaphragm Caps
• Made of latex
• Fit across vagina
• Sizes 55 – 95mm in 
5cm jumps
• Must be used with 
spermicide and left in 
at least 6 hours after 
sexual intercourse
 Suction (cervical) Caps
• Made of plastic
• Suction to cervix or 
vaginal vault
• Different sizes
• Must be used with 
spermicide and left in 
6 hours or more.
28
Q

Caps- Advantages

A 
Diaphragm Caps
• Woman in Control
• Can be put in in 
advance
• Offers protection 
against cervical 
dysplasias
• Perceived as “natural”
Suction Caps
• Suitable for women 
with poor pelvic 
muscles
• No problems with 
rubber allergies
• Very unobtrusive
• Woman in control
29
Q

Caps- Disadvantages

A 
Diaphragm Caps
• Needs to be taught
• Messy
• Higher failure rate 
than most other 
methods
• Higher UTI
• Higher Candiasis
Suction Caps
• Needs an accessible 
and suitable cervix
• Higher failure rate 
than diaphragm
• Not easy to find 
experienced teacher
30
Q

Fertility Awareness

A

• Prediction of ovulation ? 14/7 before period
• Sperm can survive 5 days in female tract
• Ova can survive 24 hours
• Ova are fertilised in the fallopian tube and take 4
days to reach the uterus and implant
• Cervical mucus is receptive to sperm around the
time of ovulation
• Use Periodic Abstinence/alternative contraception
to avoid pregnancy
• Time intercourse to pre-ovulatory phase to
conceive

31
Q

Natural Family Planning

A
  • Temperature
  • Rhythm
  • Cervix position
  • Cervical mucus
  • Persona
  • Lactational amenorrhoea (LAM)
32
Q

Fertility Awareness adva/disadvs

A 
Advantages
• Non medical
• Can be used in 3rd
world
• Allowed by Catholic 
church
• Can result in closeness 
of understanding 
between partners
Disadvantages
• Failure rate heavily user 
dependent
• Requires skilled teaching
• May require cooperation 
between partners
• May involve limiting 
sexual activity
• Can cause strain
33
Q

Emergency Contraception

A

• Postcoital Pills
- Up to 72 hours after unprotected sexual intercourse (UPSI)
• Schering PC4 – prevents 3 out of 4 pregnancies which would have occurred

• Levonelle – prevents
7 out of 8 pregnancies
• ellaOne (ulipristal)–similar

• Copper bearing IUCDs
• Up to 5 days after
presumed ovulation or 5 days after one singleepisode of UPSI at any time of the cycle
• Failure extremely rare

34
Q

Postcoital pills

A

Levonelle 2 consists of 2 tablets each
containing 750 micrograms of
Levonorgestrel
• 1.5mg one dose

• PC4
• Lower failure rate in 
1st 24 hours.
• Causes nausea & 
vomiting in many 
women
• Contraindicated 
during focal Migraine 
attack
• Levonelle 2
• Lower failure rate in 
1st 24 hours
• Very little nausea
• Only contraindicated 
in women taking very 
potent liver enzyme 
medication (anti TB)
ellaOne – ulipristal acetate
• New selective progestagen receptor 
modulator (SPeRM)
• Up to 120 hours
• RR 0.58 pregnancy vs Levonelle
• Possible slightly higher side effect profile –
GI symptoms mainly
35
Q

Post coital pills - effectiveness

A

Levonelle 2
Up to 24hrs – 95%
25 – 48 hrs - 85%
49 – 72 hrs- 58%

Schering PC4
Up to 24 hrs – 77%
25 – 48 hrs – 36%
49 – 72 hrs – 31%

36
Q

Postcoital Contraception

A 
PC4 & Levonelle 2
• Act by postponing 
ovulation in 1st part of 
the cycle – So beware!
• ??Act  by preventing 
implantation in 2nd
part of the cycle
• Copper IUCDs
• Copper kills sperm in 
1st part of the cycle
• Device prevents 
implantation in 2nd
part of the cycle
37
Q

CONTRACEPTIVE

EFFICACY (perfect use!)

A 
COCP - <1 /100 WOMAN YEARS
Depo   - <1 /100 WOMAN YEARS
IUCD  - <1 /100 WOMAN YEARS
IUS - <1 /100 WOMAN YEARS
Implants - <1 /100 WOMAN YEARS
POP - 1 /100 WOMAN YEARS
Condoms- Male     - 2 /100 WOMAN YEARS
- Female  - 5 /100 WOMAN YEARS
NFP - 2 /100 WOMAN YEARS
Diaph /Caps - 4-8 / 100WOMAN YEARS
Female Sterilisation - 1 / 200 failure rate
Male Sterilisation - 1 / 2000 failure rate
38
Q

CONTRACEPTIVE

EFFICACY (real use!)

A

COCP - 8 /100 WOMAN YEARS
• POP - 8 /100 WOMAN YEARS
• Condoms - 10-15 /100 WOMAN YEARS
• If it involves user input error the risks of failure are much
higher…

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