Contraception Flashcards
Physical reasons for consensual sex?
- Sexual pleasure
- Release of sexual tension (lust/passion)
- Attraction specifically to one person
- Stress relief
- Mood booster
Emotional reasons for consensual sex?
- Love
- Commitment
- Sexual curiosity and novelty
- Gratitude
10.Need for affection
11.Nurturance: to create + maintain intimacy/closeness in their relationship
12.“Spiritual transcendence”
Insecurity reasons for consensual sex?
- To boost self-esteem
- To keep partner
- Feeling “sense of duty”
- Internal pressure (wanting to be “normal”/ fit in)
- External pressure (partner(s), peers, social media)
Goal-based reasons for consensual sex?
- To improve social status and reputation
- To enhance power
- To seek revenge
- To foster jealousy
- For financial or material gain
- To make a baby
% of unplanned pregnancies in the UK?
40%
Family planning definition?
the practice of controlling the number of children one has and the intervals between their births, particularly by means of contraception or voluntary sterilization
Contraception definition and types?
the deliberate use of artificial methods or other techniques to prevent pregnancy as a consequence of sexual intercourse.
The major forms of artificial contraception are:
barrier methods, of which the commonest is the condom or sheath
the contraceptive pill, which contains synthetic sex hormones which prevent ovulation in the female
intrauterine devices, such as the coil, which prevent the fertilized ovum from implanting in the uterus
male or female sterilization
Birth control definition?
the practice of preventing unwanted pregnancies, especially by use of contraception.
Preventative actions of contraception?
Prevention of ovulation
Prevention of fertilisation
Prevention of implantation
Prevention of ovulation mechanism of action?
works by suppressing FSH and LH (negative feedback to
hypothalamus/pituitary/ovary axis)
main mechanism of most hormonal methods (except hormone coils and traditional progestogen only pills POPs*)
emergency hormonal contraception can only temporarily delay (rather than suppress) ovulation
- “Traditional” POP containing 25 levonorgestrel or norethisterone do not suppress ovulation. Modern” POP
containing desogestrel or drospirenone do suppress ovulation.
Prevention of fertilisation mechanism of action?
Mechanical or surgical barrier:
External (“male”) and internal (“female”) condoms, diaphragm + spermicide, “female” and “male” male sterilisation (tubal ligation/ vasectomy).
Hormonal methods including hormone coil (LNG IUD) through “hostile” cervical mucous effect- reduced sperm penetration
Direct toxicity on sperm (spermicide) or sperm and ova (copper coil)
Negative effect on tubal mobility (POP, CHC)
Prevention of implantation mechanism of action?
hormonal contraceptive methods by creating a “hostile” endometrium(“unfavourably thin”)
IUDs causing local endometrial inflammatory reaction and direct toxicity on sperm and ovum (copper only)
this is only a secondary mechanism of action of intrauterine devices but more relevant when a copper “coil” is used as emergency contraception (EC IUD)
Main contraception classifications?
Hormonal methods
Barrier methods
Intrauterine methods
Permanent methods
Fertility awareness methods
Emergency methods
Hormonal methods of contraception?
Combined pill, ring and patch and POP (progestogen only pill)
DMPA injection and subdermal contraceptive implant
Barrier methods of contraception?
External and internal condoms
Diaphragm or cervical cap (plus spermicide)
Intrauterine methods of contraception?
Copper bearing intrauterine device (copper “coil”- Cu-IUD)
LNG releasing intrauterine device (hormone “coil”- LNG-IUD)
Examples:
Liletta and Mirena - up to 8 years
Kyleena - up to 5 years
Skyla - up to 3 years
Permanent methods of contraception?
“Female” sterilisation (tubal ligation)
“Male” sterilisation (vasectomy)
Fertility awareness methods of contraception?
Basal temperature, calendar and cervical secretion monitoring methods
Emergency methods of contraception?
Emergency contraception can be used after episodes of unprotected sexual intercourse (UPSI).
There are three options for emergency contraception:
- Levonorgestrel should be taken within 72 hours of UPSI
- Ulipristal should be taken within 120 hours of UPSI
- Copper coil can be inserted within 5 days of UPSI, or within 5 days of the estimated date of ovulation
What is method failure rate?
failure rate at perfect use
What is user failure rate?
failure rate at typical use
User failure: some reasons for condoms not being effective?
used too late (only just before ejaculation), wrong lube (oil-based), wrong technique, wrong size, inconsistent use, wrong storage, damage when opening, expired
User failure: some reasons for diaphragm not being effective?
used too late, removed too early, wrong technique (I.e.not checking if cervix covered), inconsistent use, no damage checks, no replacements
“Iatrogenic” user failure (provider failure) reasons?
poor counselling, poor or wrong instructions,+/- no support with patient information leaflets or apps, no extra precaution recommended when quickstarting, drug interaction with existing or new meds, incorrect insertion (IUDs) leading to perforation, malposition or expulsion
What is LARC?
Long-acting reversible contraception (LARC) is a form of birth control that provides effective contraception for an extended period without requiring user action.
LARC methods include injections, intrauterine devices (IUDs), and subdermal contraceptive implants. They can prevent pregnancy for several years and are over 99% effective.
LARC methods are inserted by a provider and can be removed if the user wants to become pregnant.
what is the most effective female contraception method?
Subdermal contraceptive implant (SDCI) I.e nexplanon
involve the delivery of a steroid progestin from polymer capsules or rods placed under the skin.
More than 99% effective (around 99.6%) and is most effective contraceptive method alongside copper coil and hormonal coil)
Features of SDCI (sub-dermal contraceptive implants)?
Safe for most patients
Lasts three years
Low and stable level of hormones- less hormonal side effects
Progestogen only- safe for most patients
“Invasive”- cryospray can be used for LA (insertions only)
Main side effect: prolonged PV bleeding (vaginal bleeding)
What are intrauterine devices?
Intrauterine devices (IUDs) are T-shaped devices that can be inserted into your uterus to prevent pregnancy.
There are two kinds of IUDs, copper IUDs and hormonal (levonorgestrel/LNG) IUDs.
What is a copper coil (cu-IUD)?
contains copper and creates a hostile environment for pregnancy
Most effective emergency contraception with 99% success rate
What is levonorgestrel intrauterine system (LNG-IUS)?
contains progestogen that is slowly released into the uterus
contraindications for intrauterine devices?
Pelvic inflammatory disease or infection
Immunosuppression
Pregnancy
Unexplained bleeding
Pelvic cancer
Uterine cavity distortion (e.g. by fibroids)
Main role of combined hormonal contraception?
Inhibits ovulation
How is ovulation inhibited by CHC?
Ovulation is inhibited by the oestrogen and progestogen components of the combined hormonal contraception (CHC) which act on the hypothalamo-pituitary axis to reduce production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH).
With no surge in LH and FSH to stimulate the ovaries, ovulation does not occur.
What factors may affect effectiveness of CHC?
- Impaired absorption
– GI conditions (COC) - Increased metabolism
– Liver enzyme induction or
drug interaction - Patch – less effective >90kg
3 risks of CHC?
- Venous thrombosis
- Arterial
- Adverse effects on some cancers
CHC is fine in migraine with aura. true/false?
False
Migraine with aura
* Increases the risk of ischaemic stroke
* CHC contraindicated
What is aura that occurs with migraine?
- A ‘change’ occurring 5 – 20 minutes before the
onset of headache - May be visual, typical scotoma
- Altered sensation
- Smell or taste
- Hemiparesis
What examinations can be done before prescribing CHC?
- Record BP and BMI before first prescription
- Check smear status if relevant
Key contraceptive methods?
Natural family planning (“rhythm method”)
Barrier methods (i.e. condoms)
Combined contraceptive pills
Progestogen-only pills
Coils (i.e. copper coil or Mirena)
Progestogen injection
Progestogen implant
Surgery (i.e. sterilisation or vasectomy)
Emergency contraception can be used after unprotected intercourse. true/false?
True
What is the UKMEC?
Stands for UK medical eligibility criteria and is used to categorise the risks of starting different methods of contraception in different individuals.
What is UKMEC 1?
No restriction in use of contraception (minimal risk)
What is UKMEC 2?
Benefits generally outweigh the risks
What is UKMEC 3?
Risks generally outweigh the benefits
What is UKMEC 4?
Unacceptable risk (typically this means the method is contraindicated)
What specific risk factors should be considered to make patient avoid combined oral contraceptive pill?
Uncontrolled hypertension (particularly ≥160 / ≥100)
Migraine with aura
History of VTE (venous thromboembolism)
Aged over 35 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 and antiphospholipid syndrome
Additional considerations in older and perimenopausal women?
Hormone replacement therapy does not prevent pregnancy, and added contraception is required
The combined contraceptive pill can be used up to age 50 years, and can treat perimenopausal symptoms
The progestogen injection (i.e. Depo-Provera) should be stopped before 50 years due to the risk of osteoporosis
Main methods of contraception in under 20s?
Combined and progestogen-only pills are unaffected by younger age
The progestogen-only implant is a good choice of long-acting reversible contraception (UK MEC 1)
The progestogen-only injection is UK MEC 2 due to concerns about reduced bone mineral density
Coils are UKMEC 2, as they may have a higher rate of expulsion
The combined contraceptive pill should be avoided in breastfeeding. true/false?
True
(UKMEC 4 before 6 weeks postpartum, UKMEC 2 after 6 weeks).
The progestogen-only pill and implant are considered safe in breastfeeding and can be started at any time after birth.
True
Time frame for mirena coil?
A copper coil or intrauterine system (e.g. Mirena) can be inserted either within 48 hours of birth or more than 4 weeks after birth (UKMEC 1), but not inserted between 48 hours and 4 weeks of birth (UKMEC 3).
The combined pill should be started before 6 weeks after childbirth in women that are breastfeeding. true/false?
False
Combined pill SHOULD NOT be used before 6 weeks after childbirth in breastfeeding women.
The progestogen-only pill or implant can be started any time after birth.
