Contraception Flashcards
Lactational amenorrhoea
98% effective Must be fully breastfeeding on demand <6 months postpartum
IUD expulsion rate
1:20
>40 y/o contraception
Cu-IUD + rely on it until contraception no longer needed
COCP - how it works, SE
Suppresses FH + LSH + prevents ovulation Thickens cervical mucus Thins endometrium SE: headache, nausea, HTN, breast tenderness, mood swings, acne
COCP - pros + cons, interactions
Pros: control cycle, improves menstrual problems Cons: side effects, increased risk of VTE, CHD + breast cancer Interactions: antibiotics, enzyme inducers
Progesterone only (pill, implant, injection) - how it works
Suppresses follicular growth Thickens cervical mucus Thins endometrium
Pros + cons, SE + contraindications of progesterone only
Pros: reduced MB, safe in breastfeeding, no risk of CVD, migraine, VTE Cons: no cycle control, persistent follicular cysts SE: irregular bleeding Contraindications: current breast cancer, unexplained vaginal bleeding, acute liver disease
Injection - how long for, action, SE
Depoprovera
Lasts 12 weeks
Suppresses ovulation
Can cause weight gain + reduces bone mineral density
Implant - how long for, SE, interactions
Nexplanon 3 years Can get irregular bleeding Most affected by enzyme inducers
IUD - how long for, SE
Up to 10 years May cause HMB/ PMB No hormonal side effects
IUS - how long for, SE
Lasts 5 years Hormonal side effects + irregular bleeding
Male sterilisation - method, risks, tests
Vasectomy - interrupts vas deferens Risks: bleeding, haematoma + infection Semen analysis at 12 weeks
Female sterilisation - method, failure rate, risks
Mechanical occlusion of fallopian tubes by Filshie clip Failure rate 1:200 Injuries to bowel, bladder, blood vessels
Emergency contraception - options, action, how long after UPSI
IUD - can be given 5 days after UPSI
Effects lining of womb so hostile to sperm
Levonorgestrel - inhibits ovulation, less effective when UPSI occurs around ovulation.
Licensed for 72 hours
Ulipristal acetate - inhibits ovulation, licensed for 120 hours after UPSI
Termination of pregnancy - medical + surgical (with time limits)
Medical = mifepristone then misoprostol Surgical = vacuum aspiration (up to 14 weeks), dilatation + evacuation (over 14 weeks) Give misoprostol before surgery to prepare cervix
Indications for IVF
Tubal disease Male subfertility Endometriosis Anovulation
IVF method
Downregulation of ovaries using GnRH analogues from day 21
Ovarian stimulation with FSH
Follicular maturation by adminstration of hCG
Transvaginal oocyte removal by needle guided aspiration
Fertlisation then embryo transfer through cervix on day 2-3
Progesterones given
ICSI - what is it?
Intracytoplasmic sperm injections Single sperm injected into oocyte - for men with severe semen issues Increases rate of success in IVF
Causes of subfertility
Ovulation disorder Tubal factor Male factor Unexplained Endometriosis Sexual dysfunction
Types of ovulation disorder
Primary: premature ovarian syndrome, Turners, autoimmune, surgery/ chemo Secondary: PCOS, weight change, hypopituitarism, Kallmans/ Klinefelter syndrome, hyperprolactinaemia
Investigations for subfertility
STD screen Baseline (day 2-5) hormone profile (FSH high in POF, low in hypopituitarism) Mid luteal progesterone (to confirm ovulation) Semen analysis Assess tubal patency: Hysterosalpingogram Laparoscopy + dye
Ovulation induction treatment
Weight loss
Anti-oestrogens (Clomifene days 2-6) - increases FSH levels via negative feedback -
SE: hot flushes, mood swings -limited to 12 cycles max due to ovarian ca risk
Gonadatrophins - Used in clomifene resistant PCOS -Multiple pregnancy risk
Laparascopic ovarian diathermy (ovarian drilling) - restores ovulation in women with PCOS -Effect lasts 12-18 months
Insulin sensitisers - helps in PCOS
COCP contraindications
BMI >35 requires expert judgement
Smoking >15 a day in >35 y/o
Breastfeeding <6 weeks PP
Migraine with aura
Hx of VTE
Ca breast currently
Uncontrolled HTN
Major surgery - should stop 4 weeks in advance
When can the implant be inserted?
Day 1-5 of cycle Any other point = need to use condoms for 7 days
UKMEC categories
1 = no restriction for use of method
2 = advantage of method outweighs risks
3 = risks of method outweigh benefits
4 = unaccapetable health risk
Risk of pregnancy (typical + perfect use) for pills vs implant vs coil vs injection
Pills: 9% typical 0.3% perfect
Injection: 6% typical 0.2% perfect
IUS 0.2% both
Implant 0.05% both
Missed pill rules for COCP
1 missed pill: take it when you remember but otherwise fine
2 missed pills: take the last pill you missed, leave earlier missed pills, use condoms for 7 days. If in week 1-2, carry on as normal. If in week 3, omit pill free break
May need emergency contraception if 2 or more missed in first week of pack
Missed pill rules for POP
If more than 3/12 hours: take pill as soon as you remember, use contraception for 48hrs.
If unprotected sex, may need EC.
What are the conception rates with different contraceptions?
Depo injection = 6%
Implant = 0.05%
IUS = 0.2%
Vasectomy = 0.15%
How does Ulipristal acetate (Ella One) work?
Selective progestogen receptor modulator
Can’t be given within 5 days of another hormonal method
