Contraception Flashcards
Outline broadly the various types of contraception?
- Hormonal
- Intrauterine devices
- Barrier methods
- Surgical/sterilisation
- Emergency post-coital contraception
- Natural methods/physiological
How many sexually active women become pregnant within 1 year if no contraception is used?
85%
Suitable contraception post-delivery include
- Progestogen only contraception
- Mini-pill
- Mirena IUS
- Implanon
- Depo-provera injection
- Barrier: female and male condoms
- Surgical: sterilisation
- Emergency contraception: levonorgestrel pill or copper IUD
All women should have a formal contraceptive decision-making visit with their family doctor at six-week check.
Why isn’t the combined OCP a suitable option for a woman post-delivery?
- Contraindicated within 2 weeks postpartum due to risk for thromboembolism
- Combined OCP may reduce breast milk production and, in turn, result in early discontinuation of breastfeeding or poor infant growth
- After six months postpartum, use of low-dose combined OCP is generally recommended
If you are not breastfeeding, you can choose any type of contraception
Is breastfeeding suitable contraception post-partum?
Breastfeeding is 98% effective in preventing pregnancy, but only if:
- You have not had a period since your baby was born and
- Your baby is less than six months old and
- You are exclusively breastfeeding
Once your periods return or you start giving your baby other food or drink and you do not want to become pregnant, you will need to use another method of contraception.
Note 2% risk of pregnancy may be too high for some families
Absolute contraindications to the combined OCP are…
- < 6 weeks post partum
- Smoker over age of 35
- Hypertension (systolic >160mmHg or diastolic >100mg)
- Current or past history of VTE
- Ischaemic heart disease
- History of CVA
- Complicated valvular heart disease (pulmonary hypertension, atrial fibrillation, history of subacute bacterial endocarditis)
- Migraine headache with focal neurological symptoms
- Breast cancer (current)
- Diabetes with retinopathy/nephropathy/neuropathy
- Severe cirrhosis
- Liver tumour (adenoma or hepatoma)
Relative contraindications to the combined OCP are…
- Smoker over the age of 35 (<15 cigarettes per day)
- Adequately controlled hypertension
- Hypertension (systolic 140-159mmHg or diastolic 90-99mmHg)
- Migraine headache over the age of 35
- Currently symptomatic gallbladder disease
- Mild cirrhosis
- History of combined OCP-related cholestasis
- Users of medications that may interfere with OCP metabolism
What is the failure rate of:
- Vasectomy
- Tubal ligation?
The failure rate of sterilisation is as follows:
- Vastectomy: 1 in 2000
- Tubal ligation: 1 in 200
Which questions on history are important for contraception counselling?
- Age
- Current relationship – regular partner vs multiple partners
- Menstrual history - unscheduled bleeding requires investigation & if menorrhagia, consider options that also benefit (e.g. COC, Mirena)
- Previous contraception
- Desire for pregnancy in future, and how soon - LARC vs short acting
- PMHx: current, past, STIs, pap smears, medical contraindications to oestrogen
- Family or personal history of: VTE, breast/cervical cancer, migraine with aura, MI, TIA/Stroke, liver disease, hypertension, diabetes
- Smoking status
What are the ways in which the combined oral contraceptive pill works to prevent conception?
- It thickens mucus at the opening of the uterus so it is harder for sperm to penetrate
- It changes the lining of the uterus so a fertilised egg is less likely to implant and survive
- Ovulation inhibition (-ve feedback on hypothalamus + pituitary)
Does using the pill increase a woman’s risk of developing ovarian or endometrial cancer?
Women who use the pill significantly reduce their risk of ovarian and endometrial cancers, by as much as 50% if the pill is used for 10 years or more. Protection against these two forms of cancer continues for 15 or more years after stopping use of the pill.
What are the side effects of injectable progestogen (Depo-Provera) given 12-weekly?
- Menstrual disturbance (regular, irregular or even amenorrhoea)
- Delayed conception (fertility may not return for 6-12 months)
- Weight gain (probably due to progestagen ↑ appetite)
- Bone loss (small risk of ↓ bone density with prolonged use)
Will using an injectable contraceptive cause a woman to suffer bone density loss?
Injectable contraception does contribute to bone density loss, especially in the hip and lower spine, within two years of receiving the first injection. Women who use an injectable and have low levels of calcium intake, smoke and have never given birth are at highest risk for osteopenia.
Women who use injectable contraceptives as adults appear to regain most of the lost bone density after they stop using the method.
Current research is examining whether bone loss in adolescents and young women is fully reversible. WHO considers it acceptable for adolescents to use an injectable contraceptive because preventing unintended pregnancies at a young age outweighs the risk of a fracture later in life if suitable alternatives are unacceptable.
Describe the most common side effects of levonorgestrel-containing IUD (Mirena)?
- Irregular PV bleeding in the first 3-4 months, amenorrhoea in up to 30% by 1 year
- Hormonal symptoms: nausea, headaches, breast tenderness, bloating
- Benign and usually self-limiting ovarian cysts
What are emergency contraceptive pills?
- High dose of daily oral contraceptive pill; the pills consist of a combination of progestin and estrogen or progestin only
- If taken within 72 hours of UPSI, it is estimated to prevent 85% of expected pregnancies
- May be used up to 120 hours after unprotected sex. However, the sooner a woman takes ECPs after UPSI, the greater the effectiveness
