Contraception Flashcards
IUDs available in UK
Copper intrauterine devices (Cu-IUDs) - highly effective method of contraception or emergency contraception
Levonorgestrel intrauterine devices (LNG-IUDs) -
Mechanism of action of Cu IUD
- Copper effect on:
. On ovum and sperm: inhibition of fertilization - on cervical mucus: inhibits the passage of sperm into the upper reproductive tract
- endometrium: causes an inflammatory response within the endometrium, which could impair implantation.
What is LNG-IUD action
Progestogenic effects on:
- cervical mucus prevent the passage of sperm into the upper reproductive tract
- the endometrium may inhibit implantation
- In some individuals the LNG-IUD will also inhibit ovulation.
Are IUS effective immediately
Cu-IUD - effective immediately following insertion
LNG-IUD - effective 7 days after insertion
Gynecological benefits of IUD
52 mg LNG-IUD helps in management of:
- HMB
- dysmenorrhoea
- endometrial protection as part of HRT
Duration of use of Cu Iud
5-10 years
(Can be extended if inserted over age of 40y)
Duration of use of LNG-IUD
5 years
(If inserted before 45y: extended to 6 y)
(If inserted after 45y: extended to age 55)
Duration of use of LNG-IUD
5 years
(If inserted before 45y: extended to 6 y)
(If inserted after 45y: extended to age 55)
Mirena can be used for how long as a ENDOMETRIAL protection as HRT
5 years (FSRH recommends 6y)
CU IUD failure rate
Typical use: 0.8%
perfect used: 0.6%
LNG IUD failure rate
0.2% (perfect and typical use)
IUC cannot be used by young people, individuals who have never been pregnant and individuals who have never been sexually active. True or False ?
False
When can IUC be inserted post-partum ?
UKMEC 1 - Immediately post-partum within 48 hrs or after 4 wks/28 days - interval insertion
UKMEC 3 - Between 48 hrs - 4 wks
UKMEC in postpartum sepsis ?
4
Should any investigations be done prior to insertion of IUC ?
-STI screening (Current PID, known gonorrhoea infection, symptomatic chlamydial infection, purulent cervicitis are all contraindications to IUC insertion)
Can IUC be inserted in a female with uterine cavity malformations ?
Decision made on individualized basis
According to:
- the degree of distortion
- uterine cavity size
- the accuracy of imaging available
- the indication for use and other suitable alternatives
- the type of device being inserted
- the potential consequence of complications for that particular individual.
How to insert IUD in case of fibroids, distortion or malformations
should be in a specialist setting with access to ultrasound or hysteroscopy
What is Ehlar Danlos Syndrome
connective tissue disorder associated with an increased risk of uterine rupture in pregnancy and/or joint hyperlaxity, both of which may be relevant to IUC procedures
Any CI of IUD with cardiac disease
No
But should require MDT, insertion in hospital settings
Cu-IUD use is not recommended for individuals with which metabolic disorder?
Wilson’s disease
Health risks with IUC use ?
May be an association between hormonal IUDs and breast cancer - however, any potential increased risk appears to be small.
Presence of (or history of) ovarian cysts or PCOS is a contraindication to IUC use?
No
S/E of LNG-IUD
Acne , mood swings, headache, breast tenderness
Emergency contraception
- LNG-IUD
- Ulipristal Acetate
3.Cu IUD
How long to used combined vaginal ring
Stays in the vagina for 3 weeks and is removed for 1 week to allow menstruation
All Combined contraception contains what type of estrogen? except what?
Synthetic Estrogen (Mestranol)
Except: Qlaira contains Estradiol Valerate
When to start CHCs
At any time of the cycle (as long as she isn’t pregnant)
If started in 1st to 5th day of menses: efficient immediately
If afterwards: additional contraception for 7 days
Non contraceptive benefits of CHCs
- improve acne
- cycle regularity
- inprove 1ry dysmenorrhea
- reduce HMB
- reduce some menopausal symptoms
- reduce incidence of ovarian, endometrial & colorectal cancer, benign ovarian tumor& benign breast disease
Do CHC causes weight gain
No evidence
Risk of VTE with use of CHC compared to non users?
Double
But absolute risk is still low
Risk of CVS disorders with CHC
Very small increased risk of ischemic stroke, which is influenced by smoking, HTN -and migraine with aura
CHC in a women >35y who smokes?
Not recommended
<15 cigarettes/d: UKMEK 3
>15 cigarettes/d: UKMEK 4
If a woman stopped smoking for > 1 year, can she take CHC
UKMEK 2
Using CHC in women with HTN
Risk outweighs advantages, high risk of stroke and MI
Adequately controlled: UKMEK 3
Consistently elevating : UKMEK 3&4
Women with migraine w/aura, can take CHC
No
risk of stroke and MI
What are the risk of use of CHCs
- VTE
- Stroke and MI (smoking, HTN, migraine with aura)
Only method of contraception used in case pf ischemic heart disease
Cu IUD
(Not any hormones)
Best contraception used with epilepsy AEDs
DMPA
(COC decreases the effect of lamotrigine)
(OET C3P decreases the effect of CHC)
Do contraceptions cause depression
Not any contraception causes depression
(May be mood changes)
In case of Endometriosis what is the best contraception to be.used?
All are safe
(cu ius increases dysmenorrhea)
When to stop CHC or HRT prior to surgeries
4 weeks
BMI>35 is it safe to use CHC
Risks outweigh benefits - UKMEK 3
risk fo perforation by iud insertion
<1 in 1000
risk of expulsion of iud after insertion
5% in the 1st 3 month
