Contraception Flashcards
What contraception shouldn’t be used in women with IBD?
OCP as malabsorption may occur
What contraception should be used in breastfeeding women?
Progesterone-only methods
COCP affects breast milk volume
IUD can be inserted 4 weeks post partum
What contraception should be used in later life?
Continue 2 years after last period if less than 50
Continue 1 year after last period if older than 50
Can use COCP if none smoker
IUD, IUS
What hormonal contraception exist?
POP - mini pill
Depot
CHC - COC, transdermal, vagina ring
How does the COCP act?
Negative feedback on gonadotrophin release
Inhibits ovulation
Thins endometrium and thickens cervical mucus
What are the different oestrogens the COCP contains?
Ethinyloestradiol - monophasic
Oestradiol valerate - Qlaira
4 phases of dose over 26 days and 2 pill-free days
Better for lipids, migraines and mood swings
What is the failure rate of COCP?
0.2/100 woman years
What are indications for COCP?
Menorrhagia Pre-menstrual symptoms Dysmenorrhoea Acne/hirsutism Prevention of simple ovarian cysts
When should missed pill instructions be followed?
Diarrhoea
Vomiting within 2hrs of taking the pill
Missing a pill in the last 7
What are complications of COCP?
Venous thrombosis Myocardial infarction Cerebrovascular accidents HTN Cervical and breast carcinoma
What are contraindications for the COCP?
BMI>40
Age>35yrs and smokes >15 cigarettes
What are side effects of the COCP?
Nausea
Headchaes
Breast tenderness
Suppresses lactation
Change to more potent progesterone
How should the POP be taken?
Every day without break
At same time +/- 3 hrs
How does the POP work?
Makes cervical mucus hostile to sperm
In 50% women inhibits ovulation
What is the failure rate of POP?
1/100 woman years
What are side effects of POP?
Breakthrough bleeding Weight gain Mastalgia PMS Functional ovarian cysts
When is POP better than COCP?
Breastfeeding mothers
History of thrombosis
Antibiotic takers
How is Cerazette different to other POPs?
Higher dose of progesterone
Inhibits ovulation in 95%
Can be taken in 12hr window
What is the failure rate of the injection?
What are side effects of the injection?
Irregular bleeding followed by amenorrhoea
Long return to fertility
Decreased bone density - regained after stopping
What are contraindications for the injection?
Teenagers - peak bone mass hasn’t been acheived
Older women - osteoporosis
What are indications for the injection?
During lactation
What is the failure rate for the implant?
What are side effects of the implant?
Irregular bleeding in first year
No drop in bone density
Easy removal
Rapid resumption of fertility
What and when can emergency contraception be given?
Levonelle - single dose of levonorgesterel
- within 72hr
- can cause vomiting
- 95% success rate
Ulipristal (EllaOne) - selective progesterone receptor modualtor
- prevents or delays ovulation
- within 120hr
- reduces effectiveness of progesterone containing contraceptions
Copper IUD - prevents implantation
- within 5 days after unprotected sex or expected day of ovulation
- give antibiotic prophylaxis
What is the failure rate of condoms?
2-15/100 woman years
What is the failure rate of the diaphragm?
5/100 woman years
How does the copper IUD work?
Copper is toxic to sperm
Blocks implantation
How does the IUS work?
Changes cervical mucus
Produced uterotubal fluid which impair sperm migration
Reduces menstrual loss and pain
What is the failure rate of the IUD?
What are indications for IUD?
IUD can be inserted straight after termination, puerperium and during first half of cycle
IUS can be used for menorrhagia or dysmenorrhoea
What are complications of IUD?
Pain or cervical shock Expelled (within month 1) Perforation - at insertion or later Heavier/painful periods PID from previous STI Ectopic
If threads of IUD have disappeared what do you do?
USS to look inside uterus
Abdo XR then laparoscopy
What are contraindications to the IUD?
Endometrial or cervical cancer
Active PID
Breast cancer (IUS)
Pregnancy
Previous ectopic
Nulliparity
What methods are available for female sterilisation?
Filshie clips - laparoscopy under GA
Microinserts in proximal part of tubes
What is the failure rate of female sterilisation?
0.5/100 woman years
What are complications of female sterilisation?
Pain
Ectopic pregnancy
Reversal request
How is male sterilisation done?
Ligation and removal of part of vas deferens
Can be done under LA
Sterility is confirmed by two semen analyses and may take up to 6 months
What are complications of male sterilisation?
Failure
Haematotoma
Chronic pain
