Contraception Flashcards
Barrier methods
Barrier methods of contraceptions include:
- Condoms (male and female)
- Diaphragms and caps
These are often used with a spermicide. Barrier methods are useful for STI prevention.
hormonal methods
There are many hormonal methods currently available to women wanting to use these forms of contraception. These include:
- Combined oral contraceptives (COCs)
- Progesterone oral contraceptives (POPs)
- Combined hormonal contraceptive Patches
- Combined hormonal contraceptive ring
- Levonorgestrel-releasing Intra-uterine system (IUS)
- Progestogen-only injections
- Progestogen-only subdermal implants
Injections, the IUS and implants are long acting reversible contraceptive (LARC) methods. The COC pill, patch and ring are combined hormonal methods containing both oestrogen and progesterone.
Combined hormonal methods
Combined hormonal contraception methods are an effective method of fertility control and regulation of the menstrual cycle. However they are contraindicated in some women and can have both serious and less serious side effects. Examples of combined hormonal contraceptives include the combined oral contraceptive (COC) pill, the contraceptive ring and the contraceptive patch. All contain a combination of oestrogen and a progesterone in varying strengths.
There are currently several different types of COC pill available.
Combined hormonal contraceptives can interact with other medicines (including herbal).
Progesterone only pill
Progesterone only pills inhibit fertility by changing cervical mucus to prevent sperm penetration, and/ or inhibit ovulation. There are different forms of progesterone used in different preparations
Long acting reversible contraceptive (LARC) methods
There are four types of LARC:
Copper IUD
Levonorgestrel-releasing Intra-uterine system (IUS)
Progestogen-only injections
Progestogen-only subdermal implants
Many commissioners have upgraded their emergency contraception services to sexual health services. This means that along with the provision of emergency contraception pharmacists are required to provide advice on avoiding unwanted pregnancy and sexually transmitted infections via safer sex messages and advice on condom use, information about on-going contraception, including LARC methods, and signposting onto other services. In addition to this some community pharmacy LARC services have previously been commissioned.
In 2011 pharmacists in Newcastle-upon-Tyne were commissioned to run a LARC service from their Healthy Living Pharmacy1,2 . The service included insertion and removal of progesterone-only subdermal implants and initiation and follow-up of progesterone-injections.
Fertility awareness methods
Fertility awareness methods of contraception (also known as natural family planning) track ovulation to prevent pregnancy.
Surgical methods of contraception
Surgical methods of contraception or sterilisation are designed to be a permanent method of contraception. Male sterilisation is known as a vasectomy and female sterilisation as tubal occlusion.
Emergency Contraception
There are currently three forms of emergency contraception:
- Levonorgestrel (Levonelle®) - emergency hormonal contraception, available on prescription, via PGD and over the counter
- Ulipristal acetate (ellaOne®) - emergency hormonal contraception available on prescription, via PGD and over the counter
- Copper-bearing Intra-uterine device (Cu-IUD) - available from specialist sexual health clinics and GPs
Contraception advice for women with epilepsy
- Anti-epileptic drugs such as carbamazepine, phenytoin, and phenobarbital can reduce the efficacy of hormonal contraceptives.
- Consider long acting reversible contraceptives such as medroxyprogesterone acetate depo injection, copper intrauterine device, and levonorgestrel releasing intrauterine systems in patients on enzyme inducing anti-epileptic drugs.
- Sodium valproate is not recommended in women of childbearing age because of high teratogenicity.
Types of spermicides
Gygel® vaginal cream, which contains 2% nonoxinol-9, is the only licensed spermicide available in the UK.
Nonoxinol-9 is a surfactant that disrupts sperm cell membranes
How to use spermicides
Advise that:
- Spermicides should always be used in conjunction with a diaphragm or cervical cap.
- Spermicides are not recommended for use in conjunction with condoms.
- Douching is not recommended, but if desired it should be deferred for at least six hours after sexual intercourse.
Advantages, disadvantages, and risks of spermicides
Advantages
- They are easy to use.
- They are easy to obtain, and can be bought from pharmacies without a prescription.
Disadvantages
- They are not as effective as other methods, so should not be used alone.
- They lose effectiveness after about 1 hour.
- Some people find them messy to use.
- They may irritate the genital mucosa.
- They do not protect against sexually transmitted infections (STIs).
- They should not be used by women at increased risk of STIs, as spermicides can increase the risk of HIV transmission.
Advantages and disadvantages — male condom
Advantages Male condoms:
- Are easy to obtain and use.
- Are effective in preventing pregnancy if used correctly.
- Provide significant protection against some sexually transmitted infections (STIs), including HIV.
- May protect against cervical cancer.
- Adverse effects are rare.
Disadvantages Male condoms require:
- Forward planning and may interrupt sex.
- The participation and commitment of both partners.
- Motivation at each act of intercourse.
- Careful disposal.
- Are less effective at preventing pregnancy compared to hormonal and intrauterine methods.
- Can break or slip off.
- Loss of sensitivity during intercourse may occur.
- Men who sometimes lose their erection during sex may find it difficult to use a male condom correctly.
- Allergy to latex can occur (rare).
Advantages and disadvantages — female condom
Advantages Female condoms may:
- Reduce the risk of some sexually transmitted infections, including HIV.
- Protect against cervical cancer.
- Used with oil-based lubricants because they are made of polyurethane.
- Used if either partner is allergic to latex.
Inserted up to 8 hours before sex.
- Female condoms are less likely to tear than the latex male condom.
- Some men prefer the freer sensations during the penetrative phase of intercourse.
- There are no known adverse effects.
Disadvantages Female condoms:
- Require careful insertion.
- Require motivation at each act of intercourse.
- Can be dislodged, or the penis can be inserted between the vaginal wall and the female condom.
- Can be noisy during intercourse.
- May cause discomfort during sex due to the inner ring.
- Are not as effective at preventing pregnancy as hormonal and intrauterine methods.
Types of diaphragm and cap
Diaphragms
- Two types of diaphragm are available on prescription:
- Silicone-based
- Coiled spring diaphragm; type B. Sizes range from 60-90 mm in increments of 5 mm.
- Arcing spring diaphragm; type C. Sizes range from 60-90 mm in increments of 5 mm. They are useful for women with poor vaginal muscular support, or those in whom the length or position of the cervix makes fitting a coil spring diaphragm more difficult.
Cervical caps
- These are smaller than diaphragms and are a useful alternative for women who do not want to (or cannot) use a diaphragm. They are available in sizes 22, 26, and 30 mm.