Contraception Flashcards
What are the most common forms of contraception?
Of women using contraception:
- 25% Combined OCP
- 28% sterilized
Implants only mkae 3% and Coil 6%
How do we determine the effectiveness of a contraceptive method?
Life Table Analysis or Pearl Index
% of women using a the method who get pregnant anyway.
One % for perfect use and one % for “Typical” use
Whats in the Combined OCP?
Ethinyl Oestradial (EE)
Synthetic Progesterone (Progestogen)
3rd gen pills contain Gestogene (GSD) and Desogestrel (DSG)
Dose for cOCP?
20-35microgram but 50 if on liver enzyme inducers
How often is the cOCP taken?
Every day for 21 days then 7 days off
(takes 7 days to become effective when you start it)
How does the cOCP work?
Prevents the FSH/LH surge by -ve feedback on the GnRH producing hypothalamus
Also prevents implantation by providing an inadeqaute endometrium
Alters cervical mucous to Inhibit sperm penetration
What are the non contraceptive benefits of the cOCP?
- Regular periods & ~reduce painful, heavy periods and anaemia
- Reduces Functional Ovarian Cysts
- 1/2s OVarian & endometrial cancer
- Reduces Acne, benign breast disease, RA, Colon cancer and Osteoporosis
What are the major risks of cOCP?
.Very small increased risk of VTE
Very small increased risk of Ischaemic stroke
Small risk of breast cancer
Doubles Cervical cancer risk if used for 10yrs
the cOCP is often blamed for VTEs, how risky is it really?
.The pill triples risk from 5 to 15 per 100,000.
However thats still less likely than being in an RTA and 1/4 of the risk of a VTE were you to get pregnant
It just sounds scary if you don’t actually know the numbers
What groups might we actually worry about VTEs in if we give them the cOCP?
Major surgery or immobility
Thrombophilias
FH/o VTE <45yrs
BMI > 30
Vascular Disease
first 21 days post-natally
How does Depoprovera work?
- Prevents Ovulation by -ve feedback
- Alters cervical mucous preventing sperm penetration
- Renders endometrium unsuitable, preventing implantation
What do we properly call the coil?
Long Acting Reversible Contraception (LARC)
What are the best forms of Emergency Contraception?
CU-IUD (copper coil)
Levonorgestrel pill
Ella One pill
All less effective than ongoing contraception
How long after sex can you use emergency contraception?
Copper coil up to 5 days post sex or 19 day of a cycle
Levonorgestrel - 72 hours
Ella One - 120 hours
What is the main form of female sterilization?
Laparascopic Tubal Ligation with Filshie clips
What are the pros of Depoprovera injections?
.- Good if you forget to take pills
- Stops periods in 70%
- Oestrogen-free
What are the cons of DepoProvera?
- Delayed return to fertility
- Reduces BMD (Reversible)
- Bleeding
- Weight Gain
What is used in the Subdermal Implant?
Etonogestrel (ENG) - a progestin
Coated in a rate controlling membrane of EVA
How does the subdermal implant work?
,Inhibits ovulation for 3yrs
Also has some effect on cervical mucus inhibiting sperm entry into upper repro tract
What is the main form of female sterilization?
Laparascopic Tubal Ligation with Filshie clips
How is Vasectomy done?
Permanent division of vas deferens under local anaesthetic
Then they have to come back for semen analysis before they start having unprotected sex
Can you get pain from vasectomy? Testicular cancer?
Can get pain due to a sperm granuloma (Degenerating spermatozoa surrounded by macrophages)
No risk of cancer
Is vasectomy reversible?
.Low success rate for reversals
When is a termination best performed?
<9wks as it reduces complications if its early
AT what point do we stop doing terminations?
20wks. then we refer to england who do it till 24wks
Why would you terminate a pregnancy?
IF the continuation of it would cause greater physical/mental harm to the women or existing children than terminating
- Maternal health
- Social reasons
- Fetal Anomaly
What do we do during a clinic consultation on termination?
- Talk about methods
- Advise they may have prolonged bleeding post-TOP
- Offer counselling post-TOP
- Contraception advice
- FBC, Rubella & STI checks
- Certificate A signed
Most terminations in Grampian are medical, how are they done?
Mifepristone:
Swtiches off pregnancy hormones –> 48 hours later prostaglandins (Misoprostol) initiate uterine contraction –> opens cervix & expels pregnancy
What are the risks of Medical TOP?
,Haemorrhage
Uterine Perforation
Cervical Trauma
Failure
Infection
RPOC
Damage to future fertility
Psychological problems
Whats the alternative to the Combined OCP?
Progestogen Only Pill (POP)
How often do you have to take the POP?
Take the desogestrel pill every day within the same 12 hr window
(Traditional PoPs have only a 3hr window)
How does the POP work?
Renders Cervical mucus impenetrable to sperm
Also has some effect inhibititing ovulation