Combined oral contraception What is it? What does it include & where do they act? Examples?

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

Contraception Flashcards by Hamzah Niaz

Which methods of contraception require ongoing action by the individual?

oral contraception
barrier methods
fertility awareness
coitius interruptus
oral emergency contraception

How well did you know this?

Not at all

Perfectly

What are methods of contraception which prevent conception by default?

IUCD/IUI/IUs
progestogen implants
progestogen injections
sterilisation

How well did you know this?

Not at all

Perfectly

What features would “the perfect contraceptive” acquire?

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

How well did you know this?

Not at all

Perfectly

What are risks of contraception?

cardiovascular
neoplastic
emotional
infection related
allergic
Iatrogenic

How well did you know this?

Not at all

Perfectly

What are risks of no contraception?

childbirth related
abortion related
social costs
economic costs

How well did you know this?

Not at all

Perfectly

What are benefits of treatment?

the non-contraceptive benefits
psychosocial
choice
sexual health
cost savings
female equality

How well did you know this?

Not at all

Perfectly

What are the benefits of not having contraception?

non interference
population growth
control of women

How well did you know this?

Not at all

Perfectly

Combined oral contraception

What is it?
What does it include & where do they act?
Examples?

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

How well did you know this?

Not at all

Perfectly

What are the contraceptive benefits of the combined oral pill?

reliable
safe
unrelated to coitus
woman in control
rapidly reversible

How well did you know this?

Not at all

Perfectly

What are the non-contraceptive benefits of oral contraception?

halve ovarian cancer
halve endometrium cancer
decrease colon cancer
helps endometriosis, fiborids, RA, premenstrual syndrome, dysmenorrhoea, menorrhagia

How well did you know this?

Not at all

Perfectly

What are the risks of combined oral contraception?

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

How well did you know this?

Not at all

Perfectly

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

start 1^st packet 1^st day of menstrual period
take 21 pills + stop for 7 day break (PFI)
restart each new packet on 8^th 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

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

What is the combined vaginal contraceptive?

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!!

How well did you know this?

Not at all

Perfectly

What are some progestogen only methods?

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

How well did you know this?

Not at all

Perfectly

Why is Cerazette taking over the world?

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

How well did you know this?

Not at all

Perfectly

What are IUCDs?

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

How do IUCDs act?

destroying spermatozoa
preventing implantation - inflammatory rxn + pg secretion as well as a mechanical effect

What are the two types of IUCDs?

copper bearing eg. ortho T, multiload
hormone bearing - Mirena

What are benefits of IUCDs?

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

What are disadvantages of IUCDs?

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

What are the risks of IUCDs?

miscarriage if elft in situ if a pregnancy
ectopics?
may be expelled
the uterus may be perforated

What are absolute contraindications of IUCDs?

current pelvic inflammatory disease
suspected or known pregnancy
unexplained vaginal bleeding
abnormalities of uterine cavity

What are relative contraindications of IUCDs?

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

What are advantages of condoms to the male?

* man in control * protects against STIs * no serious health risks * easily available (free at family planning clinics)

What are advantages of (female) condoms to females?

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

What are disadvantages of male condoms?

* 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

What are disadvantages of female condoms?

* obtrusive * expensive * messy * rustles during sex * uncertain failure rate

What are diaphgragm caps?

* 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

What are advantages + disadvantages of diaphgram caps?

* **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

What are suction (cervical) caps?

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

What are advantages and disadvantages of suction caps?

* **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

How long can sperm survive in the female tract?

* 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

What factors are important with natural family planning?

* temperature * rhythm * cervix position * cervical mucus * persona * lactational amenorrhoea

What are advantages of fertility awareness?

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

What are disadvantages of fertility awareness?

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

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

* 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

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

* 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

Describe similarities and differences between PC4 and Levonelle 2

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

Describe ellaOne

* 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