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Y4 reproductive health > Contraception > Flashcards

Contraception Flashcards

1
Q

Barrier contraception types

A

Male condoms

Female condoms

Diaphragms

Cervical caps

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2
Q

Male condom pros and cons

A

Pros

  • not contraindicated by any condition
  • only contraceptive method mentioned that is controlled by the male, which may be desirable
  • widely available & simple to use
  • protective against many STIs

Cons

  • perfect use is rarely achieved
  • can reduce sensitivity and/or arousal
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3
Q

Female condom pros and cons

A

Pros

  • no contraindications
  • less likely to tear than the male condom
  • may protect against some STIs
  • can be inserted up to 8 hours before intercourse

Cons

  • perfect use rarely achieved
  • penis may be inserted between condom & vaginal wall
  • can be noisy and/or uncomfortable for the woman during intercourse
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4
Q

Diaphragm/cap pros and cons

A

Pros

  • can be inserted up to three hours before intercourse

Cons

  • perfect use is rarely achieve
  • require prior planning and careful insertion
  • require measuring and fitting to find the correct size
  • associated with a higher risk of UTIs
  • STIs transmission not reduced
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5
Q

Combined hormonal contraception

A

Uses female steroid hormones oestrogen and progesterone & is very effective method of preventing pregnancy, more so than barrier contraception

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6
Q

Combined hormonal contraception mechanism of action

A

Primarily inhibit ovulation

Progesterone also inhibits proliferation of the endometrium

Period free of hormones → leads to a degeneration of the endometrium and menstrual bleeding

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7
Q

COCP

A

Contains both oestrogen and progesterone

Two types:

  • monophasic - every pill contains the same levels of oestrogen and progesterone
  • phasic - level of oestrogen and progesterone in the pills changes throughout the cycle
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8
Q

COCP monophasic pills

A

Each pill contains the same amount of progesterone and oestrogen throughout the cycle

Examples: microgynon, brevinor

  • both taken once daily for 21 days and 7 day break
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9
Q

COCP phasic pills

A

Contain a varying amount of oestrogen and progesterone across the cycle (can be biphasic, triphasic or quadraphasic)

Examples: Qlaira (quadraphasic, 28 active pills, 2 inactive), BiNovum (biphasic, 21 days with a 7 day break)

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10
Q

Contraceptive transdermal patch

A

Small patch that can be stuck onto the upper arm, abdomen, buttock or back to prevent pregnancy

Patch is applied and changed every 7 days over a period of 3 weeks (21 days in total) & then the patch is removed for 7 patch-free days → withdrawal bleed

Extremely sticky and can be used whilst bathing and swimming

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11
Q

Contraceptive vaginal ring

A

Plastic ring inserted into the vagina

Sits in the vagina for 21 days, removed for 7 days before inserting the new ring

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12
Q

Combined hormonal contraception advantages

A

Non invasive

More effective than barrier methods if taken correctly

Sex doesn’t need to be interrupted

Menses tends to be become regular, lighter and less painful

Reduced risk of cancer of the ovary, uterus & colon

Reduced risk of functional ovarian cysts

Normal fertility returns immediately after stopping usage

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13
Q

Combined hormonal contraception disadvantages

A

User dependent

Temporary adverse effects - headaches, breast tenderness & mood changes

Increase in BP

Women may experience breakthrough bleeding & spotting for the first few months

Increased risk of VTE

Small increase in risk of myocardial infarctions and strokes

Small increase risk of breast and cervical cancer

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14
Q

Combined hormonal contraception contraindications

A

BMI > 35

Breast feeding

Smoking over the age of 35

Hypertension

History/family history of VTE

Prolonged immobility due to surgery/disability

DM with complications

History of migraines with aura

Breast cancer or primary liver tumours

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15
Q

POP mechanism of action

A

Thicken the cervical mucus due to the high levels of progesterone

Prevents the entry of sperm & thereby fertilisation of the oocyte

Inhibits ovulation

Thinning of the endometrium

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16
Q

POP pros and cons

A

Pros:

  • more effective than barrier methods when taken correctly
  • sex doesn’t need to be interrupted to use contraception
  • can be used in many patients for whom the COCP is contraindicated
  • may reduce risk of endometrial cancer

Cons:

  • user dependent & has to be taken at the same time each day
  • irregular menstruation or amenorrhoea
  • some adverse affects - headaches, breast tenderness, skin changes
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17
Q

POP contraindications

A

Current/past history of breast ca

Liver cirrhosis or tumours

Lower efficacy in women > 70kg

Stroke/CHD

18
Q

Progesterone only implant mechanism of action

A

Inhibit ovulation

Thickening of cervical mucus - inhibits passage of sperm

Thinning of endometrium

19
Q

Progesterone only implant pros and cons

A

Pros:

  • extremely effective
  • can be used in women for whom COCP is contraindicated
  • users don’t have to think about contraception for 3 years
  • can be used when breastfeeding
  • normal fertility returns as soon as implant is removed
  • effective in women of all body mass
  • may reduce the risk of endometrial cancer

Cons:

  • changes in menstrual bleeding & bleeding patterns are likely to remain irregular
  • fitting and removing the implant may cause some pain, bruising and irritation
  • small increased risk of breast ca
  • implant can sometimes bend or break in situ
20
Q

Progesterone only hormonal contraception contraindications

A

Pregnancy

Unexplained vaginal bleeding

Liver cirrhosis or tumours

History of breast ca

Stroke/TIAs whilst on implant

21
Q

Progesterone only injectable contraception

A

Long lasting contraception where synthetic progesterone is slowly released into systemic circulation following IM/s.c. injection

22
Q

Progesterone only injectable contraception mechanism of action

A

Inhibition of ovulation and the thickening of cervical mucus

Thinning of the endometrium

23
Q

Progesterone only injectable contraception pros and cons

A

Pros

  • users don’t have to think about contraception
  • no known interactions with any drugs
  • can be used to combined hormonal contraceptives are not recommended
  • can be used in women with BMI < 35
  • may reduce the risk of endometrial ca

Cons

  • not rapidly reversible - up to year for normal fertility to return
  • increase in body weight
  • slightly increased risk of breast ca
  • loss of bone mineral density with long term use
24
Q

Progesterone only injectable contraception contraindications

A

Current breast ca (within 5 years)

History of severe arterial disease/very high risk factors

Pregnancy

Diabetes with any vascular disease

People who will want to return to fertility in the near future

25
Q

Fitting an IUD or IUS

A

Intrauterine device (copper coil) - releases copper, which makes the uterus an unfavourable environment for sperm. Also thought to create an endometrial inflammatory reaction, inhibiting implantation if fertilisation has already occurred

Intrauterine system (levonorgestrel-releasing coils) - thins the endometrium (preventing implantation), and thickens cervical mucus

26
Q

Procedure for IUD/IUS

A

Can be fitted at any point during the menstrual cycle:

  • IUD - provides contraception immediately after insertion
  • IUS - only effective immediately if fitted within the first 7 days of the menstrual cycle
    • any other time → another form of contraception is advised for 1 week

Small plastic T-shaped device is pushed through the cervix into the uterus, where it remains

Strings attached are cut so that they remain in the vagina → allows woman to check periodically to ensure device has not been expelled

27
Q

IUD indications

A

Contraception - those who miss pills or want long-lasting birth control

Can be used as emergency contraception, effective if fitted within 5 days of unprotected sex

28
Q

IUS indications

A

Contraception

First line therapy in the treatment of heavy menstrual bleeding

Second line treatment option for dysmenorrhoea

29
Q

IUD & IUS contraindications

A

Infection - history of PID, recent exposure to STI, recent infection of uterus

Current pregnancy/up to 4 weeks post partum

Uterine structural abnormalities

Current gynaecological malignancy

Current unexplained vaginal bleeding

Allergy to copper (IUD)

For IUS: current DVT/PE, current liver disease or hx of breast cancer

30
Q

IUD/IUS advantages

A

Very effective

Fertility usually returns to normal as soon as IUS/IUS is removed

Can be fitted at any stage of the cycle

Can be used by women who are breastfeeding

31
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35
Q

IUD/IUS disadvantages

A

No protection against STIs

Risk of ascending or iatrogenic infection

Risk of expelling

Insertion can be painful

Higher risk if pregnancy occurs, it will be ectopic

35
Q

Emergency contraception indications

A

Sexual intercourse without contraception OR

Contraceptive method has failed

35
Q

Emergency contraception types

A

‘morning after pill’

  • Levonorgestrel - synthetic progesterone
    • can delay ovulation for 5-7 days, after which any sperm will have become non-viable
    • licensed for use within 72 hours
  • Ulipristal acetate - progesterone receptor modulator
    • can delay ovulation for 5-7 days, after which any sperm will have become non-viable
    • licensed for use within 120 hours

IUD - within 5 days of unprotected sex; very effective & should be offered to all women presenting for emergency contraception

35
Q

Levonorgestrel contraindications

A

No absolute contraindications, however efficacy may be reduced by:

  • diabetes of malabsorption
  • BMI > 26 or weight > 70kg
  • enzyme inducing drugs e.g. rifampicin
36
Q

Ulipristal acetate contraindications

A

Diseases of malabsorption

Hypersensitivity to ulipristal acetate

Severe hepatic dysfunction

Enzyme inducing drugs

Breast feeding - avoid it for 7 days after taking UPA

Asthma insufficiently controlled by corticosteroids

Drugs increasing gastric pH

37
Q

Emergency contraception follow-up/contraception

A

Ask patient to seek help if vomiting occurs within 2 hours of taking levonorgestrel/3 hours of taking ulipristal

Only IUD affords protection for the rest of the cycle

IUD → increased relative risk of ectopic pregnancy & need to be alert; other adverse effects = pelvic infections, expulsion, bleeding & pelvic pain

Y4 reproductive health (11 decks)

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