Contraception 2 Flashcards
What is levonelle?
contains a single dose of progestogen levonorgestrel
best taken within 24hrs and no later than 72hrs
affects sperm function and endometrial receptivity and if given just prior to ovulation it may prevent follicle rupture
95% success rate if used within 24hrs, but reduces to 58% if delayed until 72hrs
vomiting can occur, plus menstrual disturbance in the following cycle
What is ulipristal? (ellaone)
selective progesterone receptor modulator (SPRM)
prevent or delays ovulation and may also reduce embryo implantation
can be used up to 120hrs after unprotected intercourse
as it blocks progesterone action, it will reduce effectiveness of progesterone-containing contraceptives
women should use condoms or avoid unprotected intercourse until the next period
breastfeeding should be delayed for one week after taking ulipristal. There are no such restrictions on the use of levonorgestrel
How is a IUD used as emergency contraception?
prevents implantation
most efficacious method of emergency contraception
can be inserted up to 5 days after episode of unprotected intercourse or the expected day of ovulation
antibiotics prophylaxis is usually given at the time of insertion
What are the types of barrier contraception?
Male condom- failure rate 2-15 per 100
Female condom
Diaphragms and caps- fitted before intercourse and must remain in situ for at least 6hrs afterwards. Failure rates 5 per 100 women. Some protection against PID
Spermicides- barriers methods are used in conjunction with a spermicide jelly/cream/pessary containing nonoxynol-9
How do copper containing devices work?
prevent fertilisation as the copper ion is toxic to sperm and also block implantation
• Failure rate for both IUD & IUS is <0.5 per 100 woman-years
How do hormone containing IUS work?
contain progestogen which is slowly released locally over several years
can be replaced every 3 or 5yrs
changes to cervical mucus, uterotubal fluid, backed by endometrial changes which impede implantation
reduces menstrual loss and pain
systemic side effects are lower, but irregular light bleeding is the main problem
return to fertility after removal is rapid and complete
When are intrauterine contraceptive devices inserted?
• Usually inserted in the first half of the cycle, but can be used straight after termination or in the puerperium
IUS is also used in non-contraceptive indications, such as menorrhagia or dysmenorrhoea
What are the complications of intrauterine devices?
o Pain or cervical shock (increased vagal tone) can complicate insertion
o Expulsion- usually within the first month
o Perforation of the uterine wall (<0.5%)- can occur at insertion or may migrate there afterwards
o Heavier or more painful menstruation- can occur (except with IUS)
o Infection (20% risk)- women with asymptomatic STI are at increased risk of PID during first 20 days after insertion, but mainly limited to younger women with multiple partners
o Ectopic- if pregnancy does occur with IUD/IUS present- but rate lower than without contraception
What is female sterilisation?
10% of couples rely on this method
• Most common technique is fallopian tube clips (Filshie clip)-applied laparoscopically and completely occlude the lumen
• Sometime sterilisation is performed at the same time as a C-section
• An alternative is transcervical sterilisation -hysteroscopic placement of microinserts into the proximal part of each tubal lumen
inserts expand and cause fibrosis and occlusion of the lumen
confirmed 3 months later with hysteroslapingogram
Both have failure rates of 0.5%
What is male sterilisation?
• Vasectomy is more effective than female sterilisation
involves ligation and removal of a small segment of the vas deferens
thereby prevents release of sperm
• Can be performed under local anaesthetic
• Sterility is not confirmed until azoospermia from two semen analysis- may take up to 6 months
• Natural conception following successful reversal is often prevented by antisperm antibody formation which restricts motility- such sperm can be washed and used during an insemination or IVF cycle
• Surgical sperm retrieval followed by IVF is an alternative to vasectomy reversal
What are the complications of a vasectomy?
o Failure
o Postoperative haematomas
o Infection
o Chronic pain
What is natural contraception?
- Lactation- has a major contraceptive role in the developing world
- The rhythm method- avoids the fertile period around ovulation
- Withdrawal- involves removal of the penis just before ejaculation, not recommended because sperm can be released before orgasm
When should the dose of levonelle (levonogesterol) be changed?
if vomiting occurs within 3 hours then the dose should be repeated
the dose should be doubled for those with a BMI >26 or weight over 70kg
What does each stage of the UKMEC for COCP indicate?
UKMEC 1: a condition for which there is no restriction for the use of the contraceptive method
UKMEC 2: advantages generally outweigh the disadvantages
UKMEC 3: disadvantages generally outweigh the advantages
UKMEC 4: represents an unacceptable health risk
What are UKMEC 3 conditions for the COCP?
more than 35 years old and smoking less than 15 cigarettes/day
BMI > 35 kg/m^2*
family history of thromboembolic disease in first degree relatives < 45 years
controlled hypertension
immobility e.g. wheel chair use
carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
current gallbladder disease
