Contraception Flashcards
What type of contraceptive is most effective?
The so-called “long acting reversible contracetives” (LARC).
Examples include the Copper IUD and the levonergestrel-Intrauterine system (LNG-IUS) as well as the progesteron only implant.
What is the most effective reversible contraceptive?
The implant (see exact % below)
What percentage of couples will get pregnant within a year of unprotected regular sexual intercourse?
85%
What is the mechanism of action of combined contraceptive formulations (COCP, patch, ring)?
Combined contraceptives contain oestrogen and progesterone. It thereby acts on the pituitary to reduce the levels of LH and FSH. Ultimately, this leads to suppression of ovulation
Alterations to cervical mucus and the endometrium may also contribute to the efficacy of the COCP.
What are the two ways in which you can get the COCP?
You can either get a 21 day pill (active pills for 21 days followed by a 7 day break) or the Everyday preparation (21 days of active pill, followed by 7 days of placebo).
Alternatively women can take the pill back-to-back.
How effecive are combined contraceptives at preventing pregnancy?
With typical use about 9% of woman get pregnant each year with regular sexual intercourse, and around 0.3% with perfect use. (c.f. 85% with no protection)
How would you advise a women that has missed one COC pill?
If just on pill is missed, advise her to take the missed pill asap, and continue with the rest of the pack as normal.
Emergency contraception is not required.
On what day of the cycle can you start the COCP?
From day 1-5 the COCP can be started without the need for additional contraception.
After that, the COCP can be started but pregnancy needs to be excluded and barrier contraception used for the enxt 7 days.
How would you advise a woman that has missed 2 or more COC pills?
- Take the most recently missed pill asap
- Any previsouly missed pills should be discarded
- Remaining pills should be continued as per usual.
- Use condoms for 7 consecutive days
- Consider emergency contraception if the pills have been missed in the first week after the pill free interval.
- Omit the pill free interval if the pills have been missed in the last week of the pack (or skip the placebo pills). Start a new pack straight after finishing the old one.
What is the effeciveness of condoms as contraceptives?
Around 18% and 2% of women get pregnant in 1 year of regular intercourse if male condoms are used (typical and atypical use, respectively).
However, male condoms are also really got at protecting against STIs and should therefore be worn with new partners even if other forms of contraception are used until STI checks have been carried out.
What are some absolute contraindications to starting combined hormonal contraception?
(UKMEC cateogry 4)
- Age >35 and smoking more than 15 a day
- BP >160/100
- DVT, CVA or MI (current or past)
- Multiple serious risk factors for cardiovascular disease
- Suffer from migraine with aura
- Are breastfeeding <6 weeks post-partum
- Hx of thromboembolism or thrombogenic mutations (e.g. APLS)
- Major surgery with prolonged immobilisation
- Current Breast cancer
What are some relative contraindications to combined hormonal contraception?
(UKMEC 3)
- Age 35 and smoking less than 15 a day
- BMI >35
- FHx of thromboembolic disease in 1st degree relative
- Controlled HTN
- Immobility, e.g. wheelchair use
- Carrier of known breast cancer mutations
What is the mechanism of action of the Progesterone only pill (pop)?
Usually, the mini pill works by thickening cervical mucus thereby preventing sperm from entering the uterus and meeting the egg.
Some POPs also suppress ovulation.
How does the mini pill have to be taken?
Most mini pills have to be taken in the same 3 hour time window each day.
The desogestrel pill can be taken within a 12 hour time window.
How do you advise a woman who has missed taking her mini pill?
- If <3 hours late (or 12 for desorgestrel): take missed pill asap and continue as normal. No emergency contraception required.
- If >3 hours (or 12 for desorgestrel): take missed pill as soon as you remember (if missed more than 1 only take 1) and carry on with pack as usual. Use condoms for 2 days.
- If had sex since missing the pill: Use emergency contraception
Name some advantages of the COCP.
- Non-invasive
- Quite effective, especially with typical use
- Periods might become more regular, lighter and less painful
- You can control timing of your periods (including back-to-back to avoid period)
- Reduces pre-menstrual syndrome symptoms
- Improves acne
- Reduces risk of some cancers including ovarian, uterine and colon.
Name some disadvantages of the COCP.
- Side effects: headache, nausea, mood changes, breast tenderness
- Effectiveness vairies with compliance (have to take a pill every day)
- Breakthrough bleeding and spotting might occure, especially during the first few days
- No protection against STIs (so recommend condoms if sleeping around)
- Risk:
- VTE
- Breast cancer (risk goes back to baseline with time after stopping the pill
- Cervical Cancer (possibly due to decreased condom usage hence HPV infection)
Name some advantages of the mini Pill.
- Non invasive
- Period-related problems improve (lighter, more regular, less painfull)
- Useful if oestrogens can’t be taken
- Safe during breastfeeding
- Reduces risk of endometrial cancer
Name some disadvantages of the mini pill.
- Has to be taken same time each day (might reduce efficacy if not taken regularly)
- Might get ovarian cysts (but those disappear over time and are not harmful)
- Might get acne
- Might get irregular bleeding
- Breast tenderness
- Most of the adverse effects are transient
- Slightly increased breast cancer risk
Where is the implant contraceptive inserted, and on what day of the menstrual cycle?
Into the arm, 8cm above the medial epicondyle (i.e. above the elbow)
If inserted up to and including day 5 it is effective immediately. If inserted after day 5 condoms have to be used for 7 days.
What is the name of the procedure for male sterilisation?
Vasectomy. In this, the vas deferens is cut.
It is a simpler and safer procedure than female sterilisation procedures, and also more effective.
What are the guidelines regarding contraception and woman over 45 as they are approaching the menopause?
Whilst fertility has usually significantly declined by the age of 40 years women still require effective contraception until the menopause.
No method is contraindicated by age alone. The COCP may be useful as:
- COCP use in the perimenopausal period may help to maintain bone mineral density
- COCP use may help reduce menopausal symptoms
Depo-Provera should be avoided as:
- Women should be advised there may be a delay in the return of fertility of up to 1 year for women > 40 years
- Use is associated with a small loss in bone mineral density which is usually recovered after discontinuation
