Contraception Flashcards
what does the natural family planning method take into account to work as contraception
- basal body temperature
- cervical mucous
- cervical position
- ‘standard days’
- breast feeding
what does cervical mucous tell you about ovulation
thick + sticky post ovulation
what does the cervical position tell you about ovulation
when fertile the cervix is high, soft + open
when less fertile the cervix is low, firm + closed
most fertile days
day 8-18 in a 28 day cycle
what criteria is needed to know that breast feeding is working as a contraceptive
exclusive breast feeding
less than 6 months post natal
amenorrhoeic
what is LARC + examples
Long acting reversible contraception
E.g. depo provera IM injection
what is VLARC + examples
Very long acting reversible contraception
e.g. IUD, IUS, implant
how does depo provera injection work
inhibits ovulation
when is the depo provera injection given
every 13 weeks
lasts 14 weeks
what hormones does the depo injection contain
progesterone only
side effects of depo injection
irregular bleeding, weight gain, osteoporosis, delay in return of fertility
what needs to be checked before depo injection is prescribed
BP, BMI, risks for osteoporosis
risk factors for osteoporosis
underweight / anorexia prolonged steroid use excess alcohol intake immobility family history smoking
when can you start depo injection
up to + including day 5 with no additional need for contraception
Any other time providing she is not pregnant + will need to use additional contraception for 7 days
what is different about the IUD
it is non-hormonal
how does an IUD work
prevents fertilisation- decreases sperm motility + survival
side effects of IUD
Longer, heavier, more painful periods
small chance of infection
when can IUD be inserted
up to 5 days after unprotected sex (immediately effective)
up to 5 days after ovulation
what hormone does IUS contain
progesterone only
how does an IUS work
stops implantation
thickens cervical mucous
side effects of IUS
Irregular bleeding
lighter periods
infection
when can an IUS be inserted
within first 7 days of cycle- no contraception needed
if after first 7 days, additional contraception is needed for 7 days
contraindications to IUD/IUS
current pelvic infection
abnormal uterine anatomy
pregnancy
Endometrial/cervical carcinoma
what should be checked before fitting an IUD/IUS
PV to check uterine size/position
BP and pulse
what is the implant
a single, non biodegradable subdermal rod
how does the implant work
inhibits ovulation
what hormone does the implant release
progesterone only
how long does the implant last
3 years
when can the implant be fitted
within first 5 days of cycle
up to day 5 post 1/2 trimester abortion
on of before day 21 post partum
side effects of the implant
irregular bleeding
weight gain
acne
nerve damage/vascular injury on insertion
what does the combined oral contraceptive pill contain
oestrogen + progesterone
how does the combined pill work
inhibits ovulation
thickens cervical mucous
makes endometrium unfavourable for implantation
side effects of the combined pill
increased risk of venous thromboembolism
increased risk of breast + cervical carcinoma
increased BP
The combined pill contains 21 pills- how does the system work
first 7 pills inhibit ovulation
remaining 14 maintain anovulation
advice for someone who misses one combined pill
If over 24 hours but less than 48 hours, take the pill ASAP
Take remainder of pack as normal
no emergency contraception is required
advice for someone who misses two or more combined pills
> 48 hours since last pill, take the most recent pill + remainder of pills at the correct time
Use condoms/abstain until 7 pills have been taken consecutively
through what mechanism does the combined pill stop ovulation
acts on hypothalamic-pituitary-ovarian axis traduce LH/FSH
what hormones does the patch contain
combined oestrogen + progesterone
how does the patch work
patch worn for 1 week to suppress ovulation
patch reapplied weekly for 2 weeks
4th week is patch free to allow withdrawal bleed
main side effect of the patch
withdrawal bleed may be painful
how does the vaginal ring work
ring placed in vagina for 21 days
ring free interval for 7 days to allow withdrawal bleed
side effects of vaginal ring
acne
irritability
mood changes
contra-indication for combined oral contraceptive
MIGRAINE WITH AURA
what is a migraine with aura
a ‘change’ occurring 5-20 mins before onset of headahce
may be visual, altered smell, taste, hemiparesis
protective effects of combined oral contraceptive therapy
decreased risk of endometrial and ovarian cancer
improves acne
lighter periods
what is cyproterone acetate
works as a combined oral contraceptive used in treatment of acne + hirsutism
what types of progesterone only pills are there
new- etonorgestrel
old- levonorgestrel
primary action of progesterone only pills
thicken cervical mucous
action of newer progesterone only pills
inhibit ovulation
what do progesterone only pills interact with
Liver enzymes- inducers of cytochrome P450
How are progesterone only pills taken
same time every day, no break
what happens if someone misses a progesterone only pill + has unprotected sex
emergency contraception + 2 days extra contraception
How many doctors need to sign the HSAI form for an abortion to happen legally
2
what are the two types of abortion and their time frame in NSH tayside
surgical termination- up to 12 weeks
medical termination- up to 18 weeks + 6 days
grounds for emergency termination
necessary to save the life of the woman
necessary to prevent serious permanent injury to the physical/mental health of the woman
for a medical termination, what are the 3 time frames
early- up to 9 weeks
late- 9-12 weeks
mid-trimester- 12-24 weeks
what are the stages of a medical termination
- oral mifepristone 200mg (anti-progesterone)
2. 24-48 hours later give vaginal prostaglandin e.g misoprostol
what are the methods of surgical termination
vacuum aspiration- 6-12 weeks
dilatation and evacuation- 13-24 weeks (not available in Scotland)
what is required before a surgical termination of pregnancy
cervical priming with vaginal prostaglandin
risks of surgical termination
Pain, haemorrhage, infection, failure procedure, cervical trauma, uterine perforation
methods of emergency contraception
Oral: levonelle, ella one
Intrauterine: copper IUD
What time frame can levonelle be given
up to 72 hours post unprotected sex
what time frame can Ella one be given
up to 120 hours post unprotected sex
what time frame can IUD be inserted
up to 120 hours post unprotected sex
