Contraception Flashcards
What are the methods which require ongoing action and methods which prevent contraception by default?
Methods which require ongoing action by the individual include: - Oral contraception - Barrier methods - Fertility awareness - Coitus interruptus - Oral Emergency contraception Methods which prevent conception by default: - IUCD/IUI/IUS - Progestogen implants - Progestogen injections - Sterilisation
What are the risks of contraception?
Contraception Risks Risks of treatment: - Cardiovascular - Neoplastic - Emotional - Infection related - Allergic - Iatrogenic Risks of no treatment: - Childbirth related - Abortion related - Social costs - Economic costs
What are the benefits of contraception?
Contraception Benefits Benefits of treatment: - Non contraceptive - Psychosexual - Choice - Sexual Health - Cost savings - Female equality Benefits of no treatment (seen mostly in other countries): - Non interference - Population growth - Control of women
How does each component of combined oral contraception work in the body?
Oestrogens act:
- On the anterior pituitary and hypothalamus
- Directly on the ovary
- On the endometrium, will cause proliferation by itself without progestogen
Progestogens act:
- On the anterior pituitary and hypothalamus
- Directly on the ovary
- On the endometrium, causes it to thin
- On the fallopian tubes, smooth muscle gets dilated
- On cervical mucus, causes thickening to stop sperm
What are the combined oral contraception benefits?
Contraceptive: - Reliable - Safe - Unrelated to coitus - Woman in control - Rapidly reversible Non contraceptive: - Halve ca ovary - Halve ca endometrium - Helps endometriosis, menorrhagia, dysmenorrhoea
What are the combined oral contraception risks?
- Cardiovascular:
· Arterial – Progestogen , HBP, if you smoke it might not be the best option
· Venous – Oestrogen-VTE-clotting disorders (DVT, PE, Migraine)- Neoplastic - Breast, Cervix, Liver (not so much breast or cervical cancer anymore)
- Gastrointestinal– COH/insulin metabolism (diabetics need to be careful), Weight gain (but not proven large scale), Crohns disease
- Hepatic – hormone metabolisms, congenital nonhaemolytic jaundices, gall stones
- Dermatological – Chloasma, acne, erythema multiforme
- Psychological – Mood swings, depression, Libido
What are the combined oral contraception pill rules?
Start 1st packet 1st day of a menstrual period
Take 21 pills and stop for 7 day break, this is your p something interval (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
How is the combined vaginal contraception different from the combined oral contraception pill?
Same as COCP except vaginal delivery (ring) for 21 days
Remove for 7 days
Advantage – don’t have to take every day
Disadvantage - don’t have to take every day, so you might forget you have it
What are the different types of progestogen-only contraception?
Progestogen Only method 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)
What is an IUCD?
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:
- Destroying spermatozoa through inflammation and the neutrophils recruited die and are spermicidal
- Preventing implantation
· Inflammatory reaction and prostaglandin secretion as well as a mechanical effect
What are the different IUCD types?
- 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
- Hormone bearing
- Mirena (IUS) – 5yr
What are the advantages and disadvantages of IUCDs?
IUCDs benefits
Non user dependent
Immediately and retrospectively effective
Immediately reversible
Can be used long term
Extremely reliable
Unrelated to coitus
Free from serious medical dangers
IUCDs Disadvantages
Has to be fitted by a trained medical professional
Fitting may cause pain or discomfort
Periods may become heavier and painful
It does no offer protection against infection
Treads may be felt by the male
Risks:
Miscarriage if left in situ if a pregnancy occurs
?ectopics
May be expelled, if its not pushed far enough and cervix is tight
The uterus may be perforated, if pushed in too far
What are the IUCD contraindications?
IUCDs absolute contraindications: - Current pelvic inflammatory disease - Suspected or known pregnancy - Unexplained vaginal bleeding - Abnormalities of the uterine cavity Relative contraindication: - Nulliparity - Past history of pelvic inflammatory disease - Not in mutually monogamous relationship - Menorrhagia/ dysmenorrhoea - Small uterine fibroids
What are the advantages and disadvantages of condoms?
Condoms advantages: Male: - Man in control - Protect against STIs - No serious health risk - Easily available Female: - Woman in control - Protects against STIs - Can be put in advance and left inside after erection lost - Not dependent on male erection to work
Condoms disadvantages: 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 tubber Female: - Obtrusive - Expensive - Messy - Rustles during sex - Uncertain failure rate
What are caps and the different types of caps?
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.
