Contraception Flashcards
What would the ideal contraceptive be?
Reversible, effective, convenient and unrelated to intercourse, free of SEs, protective against STIs, have non-contraceptive benefits, be low maintenance
What are the two ways of measuring the effectiveness of a contraceptive method?
Pearl index: no of pregnancies per 100 woman years
Life table analysis: contraceptive failure for each month of use (this is the one we tend to use)
What is the difference between typical and perfect use?
Perfect use is using it as you are supposed to perfectly, typical use is how most people use it and is associated with a higher failure rate in most contraceptives
What is the % of woman experiencing an unintended pregnancy using male condoms perfect use vs typical use?
Perfect - 2
Typical - 15
What is the % of woman experiencing an unintended pregnancy using hormonal IUD perfect use vs typical use?
0.1 for both
How effective is the COCP?
> 99%
What is the COCP made up from?
Ethinyl estradiol (EE) and synthetic progesterone (progestogen)
What is the usual dose of COCP?
20-35microgram
What are the second and third generated COCPs made from?
Second - levonogestrel (LNG) and norethisterone (NET)
Third - gestodene (GSD) and desogestrel (DSG)
How is the COCP taken?
21 days on, 7 days off
Takes 7 days to work unless taken in first 5 days of period starting
Is it okay to run packets of COCP together?
Can tricycle
Even evidence that continuous use may be okay
How does the COCP work?
Synthetic hormones supress GnRH through negative feedback so reduced FSH –> reduced follicular development
Inhibition of LH surge –> no ovulation
Inadequate endometrium is not suitable for implantation
Cervical mucus thickening acts as physical barrier to sperm
What are the non-contraceptive benefits of the COCP?
Regular bleeds
Reduction in heavy/painful menstruation and anaemia
Reduction in ovarian and endometrial cancer, acne and benign breast disease, RA, colon cancer and osteoporosis
What is the main risk of the COCP?
VTE
What other factors increase risk of VTE?
Major surgery, immobility Thrombophilia FH of VTA in under 45s BMI >30 Underlying vascular dx Post-natally within 21 days
In which group of people would we not prescribe COCP and why?
Focal migraine
Increases risk of stroke
What cancer does COCP increase the risk of?
Cervical cancer
Breast (risk disappears after 10y)
What are the two main brands of POP?
Cerelle/cerazette
How do you take the POP?
Every day within 3h (some now have 12h period) of the same time
How does the POP work?
Thickens cervical mucus so sperm cannot penetrate
How many days does it take the POP to work?
2 days
What substance is in the DeproProvera?
Depot medroxyprogesterone acetate
How is DeproProvera administered?
150mg deep IM into upper quadrant of buttocks
How does DeproProvera work?
Prevents ovulation
Thickens cervical mucus
Makes endometrium inhabitable for implantation
What are the pros of DeproProvera?
Don’t have to remember to take pills
Most amenorrhoeic
Oestrogen free
What are the cons of DeproProvera?
Delay in return to fertility
Reversible reduction in bone density
Problematic bleeding
Wt gain
What substance is in the subdermal implant?
68mg of progesterone etonogesrel in matrix of EVA
How long does the subdermal implant last for?
3y
How does the subdermal implant work?
Inhibits ovulation
Thickens cervical mucus
What is the non-hormonal IUD and how does it work?
Copper coil
Copper toxic to sperm so prevents penetration and implantation
What is the issue with the copper coil?
Can lead to heavy more painful periods
What are the three hormonal coils and how long do they last for?
5y - mirena
5y - kyleena
3y - Jaydess
How do the hormonal IUDs work?
Progesterone thins endometrium so it is not habitable for implantation
What is first line treatment for heavy menstrual bleeding?
Hormonal IUDs
What is the most effective emergency contraception?
CU-IUD
What are the other options of emergency contraception?
Levonorgestrel in 72h
Ella one in 120h
NB longer you wait –> less effective it is
What are the barrier methods?
Male and female condoms
Cervical cap
Diaphragm and spermicide
How is female sterilisation done?
Laparoscopically
Traditionally done with tube ligation by Filshie clips
What is vasectomy?
Permanent division of the vas deferens under LA
What are the SEs of vasectomy?
Pain due to sperm granuloma (mass of degenerating spermatoxoa surrounded by macrophages)
When should termination be aimed to be carried out by?
9wks
If it is passed how many weeks of pregnancy, you must be referred to England?
20wks
What is involved in clinical consultation of termination?
Methods of termination
Contraception
FBC/group and screen/rubella/scan/self obtained swab for chlamydia and gonorrhoea, STI blood testing offered
What is the medical method of termination?
Mifepristone (anti-progesterone) switches of progesterone which keeps uterus from contracting allow pregnancy to grow
48h later get misoprostol which initiates uterine contraction and opens cervix
What are the risks with medical termination?
Failure
Haemorrhage
Infection
Prolonged bleeding
What are the risks with surgical termination?
Haemorrhage
Infection
Failure
Cervical trauma
What is conscientious objection?
Right of medical staff to refuse participation in a termination as they have a conscientious objection
Obligation to ensure woman has access to appropriate care, and that their refusal doesn’t affect the physical/mental health of the mother
What are the rules for having a termination?
<24wks and would be less harmful to mother/baby’s health (mental or physical) to have termination
