Contraception Flashcards
what does the natural family planning method take in to account to work as contraception
1) Basal body temperature
2) Cervical mucous
3) Cervical position
4) “Standard” days
5) Breast feeding
what does the cervical mucous tell you about ovulation
Thick and sticky post ovulation
3 days after thinner, watery, stretchy mucous
what does the cervical position tell you about ovulation
when fertile, cervix is high, soft and open
when less fertile, cervix is low in vagina, firm and closed
what days tend to be most fertile in a 28 day cycle
day 8 to 18
what criteria is needed to know that breast feeding is working as contraceptive
1) exclusively breast feeding
2) less than 6/12 post natal
3) amenorrhoeic
what does the pearl index represent
no. of contraceptive failures per 100 women users/year
what is LARC and examples
long acting reversible contraception
Depo Provera IM ( medroxyprogesterone acetate) Sayana press (SC version)
what are VLARC and examples
very long acting reversible contraception
IUD
IUS
Implant
how does the Depo provera/ Sayana press [LARC] work
inhibits ovulation
when is Depo provera/ Sayana press [LARC] given
every 13 weeks
lasts 14 weeks
what else does Depo provera/ Sayana press [LARC] have an effect on
thickens cervical mucus
endometrium
what are side effects of Depo provera/ Sayana press [LARC]
irregular bleeding
weight gain
what hormones are present in Depo provera/ Sayana press [LARC]
progesterone only
what needs to be done before first prescription of Depo provera/ Sayana press [LARC]
BP
BMI
risk factors for osteoporosis
what are risk factors for osteoporosis
Underweight Anorexia Prolonged steroid use XS alcohol intake Immobility Family history Smoking Low trauma fracture
when do you start Depo
can be started up to and including Day 5 of the cycle without the need for any additional contraception
when do you start Depo after day 5
any other time provided she is ‘reasonably certain’ she is not pregnant and needs to use condoms/abstain for 7 days
what criteria is there to be reasonably certain a women is not pregnant
No sex since last period
Consistently using reliable contraception
< 7 days since last normal period
< 4 wks post partum (not breast feeding)
Fully breastfeeding, amenorrhoeic and < 6m post partum
Negative preg test AND > 3 wks since UPSI
side effects of Depo
weight gain
delay in return of fertility
irregular bleeding
risk of osteoporosis
what is different about the IUD compared to other devices
it is non-hormonal
how does IUD’s work
prevent fertilisation
decreases sperm motility and survival
what are side effects of IUD
Periods may be heavier, longer and more painful
Small chancer of getting infection in first 20 days
perforation 1-2/1000
Expulsion 1/20, most in first 3/12
when can an IUD be started
up to 5 days after UPSI
[it is immediately protective]
Up to 5 days after predicted date of ovulation (I.e. day 19 of 28 day cycle)
Either within 48 hrs or > 4 weeks post partum
what hormones do IUS contain
progesterone only
how does IUS work
Prevents endometrial proliferation (implantation)
Also thickens cervical mucus
what is side effects of IUS
Irregular bleeding/lighter+less frequency bleeding and spotting in first 6 months
Can get infection in first 20 days
when can an IUS be started
Within first 7 days of period
If after first 7 days use additional contraception
Either with in 48 hrs or > 4 weeks post partum
what are contraindications to IUD and IUS
Current pelvic infection Abnormal uterine anatomy Pregnancy Sensitivity to any of the constituents Gestational trophoblastic disease when BHCG levels are abnormal/persistently elevated Endometrial ca Cervical ca awaiting treatment
what should be checked before fitting IUD/IUS
PV to check uterine size/position
BP and pulse if you think necessary
what is the implant
single, non biodegradable, subnormal rod
how does the implant work
inhibition of ovulation
when can the implant be fitted
Within first 5 days of cycle
Up to day 5 post first/second trimester abortion
On or before day 21 postpartum
what hormone does the implant release
progesterone only
how long does the implant last for
3 years
S.E of implant
irregular bleeding
weight gain
acne
nerve damage/vascular injury on insertion
what are the types of short acting contraception
Combined Hormonal Contraception (CHC)
Progestogen Only Pill (POP)
Emergency Hormonal Contraception (EHC)
what does the COC contain
estrogen and progesterone
how does the COC work
inhibits ovulation
thickens cervical mucous
makes endometrium unfavourable for implantation
COC packet contains 21 pills - how does the system work
first 7 pills inhibit ovulation
remaining 14 maintain anovulation
side effects of COC
Increases risk of venous thromboembolism
Increases risk of breast and cervical cancer
Small risk of increase in BP > systemic hypertension
what should a person be advised to do if they miss 1 pill
Over 24 hours and less than 48 hours
Take the missed pill as soon as it is remembered
Remaining pills are taken at the normal time
EC is not required
what should a person be advised to do if they miss 2 or more pills
More than 48 hrs without pills
Take the most recent missed pill
Take the remaining pills at the correct time
Use condoms or abstain until 7 pills have been taken consecutively
through what mechanism does COC stop ovulation
action on hypothalmic-pituitary-ovarian axis to reduce LH and FSH
how does CTP work - contraceptive patch
One patch is applied and worn for 1 week to suppress ovulation.
The patch is reapplied weekly for a further 2 weeks
The 4th week is patch-free to allow a withdrawal bleed
New patch is applied after 7 patch-free days
how does CVR work - vaginal ring
A ring is placed into the vagina and left continuously for 21 days.
After a ring-free interval of 7 days to induce a withdrawal bleed, a new ring should be inserted
what factors require consideration when prescribing COC
absorption - impaired in GI conditions
metabolism - increased in liver enzyme induction, drug interaction
metabolic effects
forgetting
what is Cyproterone acetate
works as COC
used in the Tx of acne and hirsutism
when is COC contraindicated
patient suffers migraine ith aura
why is migraine with aura a contraindication of COC
Migraine with aura increases the risk of ischaemic stroke
CHC further increases thi risk
what is ‘aura’ with migraine
A ‘change’ occurring 5 – 20 minutes before the onset of headache
May be visual, typical scotoma
Altered sensation
Smell or taste
Hemiparesis
what is COC protective against
ovarian and endometrial cancers
beneficial effect on acne
can decrease bleeding
side effects of COC
Unscheduled bleeding - usually settles with time, don’t change before 3 months
Mood changes
WEight gain
side effects of CTP - the patch
more breast pain, nausea, painful periods than COC/CVR
side effects of CVR - vaginal ring
less bleeding problems, acne, irritability/mood changes
why is CHC useful along side emergency contraception [EC]
as a quick start and can be used as riding if the new contraception that patient wants has a delayed started
what types of progesterone only pills [POP] are there
Older POP - levonorgestrel, norethisterone
Newer POP – etonorgestrel
how does POP work
primary = Thickening of cervical mucous
secondary = Suppression of ovulation, decreased endometrial receptivity to blastocyst, reduction in cilia activity in fallopian tube
what does POP interact with
Liver enzyme inducers - Cytochrome P450
how are POP taken
older pills
- Daily at same time
- No break
- Within 24 - 27 hours of last dose
newer pills
- Daily at same time within 24 – 36 hours of last dose
No break
what happens is a patient is on POP and has = One missed dose plus UPSI
emergency contraception plus 2 days extra protection
what are complications of vasectomy
Anaesthetic complications
Pain
Infection
Bleeding /haematoma
Failure
Post-op testicular, scrotal, penile, lower abdominal pain
how soon are people protected on the POP
Protected immediately if started on day 1-5 of period
If taken after day 5 then must wait 2 days until protected
in terms of legality, when can an abortion happen
only if two registered medical practitioners are of the opinion, formed in good faith, that an abortion is justified within the terms of the Act
what is the types of methods of abortion that can be done and what time frame can they be done in
Surgical termination up to 12 weeks
Medical termination up to 18 weeks and 6 days
for medical termination, what are the 3 time frames that affect the treatment
early = up to 9 weeks late = 9-12 weeks mid-trimester = 12-24 weeks
what are the 2 steps in the process of medical TOP
1) Oral MIFEPRISTONE 200mg
2) 24-48 hours later – Vaginal (or oral) prostagladin e.g. misoprostol, gemeprost
what are the methods of surgical treatment and what time frames are they in
Vacuum aspiration
= 6-12 weeks
Dilatation and evacuation
= 13-24 weeks
what is required before surgical TOP
Cervical ‘priming’ – vaginal prostaglandin
what are the risks of TOP surgically
Pain, Haemorrhage Infection Incomplete/failed procedure Uterine perforation Cervical trauma Anaesthetic complications Ongoing pregnancy Uterine rupture
what is the follow up of a TOP
Urine Pregnancy Test at 2-3 weeks
what are the methods of emergency contraception and in what time frame can they be used
Oral =
Levonelle – up to 72hrs post UPSI
ellaOne – up to 120hrs post UPSI
Intrauterine =
Copper IUD - up to 120hrs post UPSI
what follow should be done after emergency contraception
urine pregnancy test after 3 weeks
