Contraception Flashcards
what is the Pearl Index?
number of contraceptive failures per 100 women years of exposure
contents of the COC
- Ethinyl oestradiol and progestogen
- Usual dose 20-35 micrograms EE (50 if on liver enzyme inducers)
- Second generation – levonorgestrel and norethisterone
- Third generation – gestodene and desogestrel
mechanism of COC
- Prevents ovulation
- Alters FSH and LH = no surge
- Prevents implantation by providing an inadequate endometrium
- Inhibits sperm penetration of the cervical mucus by altering quality and character of mucus
- Negative Feedback
how to take COC
21 days then pill free week
formulations of COC
pill
ring
patch
how to start COC
- Start days 1-5 without barrier contraception
- Takes 7 days to switch off ovaries
- Start anytime if not pregnant but use condoms for 7 days
non contraceptive benefits of COC
o Reduction in functional ovarian cysts – stops ovulation therefore no follicles form
o 50% reduction in ovarian and endometrial cancer
o Improvement in acne
o Reduction in benign breast disease, RA, colon cancer, osteoporosis
risks associated with COC
VTE ischaemia stroke focal migraines breast cancer cervical cancer
contents of the POP
• Cerelle/Cerazette – desogestrel pill with 12-hour window
mechanism of POP
• New POPs – Cerazette inhibits ovulation in 97% of cycles and although ha not been shown to be different from other POP in terms of its PI is likely to be more effective
• Mode of action
o Cervical mucus is rendered impenetrable by sperm
o A maximum effect about 48hrs after ingestion
o In older pills the effect is lost if more than 3 hours late
o Ovulation – spectrum of events
contents of depot medroxyprogesterone acetate
• Aqueous solution of crystals of the progestogen depomedroxyprogesterone acetate
how to take the depo contraceptive
150mg deep IM injection every 12 weeks
mechanism of depo injection
o High doses of progestogen
o Prevents ovulation
o Alters cervical mucus making it hostile to sperm
o Prevents implantation by rendering the endometrium unsuitable
consequences of depo injection
o No reduction in fertility but there is a delay of up to a year in return
o Reversible reduction in bone density
o Problematic bleeding
o Weight gain
subdermal implant contents
- Core – 68mg etonogestrel (ENG)
- Membrane – ethinyl vinyl acetate (EVA)
- Progesterone
mechanism of implant
inhibits ovulation
alters cervical mucus
after how long do you replace the implant
3 years
how long does the copper coil last
5-10 years
how does the copper coil work
spermatotoxic
what does the hormonal IUD contain
progesterone
what is the 1st line for heavy menstrual bleeding?
hormonal IUD
describe emergency contraception
- Copper IUD most effective option
- Levonorgestrel – within 72hrs
- Ella one – within 120hrs
- Less effective than ongoing contraception
describe female sterilisation including failure rates
• ESSURE local anaesthetic permanent
o Failure rate 1 in 500 lifetime risk
o Discontinued in UK for commercial reasons
• Filshie clips – traditional tube ligation
o 1 in 200
describe male sterilisation including failure rates
• Permanent division of vas deferens under local anaesthetic
• Failure rates 1 in 2000
• Pain due to sperm granuloma, a mass of degenerating spermatozoa surrounded by
macrophages
• Irreversibility
o Anti-sperm antibodies are implicated in the low success rates of vasectomy reversals
• No evidence of reduction in testosterone and semen the same colour and volume
• No evidence that vasectomy predisposes to testicular cancer or prostatic cancer
• Individuals should be informed that vasectomy carries a lower failure rate, in terms of post
procedural pregnancies, and that there is less risk associated with the procedure than
sterilisation carried out by laparoscopy or laparotomy
social reasons for abortion
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
medical reasons for abortion
o Foetal anomaly
o Maternal health
describe medical termination of pregancy
o Mifepristone (anti-oestrogen) switches off pregnancy hormone which is keeping uterus from contracting and allowing pregnancy to grow o 48hrs later prostaglandin initiates uterine contraception which opens cervix and expels pregnancy
complications of termination: medical
§ Failure 6 in 1000
§ Haemorrhage <5 in 100
§ Infection (screen)
§ Prolonged bleeding <5 in 100
complications of termination: surgical
§ Uterine perforation – 1-4 per 1000
§ Cervical trauma <1%
§ Failed termination 2.3 per 100
