Contraception Flashcards by Katie Clark

What is the world’s most widely used contraceptive method?

Withdrawal

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Fertility awareness involves being able to recognise the signs + symptoms of fertility during a menstrual cycle, so that you can avoid/plan a pregnancy (family planning). What 5 things in particular can a woman monitor?

Basal body temperature
Cervical mucous
Cervical position
"Standard" days in cycle
Breastfeeding

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When must basal body temperature be taken when assessing the menstrual cycle? What is the expected increase in body temperature?

Before rising in the morning

Increase greater than 0.2’C sustained for at least 3 days following 6 days of a lower temperature

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Describe cervical mucous immediately after a period

Low secretion, dry vagina

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Describe cervical mucous leading up to ovulation

Moist, sticky, cloudy 8 days before

Wet, clear, slippery, stretchy 4 days before

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Describe cervical mucous post-ovulation and its significance/relation with fertility

Thick and sticky

Fertility usually ended after day 3 of thick sticky mucous

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What is the cervical position during fertility compared to when less fertile

High in vagina, soft and open when fertile; low in vagina, firm and closed when less fertile

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In a 28 day menstrual cycle, which days are women most fertile?

Days 8-18

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Breastfeeding can be very effective for fertility. What are the 3 criteria?

Exclusively breast feeding
Less than 6 months post-natal
Amenorrhoeic

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What is the UK medical eligibility criteria (UK MEC)?

Summarises various medical conditions and their suitability for different forms of contraception

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What is category 1 of the UKMEC?

No restriction on use of contraception

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What is category 2 of the UKMEC?

Advantage of using contraception outweighs theoretical/proven risk to health

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What is category 3 of the UKMEC?

Risk of using contraception outweighs benefit, thus use is not recommended without expert clinical opinion

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What is category 4 of the UKMEC?

Unacceptable risk if contraception is used

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The Pearl Index estimates failure rates of contraception - what is the formula?

[No. of accidental pregnancies x 1200]/total no. of months of exposure

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What does LARC stand for?

Long-acting reversible contraception

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List the main LARC methods used

Injection: Depo Provera (IM)
Sayana press (SC)
Intrauterine device (IUD)
Intrauterine system (IUS)
Implant

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How does Depo Provera work? How often is it given?

Inhibits ovulation, thickens cervical mucous and thins endometrium
Given every 13 weeks

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Depo Provera contains a complex which is a synthetic form of which hormone?

Progesterone

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What chronic conditions may have implication when Depo Provera is used?

Hypothyroidism
Coeliac disease
Rheumatoid arthritis
Hyperparathyroidism
IBD

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When is conception most likely to occur?

Unprotected sex on the day of ovulation or the preceding 24 hours

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When should Depo Provera be started without the need for using other contraception?

Up to and on day 5 of a normal cycle

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When can Depo Provera be started beyond day 5 of a normal cycle?

Can be started at any other time provided the woman is reasonably certain she is not pregnant and has been using condoms or abstinent for at least 7 days

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When can a woman be “reasonably certain” she is not pregnant?

Not had sex since last period
Consistently using reliable contraception
Is within first 7 days of onset of period
Is within 4 weeks post-partum
Is within first 7 days of miscarriage/abortion
Negative pregnancy test after 3 weeks since unprotected sex

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List the main side effects of Depo Provera

Weight gain (increased appetite) Delay in return of fertility Irregular bleeding Osteoporosis

Describe the composition of the LARC IUD

Non-hormonal T-shaped device made of copper and plastic

What is the significance of an IUD being made of copper? (how does this relate to its mode of action?)

Toxic to sperm and ova, therefore prevents fertilisation and causes inflammatory response in the endometrium

When should an IUD be started?

Within first 7 days of a period | Any time when "reasonably certain" not pregnant

When can an IUD be used as emergency contraception?

Up to 5 days after unprotected sex or up to 5 days after predicted date of ovulation

Describe the composition of the LARC IUS

T-shaped device with elastomere core that secretes progesterone into uterus

How does IUS work?

Makes implantation harder by thickening mucous and thinning endometrium N.B. does not prevent fertilisation

When should an IUS be started?

Within first 7 days of a period | Any time when "reasonably certain" not pregnant

What are the contraindications to using an IUD or IUS?

``` Current pelvic infection Abnormal uterine anatomy Pregnancy Sensitivity to composition Gestational trophoblastic disease (molar pregnancy) Endometrial cancer ```

List some side effects of using an IUD or IUS

``` Heavy periods (though IUS may have lighter periods) Pain, infection Perforation Expulsion Failure to work! Ectopic risk with IUS ```

Describe the composition of the LARC implant

Non-biodegradable subdermal rod inserted above elbow that releases progestogen

How does a LARC implant work?

Inhibits ovulation Thickens cervical mucous Thins endometrium

When should a LARC implant be started?

Within first 5 days of menstrual cycle

List some side effects of LARC implant

Irregular bleeding Weight gain Acne NV injury

List the LARC methods in order of lowest to highest Pearl index score [highest = increased failure rate]

Implant, IUS, Depo Provera, IUD

What are the 3 main methods of non-LARC/short-acting contraception?

Combined hormonal contraceptive (CHC) Progesterone-only pill (POP) Emergency hormonal contraception (EHC)

List the non-contraceptive benefits of CHC

``` Reduce all of: Heavy menstrual bleeding Painful periods Acne Irregular periods Endometriosis Menstrual migraine ```

What are the 3 forms of CHC available?

Combined oral contraceptive pill (COC) Combined transdermal patch (CTP) Combined vaginal ring (CVR)

How does CHC work?

Inhibits ovulation via the HPO axis to reduce LH and FSH Thickens cervical mucous Thins endometrium

Describe a standard regime for taking COC

Take daily for 21 days then stop for 7 days, during which withdrawal bleed occurs

Describe a standard regime for taking CTP

One patch worn for 1 week and reapplied weekly for further 2 weeks Fourth week is patch-free to allow withdrawal bleed

Describe a standard regime for taking CVR

Ring is placed and left in vagina for 21 days, then removed to allow withdrawal bleed New ring inserted afterwards

What factors may affect the effectiveness of CHC?

``` Impaired absorption (GI conditions) Increased metabolism (drug interactions) Forgetting ```

If a woman missed one pill of CHC, what should she do?

Take the last pill missed immediately | Continue taking the rest of the pack normally

If a woman missed 2 or more pills of CHC, what should she do?

Take the last pill missed immediately Continue taking the rest of the pack normally Use an additional contraceptive method for the next 7 days

What are the risks/side-effects of CHC?

Venous thrombosis Arterial thrombosis Alteration of clotting factors Adverse effects on some cancers

CHC's that contain which compounds have the lowest risk of venous thromboembolism?

Levonorgestrel Norethisterone Norgestimate [3rd generation COCs]

COC use can increase blood pressure. True/False?

True

Migraine with aura in COC users further increases the risk of what?

Stroke | Thus COC is contraindicated in these patients

CHC can aggravate breast cancer. If there is a personal history of breast cancer, what score on UKMEC is given?

4 - CHC contraindicated in these patients

CHC can aggravate breast cancer. If there is a family history of breast cancer, what score on UKMEC is given?

1 - CHC can be used

CHC can aggravate breast cancer. If there is a BRACA mutation, what score on UKMEC is given?

3 - CHC generally avoided

CHC offers protection against which cancers?

Ovarian and endometrial cancer

When should COC be started?

COC started up to or on day 5 of cycle | Anytime after day 5 providing "reasonably certain" not pregnant and has been using condoms

What does the POP notably interact with?

Liver enzyme inducers

Which has the higher Pearl index - CHC or POP?

Neither! Both the same at 0.3%