Contraception Flashcards
If asked to discuss contraception in an OSCE, what should you cover?
- Patients wishes (including whether want to remember every day, need STI protection, planned pregnancies in future etc…)
- Different options
- Suitability (considering contraindications & risks)
- Mechanism of action
- Instruction of usage
State some contraceptive methods
- Natural family planning (“rhythm method”)
- Barrier methods (i.e. condoms)
- Combined contraceptive pills
- Progestogen-only pills
- Coils (i.e. copper coil or Mirena)
- Progestogen injection
- Progestogen implant
- Surgery (i.e. sterilisation or vasectomy)
- Emergency contraception (not to relied on as a regular contraceptive)
What is the UKMEC?
Describe the 4 levels
Faculty of Sexual & Reproductive Health (FSRH) published UK Medical Eligibility (UKMEC) guidelines to categorise risk of different contraceptive methods in different individuals
- UKMEC 1: no restriction (minimal risk)
- UKMEC 2: benefits generally outweigh risks
- UKMEC 3: risks generally outweigh benefits
- UKMEC 4: unacceptable risk (contraindicated)
Only contraceptive method that is 100% effective is….
Complete abstinence
State the effectiveness with both perfect use and typical use for the following contraceptive methods:
- Natural family planning
- Condoms
- COCP
- POP
- Progestogen injection
- Progestogen implant
- Coils
- Surgery (vasectomy or sterilisation)
*NOTE: sterilisation has failure rate of 1 in 200, vasectomy has failure rate of 1 in 2000
You need to see if pt has any specific risk factors/potential contraindications to determine most suitable contraception; state some key risk factors/contraindications you should ask about (and for which contraceptive method it applies to)
- Breast cancer: avoid hormonal treatment and go for barrier or IUD
- Cervical or endometrial cancer: avoid IUS
- Wilson’s disease: avoid IUD
There are specific risk factors that should make you avoid the combined contraceptive pill (UKMEC 4):
- Uncontrolled hypertension (particularly ≥160 / ≥100)
- Migraine with aura
- History of VTE
- Aged over 35 smoking more than 15 cigarettes per day
- Major surgery with prolonged immobility
- Vascular disease or stroke
- Ischaemic heart disease, cardiomyopathy or atrial fibrillation
- Liver cirrhosis and liver tumours
- Systemic lupus erythematosus and antiphospholipid syndrome
Does HRT provide contraception?
NO
COCP can be used up until what age?
COCP can be used up to 50yrs and can treat perimenopausal symptoms
Progestogen injection should be stopped before what age and why?
Should be stopped before 50yrs dur to risk of osteoporosis
What is the advice regarding contraception for women that are approaching/of menopausal age and are taking progestogen only contraception?
Continue until either:
- FSH blood test >30IU/L on 2 tests taken at least 6 weeks apart- advise to continue for 1 more year
- 55yrs of age- advise can stop contraception
Discuss, generally, what contraception is often best in those under 20yrs
- Combined and progestogen-only pills are unaffected by younger age
- The progestogen-only implant is a good choice of long-acting reversible contraception (UK MEC 1)
- The progestogen-only injection is UK MEC 2 due to concerns about reduced bone mineral density
- Coils are UKMEC 2, as they may have a higher rate of expulsion
What should you advise pts, regarding lubricants, if they use condoms for contraception?
Avoid oil based lubricants as they can damage latex condoms making it more likely that they will tear
*NOTE: polyurethane condoms can be used in latex allergy
State some examples of barrier contraceptives
- Condoms (male & female)
- Diaphragms
- Cervical caps
- Dental dams
Explain how diaphragms work
Typically rubber structures with metal inner frame that span the posterior fornix to the anteriorinferior wall of vagina; they cover cervix and hence prevent sperm entering. Held in place by vaginal muscles, tension of ring & pubic bone. Often combined with spermicide to increase effectiveness.
Explain how cervical caps work
Sit directly over cervix to prevent sperm entry; held in place by suction & vaginal tone. Often combined with spermicide to increase effectiveness.
State some advantages & disadvantages of male condoms
Advantages
- No contraindications (use polyurethane if latex allergy)
- Only contraception controlled by male (may be desirable)
- Widely available
- Simple to use
- Protection against STIs
Disadvantages
- Perfect use rarely achieved
- Reduce sensitivity and/or arousal
- Have to interrupt sex to put it on
State some advantages & disadvantages of female condoms
Advantages
- No contraindications
- Less likely to tear than male condoms
- May protect against some STIs (not as much as male condoms)
- Can be inserted up to 8hrs before intercourse
Disadvantages
- Perfect use rarely achieved (may forget, may be dislodged)
- Penis could insert between condom & vaginal wall
- Can be noisy or uncomfortable for woman during sex
State some advantages & disadvantages of diaphragms and cervical caps
Advantages
- Can be inserted up to 3hrs before intercourse
Disadvantages
- Perfect use rarely achieved
- Require planning
- Dexterity/ability to insert
- Needs to be correct size (hence any weight gain or pregnancy requires a refitting)
- Increased risk of urinary tract infections
- Little/no protection STIs
- Cannot be used during menstruation (alternative contraception required)
Explain how you would instruct a pt to use a diaphragm and cervical cap
- Requires fitting by trained professional to ensure correct size & teach woman how to use
- Check for any holes/damage prior to insertion
- Apply spermicide (either fill cap or put a couple of strips on diaphragm)
- Insert up to 3hrs before sexual intercourse
- Leave for at least 6hrs after
- Diaphragms must be removed after 30hrs
- Caps must be removed after 48hrs
- So long as not exceeding above time periods, can be left in place for recurrent sexual intercourse but additional spermicide (inserted into vagina) should be used and should always check is still in position
- When remove, wash with mild soap & water then dry
Explain how dental dams work
Used during oral sex to provide barrier between mouth & vulva, vagina or penis. Used to prevent infections that can be spread via oral sex including chlamydia, gonorrhoea, HSV 1 & 2, HPV, HIV, public lice etc…
Describe the mechanism of action of COCP (3)
- Preventing ovulation (primary mechanism of action)
- Progesterone thickens cervical mucus
- Progesterone inhibits proliferation of endometrium thus reducing chance of sucessful implantation
*Inhibits ovulation as oestrogen & progesterone have negative feedback on hypothalamus & anterior pituitary supressing release of GnRH, LH and FSH. Without LH surge, ovulation does not occur. When have pill-free week (or take placebos) causes a fall in oestrogen and progesterone hence endometrium degenerates resulting in a withdrawal bleed (not called menstrual period as not part of natural menstrual cycle)
Breakthrough bleeding can occur when taking COCP for extended periods of time without a pill-free period; true or false?
True
State the two types of COCP and explain the difference
- Monophasic: contain same amount of hormone in each pill
- Biphasic: contain varying amounts of hormone to match normal cyclical hormone changes more closely
