Contraception Flashcards
methods of contraception that require ongoing action by the individual
- Oral contraceptives
- Barrier methods (most common is condoms)
- Fertility awareness (knowing when it is “safe”)
- Coitus interruptus (pull-out)
- Oral Emergency contraception
methods of contraception that have no need for action by the individual
- IUCD/IUI/IUS (intrauterine devices)
- Progestogen implants
- progestogen injections (12 weekly in the buttock)
- Sterilisation
risks of not using contraception
- childbirth related (having increased children)
- abortion rate (increases)
- social costs
- economic costs.
risks of using contraception
ST effects - all body systems including cvs
LT - neoplastic effects
hormones affect brain so may cause emotional changes
implantations may introduce pathogens to body .’. infection
what is meant by ‘iatrogenic’
adverse effects of a medical treatment are iatrogenic
benefits of treatment with contraception
- Non-contraceptive benefits?
- Psychosexual benefits
- Good for sexual health
- Economically beneficial
benefits of not using contraception
- Non-interference with sex
- Allows population growth
- Other people say contraception allows control of women
what does the combined oral contraceptive pill contain
synthetic progesterone and oestrogen.
Oestrogen as ethinyloestradiol
why are there many different types of COCP
depends on type of progestogen it contains.
what is a progestogen
acts like progesterone but is not chemically the same
what are some types of progestogen
old= -norethisterone new - norgestimate - gestodene
what is the benefit of using Drospirenone COCP
reduced bloating as compared to the other two
when taking COCP, what happens to the oestrogen and progesterone
oestrogen and progesterone levels v high. above levels seen in a typical menstrual cycle.
how does high oestrogen work in COCP
- ve feedback loop with ant. pituitary and hypothalamaus
- > so gonadotrophin levels are low
- > low FSH means follicles dont mature and no folliculogeneis
- > low LH and no +ve feedback by oestrogen so no LH surge SO NO OVULATION.
where does oestrogen act in the body
Oestrogen acts on the endometrium causing proliferation, if we just gave oestrogen it would cause excessive proliferation of the endometrium. This is why we give progestogens as well
what is LH
Luteinizing hormone
produced in pituitary
rise in oestrogen tells pituitary to stop producing FSH and start producing LH.
shift in LH causes ovulation into the empty follicle.
In the empty follicle, cells proliferate + turn into corpus luteum. This structure releases Progesterone which is needed to mantain pregnancy
What is the effect of progestogens in the COCP
constantly high so -ve feedback on ant. pituitary and hypothalamus
- causes thinning of endometrium so isnt receptive to implantation
- also thickens cervical mucus so hard for sperm to swim through
- and reduced contractility of uterine tubes so oocyte cannot pass down properly
what are the three main actins of COCP
- Stops ovulation
- Prevents implantation
- Thick cervical mucus
what are the benefits of the COCP
- reliable
- safe
- Unrelated to coitus (as don’t have to put condom on before sex)
- Effects rapidly reversible, fertility kicks in very rapidly once you stop taking pill (10 days after you stop taking your next cycle kicks in)
LT benefits of taking the COCP
- Halve risk of ovarian cancer
- Have risk of endometrial cancer
- Decrease risk of colon cancer
- May also help endometriosis, fibroids, rheumatoid arthritis, premenstrual syndrome, dysmenorrhea, menorrhagia
cardiovascular effects of COCP
- Arterial effects most commonly hypertension
- Venous effects most commonly clotting disorders (caused by oestrogens), increased risk of DVT, pulmonary embolism, migrane
gastrointestinal effects of COCP
Insulin metabolism (makes you insulin resistant) may cause weight gain, risk of Crohns disease
hepatic risk of COCP
Can cause gallstones occasionally, jaudice
Dermatological effects of COCP
Chloasma, acne, erythema,
psychological effects of COCP
Mood swings, depression, lowered libido
medication contraindicating with COCP
Liver enzyme inducing drugs e.g. rifampicin and anti-epileptics affect the metabolism of both oestrogen and progesterone
Broad spectrum antibiotics may kill the microbiome of the gut which affects the enterohepatic circulation (reabsorption) of oestrogen.
what is the combined Vaginal Contraceptive (CVC)
This is the same as the COCP but instead is delivered vaginally as a ring which remains in for 21 days and then you remove for 7 days (have a little bleed). This releases the oestrogen/progesterone
what are progestogen only methods of contraception
o Impants such as Impalanon and Norplant, inserted into the arm where it remains for three years.
o Hormone releasing IUCD,
how do hormone releasing IUD work
these sit inside the uterus and release progestogens into the uterus thinning the endometrium, makes cervical mucus, stops uterine tubes working etc. A common example is Mirena IUS
why is the progestogen only pill ‘cerazette’ so popular?
- as effective as COCP
- Bleeding as predicable as COCP
- no oestrogen, so less contraindications (eg breastfeeding women can use it)
- 12 hour window if you forget the pill for it to work
what are the 2 most common Intrauterine contraceptive devices (IUD)
mirena and copper bearing IUCDs
what is the mechanism of action of coppe IUD
The copper being spermicidal and killing spermatozoa
- > sets up inflammatory reaction & prostaglandin secretion
- > the mechanical effect of it being there which prevents implantation
what are the benefit of IUCD
- non-user dependent (no maintenance etc)
- Immediately and retrospectively effective
- Is immediately reversible
- left in LT
- extremely reliable method
- Is unrelated to coitus
- Free from serious medical dangers
disadvantages of IUCD
- fitted by trained medical personnel
- fitting may cause pain or discomfort
- Copper IUCDs may cause periods to become heavier + painful
- IUCDs do not offer protection against infection
- threads may be felt by the male
risk associated with IUCD
- likely to miscarriage if IUCD is in situ if pregnant
- relative increase in ectopic pregnancy, but absolute risk is lower
- IUCDs if not fitted properly may fall out and be expelled
- When inserting the IUCD, uterus may become perforated
contraindictions with IUCDs
- risk of misscariage more likely
- increase relative risk of ectopic pregnancy
- may perforate the uterus
- If not fitted properly, may fall out and be expelled
advantage of male condoms
- Man is in control
- Best protection against STIs
- No serious health risks
- Easily available, free at family planning clinics
advantages of female condoms
- Woman in control
- Protects against STIs
- Can be put in advance and left inside after erection lost
- Not dependent on male erection in order to work
disadvantages of male condoms
- There is a tendency towards last minute use (bad as there is sperm in pre-ejaculate)
- How to put a condom on needs to be taught
- The condom may cause allergies
- May cause psychosexual difficulties
- There is a higher failure rate amongst some couples
- Oily preparations used in coitus rot the rubber
disadvantage of femidom
- Is an obtrusive method
- They are expensive
- They can be messy
- They rustle during sex
- Failure rates were uncertain for a while as males would go down the side
what are diaphragm caps
Diaphragm caps are made of latex and fit across the vagina. They must be used with spermicide and left in at least 6 hours after sexual intercourse
what are suction caps
- Suction caps are made of plastic, they suction to the cervix (or vaginal vault)
- must be used with spermicide and left in for 6 hours or more.
advantages of diaphragm caps
- Puts the woman in control
- Can be put in prior to sex
- It offers protection against cervical dysplasias
- Perceived as being a natural method
disadvantages of diaphragm caps
- Need to be taught how to insert
- Are messy
- They have a higher failure rate in comparison to most other methods
- Higher risk of UTI
- Higher Candiasis (fungal infection)
advantages of suction caps
- A suitable method for women with poor pelvic floor muscles
- There are no problems with regards to causing rubber allergies
- Regarded as being a very unobtrusive method
- Puts the woman in control
disadvantages of suction caps
- Requires an accessible and suitable cervix
- Higher failure rate than diaphragm
- Not easy to find an experienced teacher
what variables help measure ovulation
Temperature increases when you ovulate
- > Cervix position moves down nearer ovulation
- > Cervical mucus more thin when ovulating
- > Persona (is a urine test measuring the LH surge)
- > Lactional amenorrhoea (LAM), while breastfeeding periods stop, this is a good contraceptive
when do we ovulate
If you have a regular cycle you will ovulate 14 days before your cycle starts.
how long does sperm survive in the female tract
5 days
how does cervical mucus change around the time of ovulation
less viscous and more more receptive to sperm
what is the fertility awareness module
having sex/abstaining around the time of ovulation
no physical contraception
what is the advantages of the fertility awareness model
- Is a non-medial method
- Can be used in developing countries where other methods are not available
- The catholic church allows this method
- This method can result in closeness of understanding between partners (enhance relationship)
disadvantages of fertility awareness model
- Failure rate is heavily user dependent (i.e. you have to do it properly)
- Requires skilled teaching
- May require co-operation between partners which causes problems
- Can limit sexual activity
Can cause strain on relationship
what is emergency contraception
contraception after having unprotected sex
either
1. postcoital pills
2. copper IUD
how soon after sex can postcoital pills be taken
upto 72 hours after unprotected sex
is possible to take upto 5 days after as before 5 days the embryo hasnt implanted
what are the names of postcoital pills
used to be PC4
- Levonelle prevents 7 out of 8 pregnancies, is the drug of choice
- ellaOne (ulipristal) is similar
benefits of levonelle 2 over PC4
- Low failure rate in the first 24hrs
- Very little nausea
- Only contraindicated in women taking very potent liver enzyme medication (e.g. anti-TB)
PC4 causes nausea + vomiting in many women & contraindicated during focal migraine attack.
benefits of ellaOne over PC4
ellaOne is a selective progestagen receptor modulator (SPeRM), it activates progesterone receptors.
Can work up to 120hrs
PC4 causes nausea + vomiting in many women & contraindicated during focal migraine attack.
mechanism of PC4 and Levonelle
giving high dose of progestogen
postpone ovulation in first part of cycle so by the time the oocyte is released, sperm is already dead.
the second part of cycle, when oocyte already released thought it works by preventing implantation
how do copper IUD prevent pregnancy
If in first part of cycle the copper kills the sperm preventing fertilisation.
If in second part of the cycle it prevents implantation in 2nd part of the cycle.
