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REPRO > Contraception > Flashcards

Contraception Flashcards

1
Q

what percentage of women 16-49 who use contraception in the UK use what?

A

Sterilised - 28%

Combined oral contraceptive pill - 25%

intrauterine methods - 6%

Progestogen only pill - 5%

progestogen only implant or injectable - 3%

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2
Q

what percent of women do not use contraception despite not wanting to become pregnant

A

12%

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3
Q

what is the pearl index

A

defined as the number of contraceptive failures per 100 women-years of exposure

looks at the total months or cycles of exposure from initiation of the product to the end of the study

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4
Q

what is the life table analysis

A

provides the contraceptive failure rate over a specified time-frame and can provide a cumulative failure rate for any specific length of exposure

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5
Q

what is more accurate/used more commonly - the pearl index or life table analysis

A

life table analysis

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6
Q

what is perfect use

A

when a method of contraception is used perfectly as directed/prescribed

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7
Q

what is typical use

A

how a method of contraception is used by the average women(or men) i.e. will skip some pills, forget to get an injection on time, incorrectly use a condom

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8
Q

what are some of the most effective forms of contraception (i.e. smallest difference between perfect and typical use)

A

progestogen implant: 0.05% - 0.05% unintended pregnancies

Hormonal IUD - 0.1%-0.1%

male sterilisation - 0.10%-0.15%

female sterilisation - 0.5%-0.5%

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9
Q

what are the three main forms of combined hormonal contraception

A

pill
patch
vaginal ring

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10
Q

what two hormones are in combined hormonal contraception

A 
ethinyl estradiol (EE - synthetic oestrogen)
progestogen (synthetic progesterone)
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11
Q

what does of EE is usually in combined hormonal contraception (and with what exception)

A

20-35 micrograms

BUT 50 if on liver enzyme inducers

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12
Q

how is the OCP usually taken

A

taken for 21 days with a pill free week for a period

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13
Q

what is the mode of action of the COC

A

prevents ovulation

prevents implantation

inhibits sperm penetration of the cervical mucus

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14
Q

how does the COCP prevent ovulation

A

alters FSH and LH so there is no surge

i.e. affects the HPG axis - synthetic hormones stop production of GnRH - in turn stops production of LH and FSH

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15
Q

how does the COCP prevent implantation

A

by providing an inadequate endometrium - kept very thin

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16
Q

how does the COCP prevent sperm penetration the cervical mucus

A

alters quality and character of mucus - thickens

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17
Q

how should the COCP be started

A

if starting day 1-5 of cycle - immediately protective, no barrier contraception needed

if starting any other time of cycle need 7 days with barrier contraception in order to give time for hormones to “switch off” ovaries

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18
Q

what are some non-contraceptive benefits of the COCP

A

regular bleed
reduction in painful/heavy period
reduces anaemia
reduction in ovarian cysts
50% reduction in ovarian and endometrial cancer
improves acne
reduced benign breast disease, rheumatoid arthritis, colon cancer, osteoporosis

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19
Q

what are some risks of COC use

A

venous thromboembolism - 25 per 100,000 women year with

oestrogen acts as a pro-thrombotic

20
Q

what are other factors that can affect risk of VTE

A 
major surgery + immobility
thrombophilias
FH of VTE in under 45s
BMI over 30
underlying vascular disease
postnatally within 21 days
21
Q

what is the POP

A

progestogen only pill (desogestrel pill - creel/cerazette)

22
Q

how is the POP taken

A

one pill taken within 3 hours of the same time everyday without a pill free interval

effect lost if more than 3 hours late - BUT some newer pills have a 12 hour window

23
Q

what is the mode of action of POP

A

renders cervical mucous impenerable by sperm - max effect about 48hrs after ingestion

24
Q

what is the progestogen injection

A

DepoProvera

an aqueous solution of cystals of the progestogen depomedroxyprogesterone acetate

25
Q

how is depoprovera given

A

150mg given deep IM injection into the upper outer quadrant of the buttock every 12 weeks

26
Q

what is the mode of action of depoprovera

A

prevents ovulation
alters cervical mucous making it hostile to sperm
prevents implantation by rendering the endometrium unsuitable

27
Q

what are the pros of depoprovera

A

good for forgetful pill takers
70% women amenorrhoeic
estrogen free

28
Q

what are the cons of depoprovera

A

delay in return to fertility (BUT no reduction in fertility
reversible reduction in bone density
problematic bleeding
weight gain

29
Q

what comprises the subnormal implant

A

small plastic rod

  • contains 68mg progestogen etonogestrel (ENG)
  • covered in a rate controlling membrane made from ethanol vinyl acetate (EVA)
30
Q

what is the primary mode of action go the implant

A

inhibition of ovulation

  • 100% women
  • over 3 years of use
  • regardless of weight
31
Q

what is the secondary mode of action of the implant

A

effect on cervical mucous

- inhibiting sperm entry into upper repro tract

32
Q

what does LARC mean

A

long acting reversible contraception - 5-10 years

33
Q

what are examples of intrauterine contraception

A

copper coil

hormonal coil

34
Q

what is the mode of action of the copper coil

A

copper is toxic to sperm - effective also as a form of emergency contraception

35
Q

what is the mode of action of the hormonal coil

A

affects the lining of the womb - implantation unable to take place

36
Q

what are the main forms of emergency contraception and which is most effective

A

copper coil - most effective
levonel - “morning after pill”
ella one

37
Q

when can ella one be taken

A

up to 120 hours after unprotected sex

38
Q

when can level be taken

A

levonel (levonorgestrel) can be taken up to 72 hours after unprotected sex

39
Q

when can the copper coil be used as emergency contraception

A

up to 5 days after unprotected sex or up to day 19 in a cycle

40
Q

what is female sterilisation and how is it carried out

A

laparoscopic sterilisation

traditional tube ligation (filshie clips)

41
Q

what are the failure rates of female sterilisation

A

1 in 500 lifetime risk for laparoscopic

1 in 200 for mixed occlusion methods

42
Q

what is a vasectomy

A

the permanent division of the vas deferens under local anaesthetic - irreversible procedure (low success rates to reverse)

43
Q

what are the failure rates for a vasectomy

A

1 in 2000

44
Q

what are some complications of a vasectomy

A

pain due to sperm granuloma, mass of degenerating spermatozoa surrounded by macrophages

45
Q

is a vasectomy immediate interns of protection against pregnancy

A

no - need to use other contraception until sperm sample confirms procedure has worked

REPRO (44 decks)

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