Contraception Flashcards

1
Q

what is the Pearl Index?

A

number of contraceptive failures per 100 women years of exposure

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2
Q

contents of the COC

A
  • 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
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3
Q

mechanism of COC

A
  • 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
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4
Q

how to take COC

A

21 days then pill free week

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5
Q

formulations of COC

A

pill
ring
patch

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6
Q

how to start COC

A
  • 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
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7
Q

non contraceptive benefits of COC

A

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

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8
Q

risks associated with COC

A
VTE
ischaemia stroke
focal migraines
breast cancer 
cervical cancer
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9
Q

contents of the POP

A

• Cerelle/Cerazette – desogestrel pill with 12-hour window

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10
Q

mechanism of POP

A

• 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

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11
Q

contents of depot medroxyprogesterone acetate

A

• Aqueous solution of crystals of the progestogen depomedroxyprogesterone acetate

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12
Q

how to take the depo contraceptive

A

150mg deep IM injection every 12 weeks

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13
Q

mechanism of depo injection

A

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

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14
Q

consequences of depo injection

A

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

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15
Q

subdermal implant contents

A
  • Core – 68mg etonogestrel (ENG)
  • Membrane – ethinyl vinyl acetate (EVA)
  • Progesterone
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16
Q

mechanism of implant

A

inhibits ovulation

alters cervical mucus

17
Q

after how long do you replace the implant

A

3 years

18
Q

how long does the copper coil last

A

5-10 years

19
Q

how does the copper coil work

A

spermatotoxic

20
Q

what does the hormonal IUD contain

A

progesterone

21
Q

what is the 1st line for heavy menstrual bleeding?

A

hormonal IUD

22
Q

describe emergency contraception

A
  • Copper IUD most effective option
  • Levonorgestrel – within 72hrs
  • Ella one – within 120hrs
  • Less effective than ongoing contraception
23
Q

describe female sterilisation including failure rates

A

• 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

24
Q

describe male sterilisation including failure rates

A

• 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

25
Q

social reasons for 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

26
Q

medical reasons for abortion

A

o Foetal anomaly

o Maternal health

27
Q

describe medical termination of pregancy

A
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
28
Q

complications of termination: medical

A

§ Failure 6 in 1000
§ Haemorrhage <5 in 100
§ Infection (screen)
§ Prolonged bleeding <5 in 100

29
Q

complications of termination: surgical

A

§ Uterine perforation – 1-4 per 1000
§ Cervical trauma <1%
§ Failed termination 2.3 per 100