Contraception Flashcards by Annie Caldwell

Types of combined contraception

pills
patch
vaginal ring

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Types of progesterone only contraception

pill
injection
implant

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Which contraception has the most serious side effects

Ones containing oestrogen

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Non contraceptive benefits are particularly evident in

COC

mirena

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Contraception that is most effective

Vasectomy followed by implant

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Pearl index definition

Number of contraceptive failures per 100 women-years of exposure

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Life table analysis definition

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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Failure rates in clincial trials for contraception are reported by

Pearl index

Life table analysis

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Combination of which hormones are in the combined oral contraceptive pill?

Ethynyl estradiol (EE) and Synthetic progesterone (progesterone)

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Combined oral pill mode of action

Prevents ovulation
Alters FSH and LH => no surge
Prevents implantation by providing an inadequate endometrium
inhibits sperm penetration of cervical mucus by altering quality and character of mucus

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Non-contraceptive benefits of combined contraceptive pill

Regular bleed with 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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Risks of the combined oral pill

VTE
No increase of MI in non smokers
Very small increase in ischaemic stroke which is increased further in those with focal migraine
Breast cancer risk likely small and disappears after 10 years COC
Cervical cancer risk doubles after 10 years use
Liver disease

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Mode of action of progesterone only pill

Cervical mucus rendered impenetrable by sperm

Spectrum of effects on ovulation

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When is the max effect seen of the POP?

48 hours after ingestion

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What is the solution in the contraceptive injection?

Aqueous solution of crystals of the progesterone depomedroxyprogesterone acetate

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How is the contraceptive injection taken?

150mg given IM into upper quadrant of buttock every 12 weeks (3 months)

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Mode of action of the contraceptive injection

Prevents ovulation
Alters chemical mucus making it hostile to sperm
Prevents implantation by rendering endometrium unstable

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Side effects of contraceptive injection

Delay in return to fertility (no reduction in fertility)
Reversible reduction in bone density
Problematic bleeding
Weight gain

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What hormones are in the subdermal implant?

Core - etonogestrel (ENG)

Membrane - ethinyl vinyl acetate (EVA)

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Mode of action of the subdermal implant

PRIMARY = inhibition of ovulation (100% of women)
SECONDARY = effect on cervical mucus (inhibiting sperm entry into upper repro tract)

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Intrauterine contraception lasts for

5-10 years

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Most effective emergency contraception

CU-IUD

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Pill that you have to use within 72 hours of unprotected sex

Levonorgestrel

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Pill that you have to use within 120 hours of unprotected sex

Ellaone

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Vasectomy definition

Permanent division of vas deferens under local anaesthetic

Side effects of vasectomy

Pain due to sperm granulomas | Irreversibility

Clinic consultation about TOP should involve

``` Methods of termination Prolonged bleeding after TOP Counselling available after TOP Contraception agree and advise Certificate A signed FBC, group and screen, rubella Self obtained swab for chlamydia and gonorrhoea STI bloods offered ```

TOP meaning

Termination of Pregnancy

How medical termination of pregnancy is carried out

Take MIFEPRISTONE then take MISOPROSTOL 48 hours later

Mifepristone method of action

Switches off pregnancy hormone which is keeping uterus from contracting and allowing pregnancy to grow

Misoprostol method of action

Initiates uterus contraception which opens the cervix and expels the pregnancy

Complications of TOP

``` failure <5 in 100 haemorrhage <5 in 100 infection (screen) prolonged bleeding <5 in 100 uterine perforation ```

When discussing emergency contraception, need to ask

``` first day of LMP Used before? are they on contraception and is it reliable? regular cycles? Medications? allergies? untreated UTI? problems with womb/cervix e.g. unexplained bleeding age of partner timings ```

Fertility of the menstrual cycle

Days 1-0 = 2-3% Days 10-17 = 20-30% Days 18-28 = 2-3%

High risk for BBV if

Blood donation from certain countries Unlicensed tattoo parlours MSM IVDU

Barrier methods of contraception

Condoms Cervical Cap Diaphragm

Until how many weeks gestation can you have surgical TOP?

up to 12 weeks

Which intrauterine device can be used as an emergency contraceptive?

the copper intrauterine device | the mirena intrauterine device IS NOT an emergency contraceptive

Teratogenic drugs

``` Chemotherapy Radiotherapy Lithium Retinoids ACEIs Tetracycline Methotrexate ```

Causes of false +ves for pregnancy tests

Fertility treatment | Germ cell tumours

What types of USS are done before 12 weeks and after 12 weeks gestation?

< 12 Transvaginal USS | > 12 Abdominal USS

If you can see the yolk sac on USS, what does this indicate?

An IU pregnancy

What type of drug is mifepristone?

Anti-progesterone

What type of drug is misoprostol?

Prostaglandin

When is misoprostol used?

Abortion Inducement of labour PPH

What is a common S/E after TOP and how long do you get it for?

Heavy periods | 1 - 2 week

How does SMM work?

Cervical priming 3 hours before procedure | Suction tube

Risk of perforation in SMM

1 in 1000 risk

Blood tests done before TOP

Syphillis HIV Rheus status Chlamydia

Does TOP affect fertility?

Not unless a complication arises

How quickly can someone get pregnant after TOP?

5 days

How quickly can someone start contraception after TOP?

Pill next day Implant same day Injection same day

How many women have a TOP in their lifetime?

1 in 3

Is the patch combined contraception?

Yes

How often is the patch changed?

Every week

Who is the patch good for?

Patients with - bulimia - GI upset

How long does the vaginal ring stay in for?

3 weeks

Can the vaginal ring be taken out?

Yes, 4 hours every 24 hours and it will still work

Is the vaginal ring combined contraception?

Yes

Side effects of the subdermal implant

VERY irregular bleeding that may settle or may not

Side effects of the copper coil

Sore to fit | Heavier, longer, more crampier periods

Risks of IUD

5/100 risk of expulsion | 1/1000 risk of perforation

Risk of ectopic pregnancy with coil

1 in 10

Which female barrier methods have a high failure rate?

Diaphragm | Female condom

If 100 couples are trying for a baby, how many will get pregnant?

If 100 couples use condoms perfectly, how many will get pregnant?

If 100 couples are on the pill/patch, how many will get pregnant?

<1 | Real life 4 - 8

If 100 couples are on LARC, how many will get pregnant?

<1 | Depo in real life 2 - 3

What does LARC stand for?

Long acting reversible contraception

Examples of LARC

Injection Coil Implant

What is the most effective emergency contraception?

Copper coil

How long after sex can you get the copper coil as emergency contraception?

120 hours after accident or predicted ovulation

What type of drug is ellaone?

Anti-progesterone

Contraindications of ellaone

Acid enzyme reducing drugs | Pregnancy

Contraindications of levonelle

None

How long does a vasectomy take to work?

3 - 5 months

Failure rate of female sterilisation

1 in 200 which could be ectopic

How does the IUS / Mirena work?

Thickens cervical mucus | Some women may prevent ovulation

What are the unacceptable health risks which means that the COCP is not an option for the patient?

> 35 y/o and smoking > 15 cigarettes / day Migraine with aura History of thromboembolic disease or thrombogenic mutation History of stroke or ischaemic heart disease Breast feeding < 6 weeks post partum Uncontrolled HTN Current breast cancer Major surgery with prolonged immbolisation

How does the IUD / copper coil work?

Slows down sperm and survival

How long is there a window to forget to replace your contraception patch in which it still protects against pregnancy?

48 hours

When should oestrogen contraceptives be stopped before major elective surgery?

4 weeks before

What is an absaloute contraindication to the copper IUD?

PID