Contraception Flashcards
What are some absolute contraindications of the COCP?
Smoker ages 35+, <6 weeks post-partum, breast feeding, hypertension, current/past VTE history, migraine with aura, CVD, current breast cancer, liver cirrhosis
What are some relative contraindications of the COCP?
Adequately controlled hypertension, migraine and 35+, BMI over 35, enzyme-inducing medications
How does the COCP work?
- Stops ovulation
- Increases cervical mucus
- Thins endometrium
How is the COCP taken?
Once daily-> 3 weeks on + 1 week off
What are the risks and side effects of the COCP?
- Hormonal-> weight gain, acne, mood changes, headache
- Blood clots
- Increases breast + cervical cancer risk
- Lighter periods
What are some positives about the COCP?
- Can control periods, bleeding and pain
- Reduces risk of endometrial + cervical cancer
What should someone do if they miss one pill (COCP)?
- Take ASAP even if means two at same time
- If next pill on time then should be fine
What should someone do if they miss two pills (COCP)?
- Take 1 pill immediately
- Use condoms for 7 days
- Further management depends on week
What should someone do if they miss two pills (COCP) in the first week of their packet?
If had sex in pill-free interval or 1st week of packet-> will need emergency contraception
What should someone do if they miss two pills (COCP) in the second week of their packet?
- Take 1 pill immediately
- Use condoms for 7 days
- No further action
What should someone do if they miss two pills (COCP) in the third week of their packet?
- Take 1 pill immediately
- Use condoms for 7 days
- Omit the pill-free week
When should someone on the COCP use condoms for 7 days?
- D+V
- Enzyme inducing drugs
- Usually when missed 2 or more pills
What are some absolute contraindications of the combined contraceptive patch?
Same as COCP-> smoker ages 35+, <6 weeks post-partum, breast feeding, hypertension, current/past VTE history, migraine with aura, CVD, current breast cancer, liver cirrhosis
What are some absolute contraindications of the combined contraceptive vaginal ring?
Same as COCP-> smoker ages 35+, <6 weeks post-partum, breast feeding, hypertension, current/past VTE history, migraine with aura, CVD, current breast cancer, liver cirrhosis
What are some relative contraindications of the combined contraceptive patch?
Same as COCP-> Adequately controlled hypertension, migraine and 35+, BMI over 35, enzyme-inducing medications
What are some relative contraindications of the combined contraceptive vaginal ring?
Same as COCP-> Adequately controlled hypertension, migraine and 35+, BMI over 35, enzyme-inducing medications
How does the combined contraceptive patch work?
- Stops ovulation
- Increases cervical mucus
- Thins endometrium
How does the combined contraceptive vaginal ring work?
- Stops ovulation
- Increases cervical mucus
- Thins endometrium
How is the combined contraceptive patch administered?
Change weekly with 1 patch-free week per month
What are some of the risks and side effects of the combined contraceptive patch?
- Hormonal-> weight gain, acne, mood changes, headache
- Blood clots
- Increases breast + cervical cancer risk
- Lighter periods
- Local irritation
What are some positives about the combined contraceptive patch?
- Can control periods, bleeding and pain
- Reduced risk of endometrial + ovarian cancer
- Don’t need to remember to take a pill every day
- Effective when D+V etc
How is the combined contraceptive vaginal ring administered?
Leave in for 3 weeks then 1 ring-free week
What are some of the risks and side effects of the combined contraceptive vaginal ring?
- Hormonal-> weight gain, acne, mood changes, headache
- Blood clots
- Increases breast + cervical cancer risk
- Lighter periods
- Pain from ring during intercourse-> can remove but only for 3 hours max
- Can come out on its own
What are some of the positives of the combined contraceptive vaginal ring?
- Can control periods, bleeding and pain
- Reduced risk of endometrial + ovarian cancer
- Don’t need to remember to take a pill every day
- Effective when D+V etc
How effective if the COCP?
- When used correctly-> 99%
- Typically-> 92%
How effective is the combined contraceptive patch?
- When used correctly-> 99%
- Typically-> 92%
How effective is the combined contraceptive vaginal ring?
- When used correctly-> 99%
- Typically-> 91%
How effective is the progesterone-only pill?
- When used correctly-> 99%
- Typically-> 92%
What are the contraindications of the progesterone-only pill?
Forgetfulness, breast cancer, undiagnosed PV bleeding, liver disease
How does the progesterone-only pill work?
- Increases cervical mucus
- Thins endothelium
How is the progesterone-only pill administered?
Once daily without a pill-free break
What are some risks and side effects of the progesterone-only pill?
- Hormonal-> weight gain, acne, mood changes, headache
- Periods-> can stop or be irregular, lighter or more frequent
- Must take at same time each day-> window of effectiveness much narrower
What are the positives of the progesterone-only pill?
- Not as many side effects as COCP
- Very effective when taken properly
What should be done if someone misses one dose of the progesterone-only pill (within 3 hours)?
Take as soon as remember + no action needed
What should be done if someone misses one dose of the progesterone-only pill (3 hours late or 12 hours late for Cerazette?)
- Use condoms for 2 days
- Consider emergency contraception-> if had sex in 2-3 days before or since missed pill
How effective is the copper coil (IUD)?
Over 99%
What are the contraindications of the copper coil (IUD)?
Pelvic infection, PID <3 months ago, gynae cancer, small uterine cavity, undiagnosed PV bleeding, copper allergy
How does the copper coil (IUD) work?
Acts as spermicide + causes intra-uterine inflammation
How long does the copper coil (IUD) last?
-Usually 5 years
What are the risks and side effects of the copper coil (IUD)?
- Infection in 1st 3 weeks
- Bleeding after procedure
- Perforation (1/1000)
- Expulsion (1/20)
- Vasovagal (1/10)
- Heavier periods
What advice should be given to people getting the copper coil (IUD)?
- Check strings monthly
- STI check before insertion
- If >40 can stay in place until menopause
When can the copper coil (IUD) be fitted?
- As emergency contraception (within 5 days of sex)
- Any time if not had sex since period
- Ideally within first 5 days of period
- Should be effective immediately
How effective is the intra-uterine coil (IUS)?
Most effective-> over 99%
What are the contraindications of the intra-uterine coil (IUS)?
Pelvic infection, PID <3 months ago, gynae cancer, small uterine cavity, undiagnosed PV bleeding
How does the intra-uterine coil (IUS) work?
- Stops ovulation
- Increases cervical mucus
- Thins endometrium
How long does the intra-uterine coil (IUS) last?
- Usually 5 years
- Jaydess-> 3 years
What are the risks and side effects of the intra-uterine coil (IUS)?
- Infection in 1st 3 weeks
- Bleeding after procedure
- Perforation (1/1000)
- Expulsion (1/20)
- Vasovagal (1/10)
- Some hormonal-> mood swings, breast tenderness, acne
- Spotting for 6 months then light/absent periods
What are the positives of the intra-uterine coil (IUS)?
- Can forget about it
- Reduced dysmenorrhoea + menorrhagia
What additional advice should be given to people getting the intra-uterine coil (IUS)?
- Check strings monthly
- STI check before insertion
- If >45 can stay in place until menopause
When should the intra-uterine coil (IUS) be fitted?
- Ideally within first 7 days of period
- If not-> should use barrier contraception for 7 days after fitting
What are the contraindications of the implant?
Liver/genital/breast cancer, liver disease, undiagnosed PV bleeds, on enzyme inducing medications
How does the implant work?
- Contains progesterone
- Stops ovulation
- Increases cervical mucus
- Thins endometrium
How long does the implant last?
3 years
What are some of the side effects of the implant?
- Some hormonal side effects-> weight gain, acne etc
- Periods can stop, become irregular or get longer
- Insertion risks-> bruising, infection, scarring, expulsion
How is the implant inserted?
- Under the skin of upper arm under local anaesthetic
- Can feel it
When should the implant be inserted?
- Ideally within first 7 days of period
- If not-> should use barrier contraception for 7 days after fitting
How effective is the implant?
Over 99%
How effective is the Depo injection?
97%
What are the contraindications of the depo injection?
Liver/genital/breast cancer, liver disease, undiagnosed PV bleeds, on enzyme inducing medications
How does the depo injection work?
- Contains progesterone
- Stops ovulation
- Increases cervical mucus
- Thins endometrium
How long does the depo injection last?
3 months (13 weeks)
What are the side effects of the Depo injection?
- Some hormonal side effects-> weight gain, acne etc
- Periods-> can stop, become irregular or longer
- Takes time for fertility to return
- Osteoporosis-> should consider stopping at 2 years and definitely at 5 years
- Side effects can last 3 months as irreversible
How effective are condoms?
- When used properly-> 98%
- Typical use-> 85%
What are the contraindications to condoms?
Latex allergy-> can get ones without
How do condoms work?
Physical barrier to sperm
What are the risks of condoms?
- Small allergy risk
- May slip off or break
- Interrupts sex
What are the benefits of condoms?
Only contraception with STI protection
How effective is the diaphragm?
Around 84%
How is the diaphragm used?
- Inserted into vagina before sex to cover cervix
- Needs spermicide
- Leave in for 6 hours after
What are the positives of using a diaphragm?
- No hormonal side effects
- Reuseable after cleaning
What are the risks of using a diaphragm?
- Insertion can be difficult
- Cystitis
- Doesn’t protect from STIs
- Don’t use during periods-> TSS risk
How effective is tubal ligation?
- Failure rate of 1/200
- So over 99% effective
How is tubal ligation done?
Fallopian tubes clipped laproscopically under GA
What are the risks of tubal ligation?
- Failure-> 1 in 200
- Anaesthetic risks
- Bleeding, bruising, infection
- Irreversible
How effective is vasectomy?
-Very-> failure rate only 1 in 2000
How is a vasectomy perfored?
- Vas deference cut + tied with forceps through skin or scrotum
- Local anaesthetic
- Takes 20 minutes
What are the risks of vasectomy?
- Failure rate-> 1 in 2000
- Bleeding, bruising, infection
- Swollen scrotum for few days
- Sperm granulomas if leaks
- Chronic testicular pain
What follow up and advice should be given after a vasectomy?
- Can take 3 months for remaining sperm to be used up
- Take sperm sample at 8 weeks then 2-4 weeks later-> both need to be negative
- Can have sex with a condom whenever feel ready
How effective is the fertility awareness method?
Around 73%
How does the fertility awareness method work?
- Monitor and record fertility signals during cycle-> temperature, cervical fluids
- Use to work out when likely to get pregnant
What are the benefits of the fertility awareness method?
- No side effects
- Normal fertility instantly if decide to plan pregnancy
What are the risks of the fertility awareness method?
- Least effective method
- Can be a lot of effort
- Measurements can be affected by stress or illness
