Contraception Flashcards
Typical use vs. perfect use effectiveness rates of natural family planning:
25% vs. 1-9%
Typical use vs. perfect use effectiveness rates of the pill (both combined and progesterone only):
8% vs. 0.3%
Typical use vs. perfect use effectiveness rates of the injection:
3% vs. 0.3%
Typical use vs. perfect use effectiveness rates of the implant:
0.05% both
Typical use vs. perfect use effectiveness rates of the copper IUD:
0.8% vs. 0.6%
Typical use vs. perfect use effectiveness rates of the IUS:
0.1% both
Typical use vs. perfect use effectiveness rates of condoms:
15% vs. 2%
Typical use vs. perfect use effectiveness rates of withdrawal:
27% vs. 4%
What is the name of the criteria which are the conditions under which breastfeeding can be used safely and effectively as a contraceptive method?
LAM criteria
What are the LAM criteria?
- Amenorrhoea
- Fully or nearly fully breastfeeding
- <6 months postpartum
What are the positives of POPs?
- Independent of SI
- May be suitable in those whom are not suitable for COCP
- Decreases the risk of endometrial cancer
- No evidence of WL, lower libido, or depression
- Return of normal fertility on discontinuation of use
What are the negatives of POPs?
- Pills must be taken at the same time every day
- Menstrual irregularities = common
- Except Cerazette, may be less effective in women >70kg
- Functional ovarian cysts
- Nil STI protection
- Small increased risk of ectopic pregnancy
- Small increased risk of breast cancer
When is a Cerazette pill considered ‘missed’?
> 12 hours late
What is a non-Cerazette pill considered ‘missed’?
> 3 hours late
What are the C/I’s to COCP?
- > 35 and smoking >15 cigarettes
- Current breast cancer
- Migraine with aura
- Multiple RFs for CVD - e.g. HTN, DM, smoking
- Inadequately controlled HTN
- SLE with antiphospholipid Abs
- PMHx or high risk of VTE
- PMHx of TIA/CVA
- PMHx of ischaemic HD
- Breastfeeding and less than 6 months postpartum
What are the positives of the COCP?
- Independent of SI
- Menstrual bleeding is lighter and less painful
- Decreased risk of cancer of the ovary, uterus and colon
- Decreased acne
- Return to normal fertility upon discontinuation
What are the negatives of the COCP?
- Increased BP
- Temporary adverse effects - e.g. headaches, nausea, mood changes, breast tenderness
- Small increased risk of MI and stroke
- Increased risk of STI
- Increased risk of VTE
- Increased risk of breast and cervical cancer
What are the positives of transdermal patches?
In addition to those of COCs:
- Only need to be changed once weekly
- Efficacy unaffected by D&V, unlike a pill
What are the negatives of transdermal patches?
In addition to those of COCs:
- Patch may irritate the skin
- Patch may detach from skin
- Less effective in women >90kg
- VTE risk may be greater
- Delay in return to normal fertility following discontinuation
What are suitable patch sites?
- Upper outer arm
- Upper torso (NOT breast)
- Buttock
- Lower abdomen
After what period of patch detachment should a new patch cycle be started and barrier protection used for the next 7 days?
> 48 hours
What are the disadvantages of the vaginal ring?
- Increased frequency of vaginal infection/discharge
- Foreign body sensation in the vagina
- Breakage or expulsion from the vagina, compromising efficacy
- Dyspareunia
- Delay in return of normal fertility following discontinuation
- Very rarely, inadvertent insertion into the urethra + migration into the bladder
How long should a vaginal ring be left in-situ?
3 weeks, followed by a 7 days ring-free period, before replacing with a new ring
May the ring be removed for intercourse?
Yes, uncomfortable, but for no more than 3 hours
What should the patient do if the ring is expelled in weeks 1 or 2?
<48 hours? - efficacy not compromised. Re-insert
>48 hours? - efficacy expelled. Re-insert, use condoms for 7 days, consider emergency contraception if unprotected SI has taken place in the last 5 days
What should the patient do if the ring is expelled in weeks 3?
<48 hours? - efficacy not compromised. Re-insert
>48 hours? - follow instructions as with weeks 1 and 2, OR insert new ring and miss ring-free week OR have a withdrawal bleed and reinsert a new ring no more than 7 days post- the date of expulsion
How often should the depo-provera injection be given?
Every 12 weeks
What is a long-term complication of depo-provera?
Loss of BMD - therefore avoid in adolescents and women with RFs for osteoporosis
What are the RFs for osteoporosis?
- Long term treatment with corticosteroids
- BMI <19
- FHx of maternal hip fracture before the age of 75
- Conditions associated with prolonged immobility
- Medical disorders independently associated with bone loss - IBD; RA; hyperthyroidism; coeliacs
At what point in a cycle should depo-provera be given?
Day 1-5. At any other time int he cycle it will be necessary to use condoms for 7 days
What is the difference between nexplanon and implant?
Nexplanon is radio-opaque and so can be located by x-ray. It also comes in a preloaded applicator to reduce errors during insertion
What are the +ve’s of nexplanon?
- Lasts 3 years
- Can be used when breast feeding
- Normal fertility returns post-discontinuation
- Can be used by those for whom CHC is unsuitable
- Effective in women of all BMIs
What are the -ve’s of nexplanon?
- Bleeding patterns are likely to be, and remain, irregular
- Fitting and removing is a minor surgical procedure ( and carry the risks of such)
- May slightly increase the risk of breast cancer
- Rare complications fo abscess, scarring and migration
For how long is the Mirena IUS licensed for contraceptive use?
5 years
What is the lifetime failure rate of vasectomy?
1/2000
What is the lifetime failure rate of female sterilisation?
1/200
What are the different methods of sterilisation?
- Filshie clip occlusion
- Tubal ligation
- Fallopian implants
- Hysterectomy
What forms of emergency contraception may be used within 5 days post- unprotected SI?
Ulipristal acetate
What forms of emergency contraception may be used within 3 days post- unprotected SI?
Levonorgestrel
