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Physiology & Science: Reproduction > Contraception > Flashcards

Contraception Flashcards

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1
Q

Which methods of contraception require ongoing action by the individual?

A
  • oral contraception
  • barrier methods
  • fertility awareness
  • coitius interruptus
  • oral emergency contraception
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2
Q

What are methods of contraception which prevent conception by default?

A
  • IUCD/IUI/IUs
  • progestogen implants
  • progestogen injections
  • sterilisation
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3
Q

What features would “the perfect contraceptive” acquire?

A
  • 100% reliable
  • 100% safe
  • non-user dependent
  • unrelated to coitus
  • visible to the woman
  • no going medical input
  • completely reversible within 24 hours
  • no discomfort
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4
Q

What are risks of contraception?

A
  • cardiovascular
  • neoplastic
  • emotional
  • infection related
  • allergic
  • Iatrogenic
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5
Q

What are risks of no contraception?

A
  • childbirth related
  • abortion related
  • social costs
  • economic costs
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6
Q

What are benefits of treatment?

A
  • the non-contraceptive benefits
  • psychosocial
  • choice
  • sexual health
  • cost savings
  • female equality
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7
Q

What are the benefits of not having contraception?

A
  • non interference
  • population growth
  • control of women
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8
Q

Combined oral contraception

  • What is it?
  • What does it include & where do they act?
  • Examples?
A
  • oestrogen + progestogens
  • oestrogen -> act on ant pit, ovary, endometrium
  • progestogens -> act on ant pit, ovary, endometrium, fallopian tubes + cervical mucus
  • older (2nd gen) - norethisterone, levnorgestrel
  • newer (3rd gen) - noregestromin
  • latest - drospirenone
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9
Q

What are the contraceptive benefits of the combined oral pill?

A
  • reliable
  • safe
  • unrelated to coitus
  • woman in control
  • rapidly reversible
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10
Q

What are the non-contraceptive benefits of oral contraception?

A
  • halve ovarian cancer
  • halve endometrium cancer
  • decrease colon cancer
  • helps endometriosis, fiborids, RA, premenstrual syndrome, dysmenorrhoea, menorrhagia
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11
Q

What are the risks of combined oral contraception?

A
  • cardiovascular - HBP, DVT, pulm embolism, migraine
  • neoplastic - breast, cervix, liver
  • gastrointestinal - COH/insulin metabolism, weight gain, crohns
  • hepatic - hormone metabolisms, jaundices, gallstones
  • dermatological - chloasma, acne
  • psychological - mood swings, depression, libido
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12
Q

What are the rules of taking the combined oral contraceptive pill?

A
  • start 1st packet 1st day of menstrual period
  • take 21 pills + stop for 7 day break (PFI)
  • restart each new packet on 8th day (same)
  • do not start new packets late
  • if late or missed pills in 1st 7 days, condoms
  • if missed pills in last 7d ays no PFI
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13
Q

What are interacting meds to look out for with combined oral contraception?

A
  • liver enzyme inducing drugs - affect metab of both oestrogen + progestogen
  • beware rifampicin + anti-epileptics
  • broad spectrum antibiotics - affect enterhepatic circulation of oestrogen only (40%)
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14
Q

What is the combined vaginal contraceptive?

A
  • similar as COCP except vaginal delivery (ring) for 21 days
  • remove for 7 days
  • adv - don’t have to take every day
  • disadv - don’t have to take every day!!
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15
Q

What are some progestogen only methods?

A
  • default methods
    • implants (implanon, norplant)
    • hormone releasing IUCD (mirena IUS)
  • user dependent methods
    • POPs (prog only pills) - eg cerazette
    • injectables - depo provera, noristerat
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16
Q

Why is Cerazette taking over the world?

A
  • as effective as COCP (slightly less though)
  • no oestrogen - contraindications eg. breastfeeding
  • favourable side effect profile vs older POPs
  • bleeding as predictable as COCP
  • 12 hour window

although it has less efficiency than COCP

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17
Q

What are IUCDs?

A
  • copper bearing intrauterine contraceptive devices are inserted into uterus
  • by suitably trained practitioners + may be left in situ long term
18
Q

How do IUCDs act?

A
  • destroying spermatozoa
  • preventing implantation - inflammatory rxn + pg secretion as well as a mechanical effect
19
Q

What are the two types of IUCDs?

A
  • copper bearing eg. ortho T, multiload
  • hormone bearing - Mirena
20
Q

What are benefits of IUCDs?

A
  • non user dependent
  • immediately + retrospectively effective
  • immediately reversible
  • can be used long term
  • extremely reliable
  • unrelated to coitus
  • free from serious medical dangers
21
Q

What are disadvantages of IUCDs?

A
  • has to be fitted by trained medical personnel
  • fitting may cause pain/discomfort
  • periods may become heavier and painful
  • it does not offer protection against infection
  • threads may be felt by the male
22
Q

What are the risks of IUCDs?

A
  • miscarriage if elft in situ if a pregnancy
  • ectopics?
  • may be expelled
  • the uterus may be perforated
23
Q

What are absolute contraindications of IUCDs?

A
  • current pelvic inflammatory disease
  • suspected or known pregnancy
  • unexplained vaginal bleeding
  • abnormalities of uterine cavity
24
Q

What are relative contraindications of IUCDs?

A
  • nulliparity (never completing pregnancy beyond 20 weeks)
  • past history of PID
  • not in mutually monogamous relationship
  • menorrhagia / dysmenorrhoea
  • small uterine fibroids
25
Q

What are advantages of condoms to the male?

A
  • man in control
  • protects against STIs
  • no serious health risks
  • easily available (free at family planning clinics)
26
Q

What are advantages of (female) condoms to females?

A
  • woman in control
  • protects against STIs
  • can be put in advance + left inside after erection lost
  • not dependent on male erection to work
27
Q

What are disadvantages of male condoms?

A
  • last minute use
  • needs to be taught
  • may cause allergies
  • may cause psycho sexual difficulties
  • higher failure rate among some couples
  • oily preparations rot rubber
28
Q

What are disadvantages of female condoms?

A
  • obtrusive
  • expensive
  • messy
  • rustles during sex
  • uncertain failure rate
29
Q

What are diaphgragm caps?

A
  • made of latex
  • fit across vagina
  • sizes 55-95mm in 5cm jumps
  • must be used with spermicide and left in at least 6 hours after sexual intercourse
30
Q

What are advantages + disadvantages of diaphgram caps?

A
  • advantages: woman in control, can be put in in advance, offers protection against cervical dysplasias, perceived as ‘natural’
  • disadvantages: needs to be taught, messy, higher failure rate than most methods, higher UTI, higher candiasis
31
Q

What are suction (cervical) caps?

A
  • made of plastic
  • suction to cervix or vaginal vault
  • diff sizes
  • must be used with spermicide and left in 6 hours or more
32
Q

What are advantages and disadvantages of suction caps?

A
  • advantages: suitable for women with poor pelvic muscles, no probs with rubber allergies, very unobtrusive, woman in control
  • disadvantages: needs an accessible + suitable cervix, higher failure rate than diaphgram, not easy to find experienced teacher
33
Q

How long can sperm survive in the female tract?

A
  • 5 days
  • Ova can survive 24 hours
  • ova are fertilised in fallopian tube + take 4 days to reach uterus + implant
  • cervical mucus is receptive to sperm around time of ovulation
  • use periodic abstinence/alternative contraception to avoid pregnancy
  • time intercourse to pre-ovulatory phase to conceive
34
Q

What factors are important with natural family planning?

A
  • temperature
  • rhythm
  • cervix position
  • cervical mucus
  • persona
  • lactational amenorrhoea
35
Q

What are advantages of fertility awareness?

A
  • non-medical
  • can be used in 3rd world
  • allowed by catholic church
  • can result in closeness of understanding between partners
36
Q

What are disadvantages of fertility awareness?

A
  • failure rate heavily user dependent
  • requires skilled teaching
  • may require cooperation between partners
  • may involve limiting sexual activity
  • can cause strain
37
Q

Postcoital pills are used as emergency contraception. What is the time window for them to be given following unprotected sexual intercourse? Examples?

A
  • up to 72 hours after unprotected sexual intercourse (UPSI)
  • Schering Pc4 - prevents 3/4 pregnancies which would have occurred
  • Levonelle - prevents 7/8 pregnancies
  • ellaOne (ulipristal) - similar
  • act by postponing ovulation in 1st part of cycle - so beware, act by preventing implantation in 2nd part of cycle
38
Q

Copper bearing IUCDs can also be given as emergency contraception. What is the time window for this?

A
  • up to 5 days after presumed ovulatin
  • or 5 days after one single episode of UPSI at any time of the cycle
  • failure extremely rare
  • copper kills sperm in 1st part of cycle, device prevents implantation in 2nd part of cycle
39
Q

Describe similarities and differences between PC4 and Levonelle 2

A
  • PC4: lower failure rate in 1st 24 hours, causes nausea + vomiting in many women, contraindicated during focal migraine attack
  • Levonelle 2: lower failure rate in 1st 24hrs, very little nausea, only contraindicated in women taking very potent liver enzyme meds (anti TB)
40
Q

Describe ellaOne

A
  • postcoital pill
  • ulipristal acetate
  • new selective progestagen receptor
  • up to 120 hours
  • RR 0.58 pregnancy vs Levonelle
  • possible slightly higher side effect profile - GI symptoms mainly

Physiology & Science: Reproduction (18 decks)

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