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