Contraception Flashcards
What are the 3 subdivisions of contraceptive?
- Hormonal
- Non-hormonal
- Permanent
In terms of the effectiveness and efficacy of contraceptives.
What is the Pearl Index?
What is the Life Table Analysis?
Pearl Index
- No. of contraceptive failures per 100 women-years of exposure. It looks at the total months or cycles of exposure from the initiation of teh product to the end of the study.
Life Table Analysis
- Provides contraceptive failure rate over a specified time frame and can provide a cumulative failure rate for any specific length of exposure.
What is the Combined Oral Contraceptive Pill?
- Effectiveness?
- Hormones contained?
- Dose?
- Taken?
The COCP is an orally active pill combination of 2 hormones
- Ethinyl estradiol (EE) and
- Synthetic progesterone (progestogen)
The usual dose is 20-35 micrograms EE
It is usually taken for 21 days with a pill free week - placebos used.
What is the mode of action for the Combined Oral Contraceptive pill?
- Prevents ovulation taking place.
- Alters FSH and LH - No surge.
- It prevents implantation by providing an inadequate endometrium.
- It inhibits sperm penetration of the cervical mucus by altering quality and character of mucus.
How does one take the Combined Oral Contraceptive Pill?
Start day 1 - takes 7 days to “switch off the ovaries”
Condoms are needed for 7 days - Also used as an STI barrier.
Taken for 21 consecutive days then stop for 7 - contraceptive protection remains.
Can use for 3 months continuously then pill free week.
What are the non contraceptive benefits of the combined oral contraceptive pill?
- Regular bleeding with a potential reduction in painful heavy menstration and anaemia.
- Reduction in functional ovarian cysts.
- 50% reduction in ovarian and endometrial cancer
- Improvement in acne
- Reduction in benign breast disease, rheumatoid arthritis, colon cancer and osteoporosis.
Generally outline absoulte and relative risk?
- The combined oral contraceptive pill is safe to use for most women.
- There can be an increase in absoulte risk through use, potentially giving risk to “alarming” relative risks (5 in 100,00 = 3x more likley.
What is there increased risk of with COCP use?
Increased risk of VTE in the following:
- Major surgery and immobility
- Thrombophillias
- FH of VTE under 45 yrs
- BMI over 30
- Underlying vascular disease
- Postnatally - within 21 days.
Myocardial Infarction - increased risk only in smokers.
Ischaemic stroke - very small risk, increased further in those with focal migraines.
Breast Cancer - small and dissapears 10 years after stopping.
Cervical Cancer - risk apparently doubles with 10 years of use.
What is the vaginal ring and how does it work?
The vaginal ring (NuvaRing) is a small soft, plastic ring that you place inside your vagina.
It releases a continuous dose of the hormones oestrogen and progestogen into the bloodstream to prevent pregnancy.
Which thickens the cervical mucus, preventing sperm from easily moving into the cervix and thins the lining of the womb so a fertilised egg is less likely to implant itself.
Outline the use of a Progestrogen-only pill.
How does it work?
Pills taken within 3 hours of the same time every day without a pill free interval.
99% effective - but user dependent.
Cervical mucus - rendered impenetrable by sperm.
Max effect about 48 hours after ingestion, but effect lost if more than 3 hours late.
What is DepoProvera and what is its mode of action?
Aqueous solution of crystals of the progestogen depomedroxyprogesterone acetate.
150mg is given by deep intramuscular injection into upper outer quadrants of the buttock every 12 weeks.
Mode of Action
- Prevents ovulation
- Alters cervical mucus making it hostile to sperm.
- Prevents implantation by rendering endometrium unsuitable.
What are the Pros and Cons of DepoProvera use?
Pros
- Good for forgetful pill takers.
- 70% women amenorrhoeic
- Estrogen-free
Cons
- Delay in return to fertility - no reduction in fertility.
- Reversible reduction in bone density.
- Problematic bleeding
- Weight gain
What is the subdermal implant and what is it’s mode of action?
Small plastic rod measuring 4cm in length. Containing progestogen, coated in a rate controlling membrane made from EVA.
Mode of Action
Primary
- Inhibition of ovulation
- 100% of women
- Over 3 years of use
- Regardless of weight
Secondary
- Inhibition of sperm entering into the upper reproductive tract.
Outline intrauterine contraceptive, including its mode of action and duration of use.
A long-acting reversible contraceptivemethod that involves the placement of a small T-shaped device inside the uterus.
This is a long term reversible contraception, lasting between 5 and 10 years.
Copper Coil (IUD)
- The copper alters the cervical mucus, which makes it more difficult for sperm to reach an egg and survive. It can also stop a fertilised egg from being able to implant itself.
IUS - Intrauterine System - Mirena and Jaydess.
- It releases the hormone progestogen to stop you getting pregnant and lasts for 3 to 5 years.
- It thickens the cervical mucus, which makes it more difficult for sperm to move through the cervix, and thins the lining of the womb so an egg is less likely to be able to implant itself.
- For some women, it can also prevent the release of an egg each month (ovulation), but most women continue to ovulate.
What are the 3 emergency contraceptives available?
- Copper IUD - most effective
- Levonorgestrel - use within 72 hours of unprotected sex.
- Ella one - newer options up to 120 hours afterwards.
