Contraception Flashcards
What are some methods of contraception that require ongoing action by the individual?
- Oral contraception
- Barrier methods
- Fertility awareness
- Coitus interrupts
- Oral emergency contraception
What are some methods that prevent contraception by default?
- IUCD/IUI/IUS
- Progestogen Implants
- Progestogen Injections
- Sterilisation
What is seen as the perfect contraception method?
- 100% Reliable
- 100% Safe
- Non user dependent
- Unrelated to coitus
- Visible to the women
- No ongoing medicinal input
- Completely reversible in 24 hrs
- No discomfort
What are some risks of treatment for contraception?
- Cardiovascular problems: Arterial, Venous
- Neoplastic: Breast Cancer, Liver
- Emotional
- Injection related
- Allergic
- Iatrogenic
What are the risks of no treatment for contraception?
- Childbirth related
- Abortion related
- Social costs
- Economic costs
What are the benefits of treatment for contraception?
- Non contraceptive
- Psychosexual
- Choice
- Sexual Health
- Cost saving
- Female equality
What are the benefits of no treatment for contraception?
- Non interference
- Population growth
- Control of women
What are some combined oral contraceptions?
- Oestrogen: EthinylOestradiol 20,30,35,50 micrograms
Progestogen
- Older 2nd gen: Norethisterone & Levonorgestal
- Newer 3rd gen: Desogestral, Gestodene & Norgestimate
- Latest: Drospirenone
Where do Oestrogen act?
- Act on the Anterior pituitary & Hypothalamus glands
- Directly on the ovary
- On the endometrium
Where does Progestogen act?
- Act on the Anterior pituitary & Hypothalamus glands
- Directly on the Ovary
- On the endometrium
- On the fallopian tubes
- On cervical mucus
What are the benefits of using combined oral contraception?
- Reliable
- Safe
- Unrelated to coitus
- Women in control
- Rapidly reversible
What are the benefits of using non contraceptive oral contraception???
- Halve ca ovary
- Halve ca endometrium
- Helps endometriosis, menorrhagia, dysmenorrhea
State the Pill rules about taking combined oral contraception
- Start 1st packet 1st day of a menstrual period
- Take 21 pills and stop for 7 day break (PFI)
- Restart each new packet on 8th day (same)
- Do not start new packets late
- If late or missed pills in first 7 days, then use condoms
- If missed pills in last 7 days no PFI
What are some interacting medications for combined oral contraception?
- Liver enzyme inducing drugs
- Affect metabolising of both oestrogen and Progestogen
- Beware rifampicin and anti-epileptics - Broad spectrum antibiotics
- Affect enterohepatic circulation of oestrogen only 40%
What is combined vaginal contraceptive?
- Same as COCP except vaginal delivery (ring) for 21 days
- Remove for 7 days
- Advantage is that you don’t have to take everyday
What are the Progestogen only methods for contraception?
- Default methods
- Implants: Nexplanon, Norplant
- Hormone releasing IUCD: Mirena IUS - User dependent methods
- Norethisterone, Ethynodiol diacetate - Injectables
- Depo Provera, Noristerat
Why is cerelle better than older POPs?
- As effective as COCP
- No oestrogen: CIs e.g. breastfeeding
- Favourable side effect profile vs older POPs
- Bleeding as predictable as COCP
- 12 hour window
What are IUCDs?
Copper bearing intrauterine contraceptive devices are inserted into the uterus by suitably trained practitioners and May be left in situ long term and act by:
- Destroying spermatozoa
- Preventing implantation: inflammatory reaction and prostaglandin secretion as well as a mechanical effect
What are the different types of IUCD’s?
- Copper bearing
- Ortho T 380 – 8 -12yr
- Multiload 375 – 5yr
- Multiload 250 – 5y
- Nova T 380 – 5yr
- Nova T 200 – 5yr
- GyneFix (IUI) – 5y - Hormone bearing
What are some benefits of using IUCDs?
- Non user dependent
- Immediately and retrospectively effective
- Immediately reversible
- Can be used long term
- Extremely reliable
- Unrelated to coitus
- Free from serious medical dangers
What are some disadvantages of using IUCDs?
- Has to be fitted by trained medical personnel
- Fitting may cause pain or discomfort
- Periods may become heavier & painful
- It does not offer protection against infection
- Threads may be felt by the male
List some risks of using IUCD’s as contraception?
- Miscarriage if left in situ if a pregnancy
- ?ectopics
- May be expelled
- The uterus may be perforated
List some contraindications when deciding to use IUCDs
- Current pelvic inflammatory disease
- Suspected or known pregnancy
- Unexplained vaginal bleeding
- Abnormalities of the uterine cavity
List some relative contraindications when deciding to use IUCDs
- Nulliparity
- Past history of pelvic inflammatory disease
- Not in mutually monogamous relationship
- Menorrhagia / Dysmenorrhoea
- Small uterine fibroids
List the advantages of using condoms in males
- Man in control
- Protects against STIs
- No serious health risks
- Easily available (free at Family Planning clinics)
List the disadvantages of using condoms in males
- Last minute use
- Needs to be taught
- May cause allergies
- May cause psycho sexual difficulties
- Higher failure rate among some couples
- Oily preparations rot rubber
List the advantages of using condoms in females
- Woman in control
- Protects against STIs
- Can be put in advance and left inside after erection lost
- Not dependent on male erection to work
List the disadvantages of using condoms in females
- Obtrusive
- Expensive
- Messy
- Rustles during sex
- Uncertain failure rate
What are the different types of caps used in contraception?
- Diaphragm Caps
- Suction (cervical) caps
Describe the use of diaphragm caps in contraception
- Made of latex
- Fit across vagina
- Sizes 55 – 95mm in 5mm jumps
- Must be used with spermicide and left in at least 6 hours after sexual intercourse
Describe the use of Suction (Cervical) caps in contraception
- Made of plastic
- Suction to cervix or vaginal vault
- Different sizes
- Must be used with spermicide and left in 6 hours or more
What are the advantages of using diaphragm caps as contraception?
- Woman in Control
- Can be put in advance
- Offers protection against cervical dysplasias
- Perceived as “natural”
What are the disadvantages of using diaphragm caps as contraception?
- Diaphragm Caps
- Needs to be taught
- Messy
- Higher failure rate than most other methods
- Higher UTI
- Higher Candiasis
What are the advantages of using suction caps as contraception?
- Suitable for women with poor pelvic muscles
- No problems with rubber allergies
- Very unobtrusive
- Woman in control
What are the disadvantages of using suction caps as contraception?
- Needs an accessible and suitable cervix
- Higher failure rate than diaphragm
- Not easy to find experienced teacher
What are some fertility awareness signs you have to be vary about?
- Prediction of ovulation ? 14/7 before period
- Sperm can survive 5 days in female tract
- Ova can survive 24 hours
- Ova are fertilised in the fallopian tube and take 4 days to reach the uterus and implant
- Cervical mucus is receptive to sperm around the time of ovulation
- Use Periodic Abstinence/alternative contraception to avoid pregnancy
- Time intercourse to pre-ovulatory phase to conceive
List some factors you take into consideration for natural family planning
- Temperature
- Rhythm
- Cervix position
- Cervical mucus
- Persona
- Lactational amenorrhoea (LAM)
List the advantages about fertility awareness
- Non medical
- Can be used in 3rd world
- Allowed by Catholic church
- Can result in closeness of understanding between partners
List the disadvantages about fertility awareness
- Failure rate heavily user dependent
- Requires skilled teaching
- May require cooperation between partners
- May involve limiting sexual activity
- Can cause strain
What are some emergency forms of contraceptions?
- Postcoital pills: prevents Up to 72 hours after unprotected sexual intercourse (UPSI)
- Schering PC4: prevents 3 out of 4 pregnancies which would have occurred
- Copper bearing IUCDs: Prevents Up to 5 days after presumed ovulation or 5 days after one single episode of UPSI at any time of the cycle, Failure extremely rare
- Levonelle: prevents 7 out of 8 pregnancies
- ellaOne (ulipristal): Similar to levonelle
Describe the postcoital pills: Levonelle
- Levonelle 2 consists of 2 tablets each containing 750 micrograms of Levonorgestrel
- 1.5mg one dose
