Contraception Flashcards
List the long acting reversible contraceptives
Depo Provera injection
Nexplanon implant
Mirena coil IUS
Copper coil IUD
List the long acting irreversible contraceptives
Female sterilisation
Male sterilisation (vasectomy)
List the short acting reversible ostrogen containing contraceptives
Combined oral contraceptive
Evra contraceptive patch
Nuvaring
List the short acting reversible contraceptives that only contain progerstone
Progesterone only pill
List contraceptive barrier methods
Diaphragm
Female and male condoms
List emergency contraception
Levonelle pill
ellaOne
Copper IUD
List the natural methods of contraception
- Coitus interuptus (pullling out)
- Body temp
- Cervical mucus monotoring
- Urinary LH levels (home hormone tests)
- Calendar techniques
- Breastfeeding
List ostrogen and progesterone containign contraceptives
COC
Evra Patch
Nuvaring
MoA of ostrogen containing contraceptive
Anovulation
MoA progesterone containing contraception
- Cerval mucus becomes hostile to sperm
- Endometrial lining remains thin and therefore imprenetrable to blastocyst
- Sometimes causes anovulation (implant, POP) but not may stay MoA of progesterone
MoA copper containing contraceptive (IUD)
- Toxic to sperm and ova
- Mucus becomes hostile
- Generalised inflammatory response is induced in genital tract making pregnancy less suitable
Main MoA of IUS
Prevents implanation through enodmetrial changes
Contraindications to ostrogen containing contraception
General contraceptive
- Pregnancy
- Undiagnosed genital bleeding
- Breast Cancer
- Liver disease esp tumours
- Aversion to SEs
Specific
- VTE/PE history esp. cardiovascular in general stroke, cerebrovascular disease, HTN
- Migraine/aura
- High BMI (patch can’t be used >90kg)
- Smoking and being over 35 (not an absolute contraindication but don’t give them ostrogen)
Contraindications to progesterone containing contraception
General ones contraceptive
- Pregnancy
- Undiagnosed genital bleeding
- Breast cancer
- Liver disease
- Aversion to SEs
Contraindications to copper contraceptives IUD
General contraceptives
- Pregnancy (unless for emergency in later slides)
- Undiagnosed genital bleeding
- Aversion to SEs
Copper
- Copper allergy
- Wilsons disease
- Dysmenarrhoea and menorhagia (not contra indications but don’t give)
General for IUD
- Malformed genital tract (fibriods, cancer of peliv tract)
- Pelvic infection
- STIs (risk of PID)
- Ectopic pregnancy
- Aversion/contraindication to fitting process
Contraindications of IUS
General contraceptives
- Pregnancy (unless for TOP in later slides)
- Undiagnosed genital bleeding
- Breast cancer
- Liver disease
- Aversion to SEs
General for IUD
- Malformed genital tract (fibriods, cancer of peliv tract)
- Pelvic infection
- STIs (risk of PID)
- Ectopic pregnancy
- Aversion/contraindication to fitting process
Specific Mirena
- Aversion to irregular bleeding
Negatives of barrier methods
General
- Not the most effective 90% if used properly
Femidon
- Not user friendly
Cap/diaphragm
- Fitted by trained health professional
- need spermicide
- not ideal for women with prolapse/ recurrent UTI’s
- Reassess size if weight changes.
Counselling points for coil fitting
- Pain - cramp like 24hrs after, use OTC analgesia
- Dizzy if clamp on cervix
- Infection
- Bleeding
- Uterine perforation
- Explusion - check strings
Side effects of hormonal contraception
- Irregular bleeding / no periods
- Weight gain
- Mood swings / depression
- Headaches
- Skin problems – mainly acne
- Breast tenderness / enlargement (occasionally galactorrhoea)
- Nausea/dizziness (oestro)
- Vaginal discharge(oestro), vaginal dryness(prog)
- Decrease libido
Who is the copper coil good for
- Long acting (10yrs)
- Can stay in till menopause in put in age 40
- Non hormonal ergo no hormonal SEs
- Most effective emergency
- Highest efficacy (same as sterilisation)
Who is the IUS good for
- Long acting (5yrs)
- Women with heavy and painful periods (bleeding issues e.g. anaemia)
- Can double as progesterone component of HRT
- High efficacy same as sterilisation
Who are barrier methods good for
- Protection against STIs and pregnancy
- Aversion to hormones SEs
- Averson to IUD fitting
- Aversion to periods affected
Femidon
- Not erection dependent
Who is the COC good for
- Short acting take a pill every day organised
- Regular bleed pattern
- Protects against endometrial and ovarian cancers
- Treats menstrual disorders, PCOS and acne
- Depo>COC>patch
Who is the Evapatch for
- Semi comitment, change weekly
- Regular periods
- Not oral good for people with GI/absorption problems
- COC>patch>ring
Who is the Nuvaring for
- Semi comitment, change monthly
- Regular periods
- Not oral good for people with GI/absorption problems
- Less ostreogen consider with SEs to COC
- patch>ring>diaphragm
Who is the POP for
- Short acting take a pill every day organised
- No ostrogen
- Cerazette (constantly taking progesterone) can dercrease periods
- Depo>POP>Patch
Who is the Depo for and negatives
- Long acting + no IUD fitting (12wks)
- No ostrogen
- possible amenorrhoeic
- Good for women taking enzyme inducers
- Highly effective IUD>Depo>Patch
Negatives
- Slow return to fertility
- Concern about bone density long term
- May get irregular bleeding to start with
- Irreversible for 3 months
Who is the implant for
- Long acting (3yrs)
- No ostrogen
- No IUD fitting, discrete in arm
- Same efficacy as IUD
Rank the contraceptives into 4 categories based on effectiveness
Assessing the best contraception
EXCLUDE PREGNANCY ask about un+protected sex
Emergency?
- Ideas about what they want and why
- Previously tried any other contraception? Thoughts
- Period history
- Sexual history
- Previous STIs
When are the different types of pills late?
- POP 3hrs
- Cerazette 12hrs also (POP)
- COC 48 hrs
Indications for emergency contraception
- UPSI
- Failure of barrier methods
- Use of withdrawal method
- Missed pill for significant amount of time (applied to patches and rings too)
- IUD expulsion/mid cycle removal
- Late Depo 2 weeks after it ran out
Levonelle pill: contents, MoA, time after UPSI, efficacy, draw backs
- 1 pill
- Progesterone only
- Stops/delays ovulation
- Liscenced 3 days after UPSI
- 2.2% Failure rate
Drawbacks
- Has to be given before LH surge (ovulation)
- Dose doubled if taking enzyme inducers
- Pill therefore malapsorption
- BMI >30 dec efficacy
ellaOne: contents, MoA, time after UPSI, efficacy, draw backs
- 1 pill
- Ulipristal Acetate 30mg (UPA)
- Stops/delays ovulation
- Liscenced 5 days after UPSI
- Failure 1.28%
Draw backs
- Pill therefore malapsorption
- Can only use once per cycle
- Caution in severe asthma, antacids/PPI/H2 antagonists, breastfeeding, hepatic dysfunction, enzyme inducing drugs
- Interferes with hormonal contraceptives
IUD as an emergency: contents, MoA, time after UPSI, efficacy, draw backs
- Coil
- Copper
- Toxic to sperm and ova, mucus becomes hostile and generalised inflammatory response is induced in genital tract making pregnancy less suitable
- 5 days after ovulation (no matter how many UPSI) or 5 days after single UPSI anytime in the cycle
- Failure <1%
Draw backs
- Fitting not fun
- Menorraghia
- Dysmenorrhia
- Not suitable for Malformed genital tract (fibriods, cancer of peliv tract), STIs (risk of PID)
- Ectopic pregnancy increased risk of ectopic
- Needs trained fitter
Emergency contraception assess and manage
Assess which EC
- Time of UPSI + dets (with who, how many, use of natural contraception)
- LMP
- Current contraception + thoughts going forward
- Ideas about methods
Follow up
- Pregnancy test 3-4 wks after UPSI
- STI screen
- Ongoing contraception
Post partum contraception
- An IUD can be fitted <48hrs after birth or >4 wks
- COC is not recommended in breast feeding women (not contraindicated) or <21 days pp
- POP and condoms are always okay (unless infection other birth stuff)
- Depo can be given immediately after birth
