Contraception Flashcards
Coil use as emergency contraceptive
within 5 days of unprotected sexual intercourse.
Contraindications coil
Pelvic inflammatory disease or infection Immunosuppression Pregnancy Unexplained bleeding Pelvic cancer Uterine cavity distortion (e.g. by fibroids)
Copper coil MOA
Copper is toxic to the ovum and sperm.
alters the endometrium and makes it less accepting of implantation.
works by causing cervical mucus to be thicker in consistency and alters motility within the uterotubal system
copper coil Benefits
Reliable contraception
It can be inserted at any time in the menstrual cycle and is effective immediately
It contains no hormones, so it is safe for women at risk of VTE or with a history of hormone-related cancers
It may reduce the risk of endometrial and cervical cancer
Copper coil drawbacks
A procedure is required to insert and remove
can cause heavy or intermenstrual bleeding
does not protect against sti
Some women experience pelvic pain
increases ectopic pregnancy risk
contraindicated in Wilson’s disease
Levonorgestrel Intrauterine System MOA
Thickening cervical mucus
Altering the endometrium and making it less accepting of implantation
Inhibiting ovulation in a small number of women
The Mirena coil is commonly used for
contraception, menorrhagia and endometrial protection for women on HRT.
It is licensed for 5 years for contraception, but only 4 years for HRT.
LNG-IUS insertion
inserted up to day 7 of the menstrual cycle without any need for additional contraception. If it is inserted after day 7, pregnancy needs to be reasonably excluded, and extra protection (i.e. condoms) is required for 7 days.
LNG-IUS benefits
It can make periods lighter or stop altogether
may improve dysmenorrhoea or pelvic pain related to endometriosis
It may improve dysmenorrhoea or pelvic pain related to endometriosis
LNG-IUS drawbacks
procedure can cause spotting or irregular bleeding Some women experience pelvic pain It does not protect against sexually transmitted infections Increased risk of ectopic pregnancies Increased incidence of ovarian cysts There can be systemic absorption causing side effects of acne, headaches, or breast tenderness can fall out
combined oral contraceptive pill MOA
Preventing ovulation (this is the primary mechanism of action) Progesterone thickens the cervical mucus (reducing chance of semen entering uterus) Progesterone inhibits proliferation of the endometrium, reducing the chance of successful implantation
Advantages of combined oral contraceptive pill
highly effective (failure rate < 1 per 100 woman years)
doesn’t interfere with sex
Times bleeding
contraceptive effects reversible upon stopping
usually makes periods regular, lighter and less painful
reduced risk of ovarian, endometrial - this effect may last for several decades after cessation
reduced risk of colorectal cancer
may protect against pelvic inflammatory disease
may reduce ovarian cysts
May reduce benign breast disease
May reduce acne vulgaris
Improved Perimenopausal Symptoms
Protection from Osteoporosis
Disadvantages of combined oral contraceptive pill
people may forget to take it
offers no protection against sexually transmitted infections
increased risk of venous thromboembolic disease
increased risk of breast and cervical cancer, returning to normal ten years after stopping
increased risk of stroke and ischaemic heart disease (especially in smokers)
temporary side-effects such as headache, nausea, breast tenderness may be seen
Mood changes and depression
specific risk factors that should make you avoid the combined contraceptive pill (UKMEC 4):
Uncontrolled hypertension (particularly ≥160 / ≥100)
Migraine with aura (risk of stroke)
History of VTE
Aged over 35 and 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 (SLE) and antiphospholipid syndrome
Starting the OCP pill
Start on the first day of the cycle (first day of the menstrual period). This offers protection straight away. No additional contraception is required if the pill is started up to day 5 of the menstrual cycle.
UKMEC 4 criteria for the Progesterone only pill
active breast cancer.
Missing more than one OCP pill (more than 72 hours since the last pill was taken)
Take the most recent missed pill as soon as possible
Additional contraception (i.e. condoms) is needed until they have taken the pill regularly for 7 days straight
If day 1 – 7 of the packet they need emergency contraception if they have had unprotected sex
If day 8 – 14 of the pack (and day 1 – 7 was fully compliant) then no emergency contraception is required
If day 15 – 21 of the pack (and day 1 – 14 was fully compliant) then no emergency contraception is needed. They should go back-to-back with their next pack of pills and skip the pill-free period
traditional progestogen-only pill cannot be delayed by more than
3 hours. Taking the pill more than 3 hours late is considered a “missed pill”.
