Contraception Flashcards
What are the types of intrauterine devices?
- Intrauterine device copper bearing
- Intrauterine system progestogen releasing
What is the mode of action of the IUD?
Primary effect through copper ions- Direct toxic effect on sperm & ova, dec sperm motility, dec sperm survival
Secondary effect on endometrium: Impedes sperm transfer, sperm phagocytosis, impedes implantation
What are the disadvantages of an IUD?
Heavier periods but regular bleeding
Intermenstrual spotting initially
What is the mode of action of an IUS?
Thickening of cervical mucus inhibiting the passage of sperm
Prevention of endometrial proliferation
Local effect of foreign body on uterus
Prevention of ovulation in some women’s cycles
What are the disadvantages of an IUS?
Irregular bleeding & eventually amenorrhoea in some women
Much lighter in most women
Other than as contraception when else can an IUS be used?
Use in HRT & menorrhagia (Mirena 5years)
What substance is released by an IUS?
Levonorgestrel
In an emergency which intrauterine device is fitted?
Copper IUD
Must be done before implantation to ensure it is not causing abortion-5day rule. Works by inhibiting fertilisation
When must an emergency IUD be fitted?
Within 5days of risk OR ovulation
When can an emergency IUD not be fitted?
Not after day 19 in a 28day cycle.
Must avoid possible implanted pregnancy
How does the emergency pill Ulipristal work?
Selective progesterone receptor modulator. Delays/inhibits ovulation. Given immediately before ovulation it suppresses growth of lead follicles delaying follicular rupture until up to 5days later.
How long is Ulipristal licensed for?
Licensed for up to 120hours
As effective as Levonorgestrel <72hours
When is Ulipristal not recommended?
Enzyme inducers & progestogens may reduce efficacy
Not recommended in women w/ s.asthma
BF- discard milk for 7days
What are the brand names of Ulipristal?
EllaOne
Ulipristal Acetate
How does progestogen only emergency contraceptive work?
Levonorgestrel:
Delays ovulation- appears to prevent follicular rupture or cause luteal dysfunction.
What are the brand names of the progestogen only emergency contraceptive?
Levonelle 1500
Levonelle One Step
When should the progestogen only emergency contraceptive be taken?
Ideally within 72hours of intercourse
What are the issues with the progestogen only emergency contraceptive?
May displace Warfarin from binding sites & increase INR
Reduced efficacy of enzyme inducers
When is persona most reliable?
If sexual intercourse is restricted to after ovulation
Name a natural type of contraception
Lactational amenorrhoea method