Contraception 2 Flashcards
3 methods of combined hormonal contraception?
combined pill
vaginal ring
patch
failure rate of CHC?
if perfect = 0.3%
typical use = 9%
how is the combined pill taken?
start in 5 days of period
or
at any time in cycle when reasonably sure not pregnant plus condoms 7 days
take daily for 21 days followed by a 7 day break
tailored regimes in combined pill?
can tricycle pill for 3 months then take a week off
or just keep taking until you have a breakthrough bleed
- stop while bleeding then start again
what may impair effectiveness of CHC?
impaired absorption (GI conditions etc) increased metabolism (liver enzyme induction, drug interaction etc) forgetting
risks in CHC?
venous thrombosis
arterial thrombosis
adverse effects on some cancers
what is the VTE risk in pregnancy?
21-30 per 10,000
i.e bigger risk than the pill
VTE risk in post-natal women?
130-140 per 10,000
even bigger than in pregnancy
unwanted effects of CHC?
systemic hypertension
- should check at 3 months initially then annually
aterial disease (small increase in MI risk, small increase in ischaemic stroke risk)
increases risk of ischaemic stroke in people who have migraine with aura (contraindication)
how can CHC affect cancer risk?
small increase in breast cancer risk
small increase in cervical cancer risk with long term use (>5 years)
- reduces to baseline 10 years after stopping
examinations in CHC?
record BP and BMI before prescribing
check smear status if relevant
check if there are multiple risk factors
protective factors of CHC?
20% reduction in ovarian cancer risk for every 5 years of use to a max 50% reduction after 15 years 20-50% reduction in endometrial cancer potential use in BRACA gene patients beneficial acne in acne - dianette
non-contraceptive benefits of CHC?
less bleeding
fewer functional ovarian cysts
premenstrual syndrome
PCOS
side effects of CHC?
nausea
bleeding
spots
breast tenderness
when should CHC be avoided?
inherited thrombophilia
migraine with aura
how to start progesterone only methods?
start on day 1-5 of period or anytime in cycle is certain not pregnant
types of progesterone only methods?
POP
subdernal implant
DMPA
risks of subdermal implant and POP?
little effect on metabolism
can be given in most circumstances
safer than pregnancy
no increased cancer risk
how does depo provera/syana press work?
supresses FSH
lowers estradiol
(sayana press = newer, self administered)
good uses of depot?
good in learning disability to control periods
only needed every 3 months
no interaction with epilepsy medications
side effects of depot?
associated risks of low oestrogen
- osteoporosis etc
benefits of diaphragm (female condom)?
71-88% effective
can be good for older women who are less fertile and dont want hormonal treatment or to take a pill every day
drawbacks of diaphragm?
need to leave it in for at least 6 hours after sex
need to apply spermacide max 3 hours before sex
- if spermacide applied then dont have sex for 3 hours, need to reapply
how is a vasectomy performed?
under local or general anaesthetic
non-scalpel technique
very easy
complications of vasectomy?
anaesthetic
pain
infection
bleeding/haematoma
failure (usually early in non-compliance)
(still much safer and less invasive than female sterilization)
how is success of vasectomy measured?
post vasectomy seminal analysis
- late - motile or >100,000 non-motile sperm at 7 months
methods of female sterilisation?
done on fallopian tubes
- removal
- band
- clip
- essure
non medical contraception?
natural family planning
- very high failure rate
- some use if just to space out periods etc
