Contraception Flashcards
What is the mechanism of action of the COC, and what is its efficacy?
Negative feedback on gonadotropin release, stopping ovulation (oestrogen)
Thins the endometrium (progesterone)
Thickens cervical mucus (progesterone)
99% effective if used correctly
What are the benefits of the COC?
Benefits: Good contraception if used correctly Cycle control Improves pre-menstrual symptoms Can be used to treat endometriosis May make periods lighter Reduces risks of ovarian tumours and colorectal Ca.
What are the side effects and disadvantages of the COC?
Not a LARC and therefore more room for human error
Increases risk of:
-VTE
-Stroke and CVD
-Breast Ca (minimal)
-Associated with an increased risk of cervical ca this is due to more unprotected sex = more HPV
Side effects:
- Breakthrough bleeding in the first 3 months
- Headache
- Nausea
- Breast tenderness
What are the contraindications for the COC?
Lifestyle:
- Pregnancy
- Breast feeding
- Older than 35yo and smokes more than 15 a day
- BMI over 35
Illness:
- Migraine with aura
- Current breast ca (within last 5 years)
- CVD or high risk
- VTE or thrombophilia
- Hepatic disease
- SLE
How can the COC pill be taken?
Monophasic: same amount of hormone in each pill.
It is usually taken for 21 days followed by a 7 day break where the women bleeds.
Phasic pill: hormone levels vary to mimic normal fluctuations. It is again taken for 21 days followed by a 7 day break for a bleed.
Everyday pill: Last 7 days are placebo pills.
Pills are taken everyday.
Monophasic can be taken on repeat to stop periods.
What different methods do the combined contraception come in and how are they taken?
Patches: Put on any part of the skin except for the breast. Put patch on weekly for 3 weeks followed by 1 week off.
Vaginal ring: Put in the vagina for 3 weeks and removed for 1 week. Can be removed from the vagina for upto 3 hours.
What is the mechanism of action of the different POP’s?
Most pills work by:
- Thickening cervical mucus
- Thinning endometrium
Desogestrel works by:
-Anovulation
99% effective if used correctly
What are the classic progesterone side effects?
- Mood disturbances
- Headaches
- Acne
- Breast tenderness
- Increased appetite
- Bloating
How does POP affect a women’s bleeding pattern?
Unpredictable periods may be:
- absent 5/10
- regular 4/10
- irregular 1/10
What are the advantages and disadvantages of POP?
Advantages:
- Few contraindications (only absolute is current breast ca)
- Safe medication few risks associated
- Good efficacy if used correctly
- Works within 48hrs
Disadvantages:
- S/e’s
- Depending on the pill needs to be taken within 3 hours of the same time everyday.
How should POP be taken?
It is taken as an everyday pill.
Desogestrel can be up to 12hrs late before emergency contraception is needed.
Other pills must be taken within a 3hr window everyday
How does the nexaplon implant work and how long does it last for?
Releases progesterone can last upto 3 years.
It causes:
- Anovulation
- Thickened cervical mucus
- Endometrial thinning
What are the side effects of the implant and risks of the procedure?
Progesterone effects:
- Mood
- Headache
- Acne
- Breast tenderness
- Increased appetite
- Bloating
Also affects bleeding:
1/5 have frequent bleeding
1/5 have amenorrhoea
3/5 have regular bleeds
Risks:
- Bleeding
- Bruising
- Infection
Are there any contraindications to having the implant?
- Pregnancy
- Current breast Ca (within last 5 years)
- Severe liver disease as affects metabolism
How does deep provera injection work?
It gives a very large dose of progesterone in one go. This occurs every 12 weeks (licensed unto 14 weeks).
Progesterone causes:
- Anovulation
- Cervical mucus thickening
- Endometrial thinning
What is the name of the alternative progesterone injection?
Noristerat
Works in the same way but only lasts for 8 weeks, it is indicated in shorter term contraception.
What are the side effects of the depo injection?
- Mood changes
- Headache
- Acne
- Breast tenderness
- Weight gain (particularly in depo)
- Initial irregular bleeding
- Amenorrhoea (70% at 1 year)
Reduced fertility lasting unto 1 year, not an excuse for not using contraception
Can reduce bone density decreases for 2-3years then stabilises and is regained after this.
Which groups should you consider not giving the depo?
Those who want interim contraception in between pregnancies as delayed fertility.
Under 18’s and over 40’s due to effects on bone density.
What are the absolute contraindications for the depo?
Pregnancy
Current breast Ca (within last 5 years)
Severe liver damage
What is the IUS also known as and how does it work?
Mirena/hormonal coil (progesterone)
It primarily works by:
- Thinning the endometrium preventing implantation
- Also thickens cervical mucus
How long can the IUS be used for?
It is licensed for contraception for 5 years.
If it is fitted in someone 40 years old or over they can have until they have finished menopause
What are the benefits of the IUS?
LARC
Tends to make periods lighter
30% are ammenorrhoeic by 1 year
Less progesteogenic side effects
What are the disadvantages of the IUS?
Can cause irregular bleeding in the 1st month
Risks associated with the procedure
What is the IUD and how does it work?
Also known as the copper coil.
Cu inhibits sperm mobility
Coil prevents implantation
What are the benefits of the IUD?
Offers immediate contraceptive protection and can be used as a emergency contraception upto 5 days after unprotected sex.
No hormones so no hormonal side effects
What are the side effects and risks of the IUD?
Makes periods heavier
May also initially cause irregular bleeding
What are the contraindications of the IUD?
Pregnancy Any genital tract infection Current endometrial/cervical/breast ca Uterine abnormalaties (fibroids) Previous ectopic (relative contraindication)
What are the risks associated with both coils?
Risk of fitting:
- Infection
- Perforation
- Expulsion
If pregnancy occurs it is very likely to be an ectopic pregnancy.
What is the general effectiveness of LARC’s, when are they economical to fit and which is the most effective?
Greater than 99% effective
Economical to fit if used for more than 12months
Implant is the most effective
What are the different barrier methods of contraception and roughly how effective are they?
Condoms 82% effective
Female condoms
Diaphragms
Caps (need measuring before can be issued)
When should contraception be started in the cycle and how long does it take to start working?
Should ideally be started in the 1st 5 days of the cycle, then should be effective immediately.
If started after this then usually takes 7 days.
Exception are with:
POP which works after 48hrs
IUD which works immediately
