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Systems: Reproduction AB > Contraception > Flashcards

Contraception Flashcards

1
Q

What types of contraception are being used in the UK?

A
  • Sterilise (28%)
  • Combined oral contraceptive pill (25%)
  • Intrauterine methods (6%)
  • Progesterone only pill (5%)
  • Progesterone only implants/ injectable (3%)
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2
Q

What are the features of the ideal contraceptive?

A
  • 100% reversible
  • 100% effective
  • 100% convenient and unrelated to intercourse
  • 100% free of adverse side-effects
  • 100% protective against STIs
  • Non-contraceptive benefits
  • Low maintenance and no-ongoing medical input
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3
Q

How do contraceptive clinical trials typically report their failure rates?

A

By the pearl index or life table analysis

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4
Q

What is the pearl index?

A
  • ThePearl Indexis defined as the number of contraceptive failures per 100 women-years of exposure.
  • It looks at the total months or cycles of exposure from the initiation of the product to the end of the study
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5
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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6
Q

What form does the combined contraceptive come in?

A
  • Pill
  • Patch
  • Vaginal ring
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7
Q

How effective is the COC?

A

Over 99% effective = Pearl index 0.3 - 4.0 per HWY

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8
Q

What does the COC contain?

A

It is an orally active pill combination of 2 hormones

  • Ethinyl estradiol (EE)
  • Synthetic progesterone (progestogen)
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9
Q

What is the usual dose of the COC?

A

Usual dose 20 – 35 microgram EE (50 if on liver enzyme inducers)

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10
Q

What are the second generation COCs?

A
  • Levonorgestrel (LNG)

- Noresthisterone (NET)

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11
Q

What are the third generation COCs?

A
  • Gestodene (GSD)

- Desogestrel (DSG)

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12
Q

How is the COC usually taken?

A

-Taken for 21 days and then a pill free week

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13
Q

What is the mode of action for the COC?

A
  • Prevent ovulation
  • Alters FSH to LH so there is 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
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14
Q

How is a surge of LH and FSH prevented when using the COC?

A

Negative feedback of oestrogen and progesterone on the hypothalamus preventing LH and FSH release

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15
Q

How is the COCP taken effectively?

A
  • Start day 1 but up to day 5 without barrier contraception
  • Takes 7 days to switch off ovaries
  • Use condoms for first 7 days
  • 21 days and stop fro 7
  • Contraceptive protection remains
  • Can use continuously for 3 months then pill free week
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16
Q

What are the non-contraceptive benefits of the COCP?

A
  • Regular bleed with a potential reduction in painful heavy menstruation 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
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17
Q

What are the risks associated with the COCP?

A
  • VTE
  • Very small increase in ischaemic stroke and increased further in those with focal migraine
  • Breast cancer risk is likely to be small and disappears 10 years after stopping COC
  • Cervical cancer risk apparently doubles with 10 years use

-No increase in risk of MI in non-smokers

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18
Q

What is the absolute risk of VTE contraception?

A
  • 5 per 100,000 women years in the general population
  • 15 per 100,000 women year with COC use (LNG and NET)
  • 25 per 100,000 women years with COC use (GSD and DSG)
  • 60 per 100,000 women years with pregnancy
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19
Q

What is the relative risk of VTE with COCP?

A

Risk increases 3 fold

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20
Q

What are the risk factors for VTE?

A
  • Major surgery and immobility
  • Thrombophilias
  • -Family history of VTE in those under age 45 years
  • BMI over 30
  • Underlying vascular diseases
  • Postnatally within 21 days
  • COCP
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21
Q

What is the effectiveness of the progesterone only pill?

A

Pearl index of 0.3-3.1 = over 99% effective but it is user dependent.

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22
Q

Why does the POP have lower failure rates in older women?

A

They are less fertile and perhaps less sexually active.

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23
Q

Give an example of a POP?

A

Desogestrel pill

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24
Q

How is the desogestrel pill taken.?

A
  • 12 hour window period

- Traditional pills taken within 3 hours of the same time every day without a pill-free interval

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25
Q

How does the effectives of new POPs such as Cerazette compare to older POPs?

A

Cerazette inhibits ovulation in 97% of cycles and although has not been shown to be different from other POP in terms of its PI is likely to be more effective

26
Q

What is the mode of action of POPs?

A
  • Cervical mucus is rendered impenetrable by sperm
  • A maximum effect about 48 hours after ingestion
  • Effect lost if more than 3 hours late (old pills)
  • Effect lost if more than 12 hours late (new pills)
  • Ovulation - spectrum of effects
27
Q

What is DepoProvera?

A

An aqueous solution of crystals of the progestogen depomedroxyprogesterone acetate

28
Q

How is DepoProvera given?

A

150 mg is given by deep intramuscularly injection into the upper outer quadrant of the buttock every 12 weeks

29
Q

What is the mode of action for DepoProvera?

A
  • It prevents ovulation
  • It alters cervical mucus making it hostile to sperm
  • It prevents implantation by rendering the endometrium unsuitable
30
Q

What are the advantages of DepProvera?

A
  • Good for forgetful pill takers
  • 70% women amenorrhoeic
  • Oestrogen-free
31
Q

What are the disadvantages of DepoProvera?

A
  • Delay in return to fertility - no reduction in fertility
  • Reversible reduction in bone density
  • Problematic bleeding
  • Weight gain
32
Q

What are the components so the subdermal implant?

A

CORE
-68mg etonogestrel (ENG) (Progesterone)

MEMBRANE

  • Ethinyl vinyl acetate (EVA)
    0. 06 mm thick
33
Q

What is the primary mode of action of the subdermal implant?

A

Inhibition of ovulation

  • 100% women
  • Over 3 years of use
  • Regardless of weight
34
Q

What is the secondary mode of action of the subdermal implant?

A

Effect on cervical mucus

-Inhibiting sperm entry into upper reproductive tract

35
Q

What is the length of use for long acting reversible contraception?

A

5-10 years

36
Q

Why is the copper coil effective against sperm?

A

Copper is toxic to sperm

37
Q

What hormone do hormone coils contain?

A

Progesterone

38
Q

What is the most effective emergency contraception?

A

Copper coil

-Can be fitted up to day 19 of a 28 day cycle or up to 5 days after unprotected sex

39
Q

What emergency contraception can be used within 72 hours of unprotected sex?

A

Levonorgestrel

40
Q

What emergency contraception can be used up to 120 hours after unprotected sex?

A

Ella One

41
Q

How does emergency contraception compare to ongoing contraception with regards to effectiveness??

A

Less effective than ongoing contraception

42
Q

Give an example of a barrier method of contraception.

A

Condom

43
Q

What is the failure rate of female sterilisation?

A

1 in 500

44
Q

How is female sterilisation carried out?

A
  • Laparoscopic

- Traditional tube ligation using Filshie clips

45
Q

What is the lifetime risk of laparoscopic tubal occlusion failure rate?

A

1 in 200

46
Q

What is a vasectomy?

A

Permanent division of vas deferens under local anaesthetic

47
Q

What is the failure rate of vasectomy?

A

1 in 2,000

48
Q

What should couples considering sterilisation be informed of?

A

-Vasectomy carries a lower failure rate, in terms of post procedural pregnancies,
There is less risk associated with the vasectomy than sterilisation carried out by laparoscopy or laparotomy

49
Q

Why can pain occur with vasectomy?

A

Pain due to sperm granuloma, a mass of degenerating spermatozoa surrounded by macrophages.

50
Q

Why are vasectomies considered irreversible?

A

Anti-sperm antibodies are implicated in the low success rates of vasectomy reversals

51
Q

What is there no evidence of with vasectomy?

A
  • Reduction in testosterone and semen remains the same volume and colour
  • No predisposition to testicular cancer or prostatic cancer
52
Q

What is the target for termination of pregnant?

A

Target is 70% performed before 9 weeks to reduce complications

53
Q

What are the criteria for induced abortion?

A

The pregnancy has not exceeded its 24th week and continuation of the pregnancy would cause greater harm to the physical or mental health of the woman and/or
her existing children than if the pregnancy were terminated

54
Q

What are the indications for induced abortion?

A

Social reasons

Medical reasons

  • Foetal anomaly
  • Maternal health
55
Q

What is home abortion?

A
  • The use of misoprostol at home -

- Safe and endorsed by WHO

56
Q

What is covered in a clinical consultation for TOP?

A
  • About methods of Termination
  • Prolonged bleeding after TOP
  • Counselling available after TOP
  • Contraception agree & advise
  • FBC/Group & Screen/ Rubella/ scan/ Self obtained swab for Chlamydia and gonorrhoea and STI bloods offered
  • Certificate A signed
57
Q

What are the methods fro medical termination of pregnancy?

A
  • Mifepristone switches off pregnancy hormone which is keeping uterus from contracting and allowing pregnancy to grow
  • 48 hours later misoprostol initiates uterine contraception which opens cervix and expels pregnancy
58
Q

What are the possible complications of medical termination of pregnancy?

A
  • Failure < 5 in 100
  • Haemorrhage < 5 in 100
  • Infection (screen)
  • Prolonged bleeding (< 5 in 100)
59
Q

How does MTOP affect future fertility?

A

-Unaffected with uncomplicated procedures but can be affected by severe infection, cervical trauma or uterine cavity damage (Ashermans)

60
Q

What is conscientious objection?

A
  • The right of medical staff to refuse participation in abortion because they have a conscientious objection to the procedure is enshrined within the 1967 Abortion Act
  • There is an obligation to ensure that the woman is still able to access abortion care
  • Staff have a right to refuse participation as long as this does not affect any duty to participate in treatment which is necessary to save the life or to prevent grave permanent injury to the physical or mental health of a pregnant woman

Systems: Reproduction AB (35 decks)

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