Contraception Flashcards
which hormones are in combined hormonal contraception (pill, patch and vaginal ring)?
- ethinyl estradiol (EE) and synthetic progestogen
how does combined hormonal contraception prevent pregnancy?
- stops ovulation
- also affects cervical mucus and endometrium
list the non-contraceptive benefits of combined hormonal contraception
- Regulate/reduce bleeding- help heavy or painful natural periods
- Stop ovulation- may help premenstrual syndrome
- Reduction in functional ovarian cysts
- 50% reduction in ovarian and endometrial cancer
- Improve acne / hirsutism
- Reduction in benign breast disease, rheumatoid arthritis, colon cancer and osteoporosis
what are the non-serious side-effects of combined hormonal contraception?
- breast tenderness
- nausea
- headache
- irregular bleeding first 3 months
- mood? weight gain?
what are the serious risks associated with combined hormonal contraceptives?
- increased risk venous thrombosis > DVT PE: avoid if BMI > 34, previous VTE, 1st degree relative VTE under 45, reduced mobility, thrombophilia e.g. SLE
- increased risk arterial thrombosis > MI/ischaemic stroke: avoid in smokers > 35, previous arterial thrombosis, focal migraine, age > 50, hypertension > 140/90
- avoid if gall bladder disease or previous liver tumour
- increased risk cervical cancer (data predates HPV vaccine)
- increased risk of breast cancer, back to normal 10 years off Rx: avoid if previous breast cancer or family history of BRCA associated breast cancer
progesterone only pill (POP) contraindications
- personal history of breast cancer/liver tumour
what are some non-serious side effects of progesterone only contraception?
- appetite increase
- hair loss/gain
- mood change
- bloating or fluid retention
- headache
- acne
how does injectable progestogen prevent pregnancy?
- prevents ovulation
- alters cervical mucus making it hostile to sperm
- makes endometrium unsuitable for implantation
injectable progestogen side-effects
- delay in return to fertility - average 9 months
- reversible reduction in bone density, discuss other risks for osteoporosis
- problematic bleeding especially first 2 doses
- weight gain 2/3 women gain 2-3kg
progestogen implant side-effects
- 60% are almost bleed free but 30% have prolonged/frequent bleeding
how long can copper IUDs last?
5-10 years depending on type
what are some risk when using IUD for contraception?
- Very small infection risk in first 3 weeks < 1:1000
- Fitting takes 10 minutes - 1:1000 risk perforation
- 5:100 risk expulsion- check threads after each period
- If conceives may be ectopic- but method is so effective that ectopic risk lower than for condoms
- Not suitable if untreated pelvic infection or distorted endometrial cavity eg submucous fibroids/ bicornuate / previous ablation
what is the mode of action of copper IUDs?
toxic to sperm, stop sperm reaching egg, may sometimes work by preventing implantation of fertilised egg
what are some emergency contraceptive options?
- copper IUD most effective option, if < 1:100 pregnancy occurs
- levonorgesterel pil ‘Levonelle’: take within 72hrs, 2-3:100 women become pregnant anyway
- ulipristal pill ‘ellaone’: take within 120hrs, 1-2:100 pregancies
how quick after delivery can a women become pregant from sex?
21 days
how quick after a miscarriage or abortion can a women become pregnant again?
5 days
can breast-feeding be a contraceptive?
only for first 6 months + feeding every 4 hours + amenorrhoeic
which drugs can interact with contraceptives?
- enzyme inducing drugs e.g. carbamazepine, topiramate, rifampicin, St Johns Wort all increase the metabolism of progesterone and oestrogen and reduce effectiveness of COC, patch, ring and POP and implant.
- lamotrigine also interacts.
- injectable progestogens and copper or levonorgestrel IUD are NOT affected.
how are women most commonly sterilised?
laparoscopic sterilisation: usually Filshie clips applied across tube to block tube lumen, metal/silicone OK for MRI
what is the failure rate of female laparoscopic sterilisation?
1 in 200 lifetime risk - could be ectopic
how are men sterilised?
vasectomy: vas deferens divided and ends cauterised small incision midline scrotum, local anaesthetic
vasectomy failure rate
- Takes 4-5 months to be effective – 2 sperm samples sent in by post after 4 and 5 months Failure rates 2 in 100 do not get clear samples
- Failure rate after x 2 clear samples 1 in 2000 lifetime
what is the abortion act 1967?
an act to amend and clarify the law relating to termination of pregnancy by registered medical practitioners.
what will a consultation discussing abortion involve?
Medical history- risk VTE/bleeding/ from GA/ contraceptive eligibility
Circumstances – reasons for considering abortion/ support
see alone / language line , check no coercion
Usually need scan to confirm gestation and viable IUP
Discuss methods of abortion
Risks infection < 10%, Blood transfusion < 1:1000
Contraception for afterwards
FBC/Rhesus Group > 10 wks or STOP +/- haemoglobinopathy
Vaginal swab for chlamydia / gonorrhoea / TV
STI bloods offered -BBV syphilis
what are the long-term effects of abortion?
- Safer than a fullterm delivery
- No effect on future fertility unless infection/perforation
- No effect on cancer risks
- Emotional effects depend on reasons for abortion/ pre-existing mental health issues
describe the surgical abortion procedure (STOP) at 5-12 weeks pregnancy
- cervical priming: misoprostol 3hrs preop helps dilation and reduces risk perforation/haemorrhage
- general anasethesia GA or local anaesthesia LA cervical block
- transcervical - 6-10mm suction catheter < 10mins
what are the complications of surgical abortion procedure (STOP) at 5-12 weeks pregnancy
- 1-4:1000 perforation
- < 1:100 cervical injury
- risks from general anaesthetic
describe the medical (MTOP) abortion procedure at 5-23 + 5 weeks pregnancy
- mifepristone oral antiprogestogen tablet
- 36-48hrs later misoprostol initiates uterine contraction which opens cervic and expels pregnancy
- average 4-6 hours to pass pregnancy under 12 weeks
- mifepristone helps misoprostol work better
what are the complication of medical (MTOP) abortion?
- failure 1 in 100 < 8 weeks
- 8 in 100 > 12 weeks need surgery for incomplete abortion
describe an early medical abortion at home (EMAH)
Legal to supply misoprostol for woman to take away from clinic for home self administration . Since COVID 2020 also legal to supply mifepristone for home self adminiatration.
An option for women who are under 10 weeks gestation and prefer a home procedure and are ‘healthy’ and have support. Analgesia supplied. Phone advice 24/7.
Follow up low sensitivity pregnancy test at 2 weeks or scan sooner if minimal bleeding.
