Contraception Flashcards
Why should other forms of contraception to the Depo-Provera be considered first for adolescents?
Due to associated loss of bone density.
What types of contraception should be used in IBD?
Non-oral due to malabsorption.
Patches, progesterone-only injectables, implants, intrauterine and vaginal methods.
Depo-Provera should not be first-line in under 18 due to women with IBD being at increased risk of bone density loss.
What contraception is recommended and contraindicated in breast feeding women?
Progesterone-only pill have no effect on milk production and can be used in the first 6 weeks postpartum and thereafter.
IUD can be inserted from 4 weeks post-partum.
COCP affects milk volume and is avoided in the first 6 weeks postpartum and is relatively contraindicated 6 weeks to 6 months postpartum.
How does breast-feeding affect ovulation?
It delays the return of ovulation.
What is the contraceptive advice in perimenopausal women?
If under 50, continue contraception for at least 2 years after the last period.
If over 50, continue contraction for 1 year after last period.
What are the 3 types of hormonal contraception?
Progesterone-only pill
Progesterone depot (Nexplanon, IUD, Depo-Provera)
Combined hormonal contraception (pill, vaginal ring, patch)
What are the common side effects of oestrogen and progesterone?
Progesterone: Depression PMT Amenorrhoea Acne Breast discomfort Weight gain Reduced libido
Oestrogen: Nausea Headaches Increased mucus Fluid retention and weight gain Occasionally hypertension Breast fullness/tenderness Bleeding
What reduces absorption of the pill?
Vomiting, diarrhoea and antibiotics (need to use condoms whilst on antibiotics and for 7 days after)
What are the major complications of taking the COCP?
Venous thrombosis and myocardial infarction.
Also cerebrovascular accidents, focal migraine, hypertension, jaundice and liver, breast and cervical carcinoma.
What are the non-contraceptive advantages of the COCP?
Regular, lighter periods.
Reduced risk of ovarian, endometrial and bowel cancer.
Helps reduce fibroids, endometriosis and simple ovarian cysts.
Reduces risk of PID (probably due to thicker mucus).
What are the contraindications to taking COCP?
Absolute contraindication: History of DVT/heart disease/stroke Migraine with aura Active breast/endometrial cancer Inherited thrombophilia Smokers >35 years smoking >15 day. BMI > 40 Diabetes with vascular complications Liver disease
Relatively contraindicated Chronic inflammatory disease Renal impairment (diabetes) Age >40 BMI >35 Breastfeeding up to 6 months post-partum
What are the non-oral combined hormonal contraception?
Combined transdermal patch (Evra)
Combined vaginal ring (Nuvaring)
What are the differences between the progesterone only pill and COCP in administration?
Progesterone-only must be taken every day with no break at the same time (no more than +/- 3 hours)
Which has the higher failure rates out of COCP and progesterone only?
Progesterone-only (1/100)
the COPC has 0.2/100
How do the COCP and progesterone work as contraceptives?
COCP = exerts negative feedback of gonadotrophins (FSH and LH) to prevent ovulation, thin the endometrium and thickens cervical mucus.
Progesterone only = makes cervical mucus hostile to sperm, in 50% of women it inhibits ovulation.
What should you do if you miss the progesterone-only pill by more than 3 hours?
Take the pill as soon as possible and use condoms for the next 2 days.
When is the progesterone-only pill okay and the COPC isn’t?
You can use to progesterone-only pill in nearly all the contraindications of COCP - there is no increased risk of thromboembolism.
What 2 things should you counsel women on before taking the mini pill?
Breakthrough bleeding (spotting) Need for meticulous timing of taking the pill.
What are the non-oral progesterone only contraceptives?
Long-acting reversible contraceptives:
Injections (Depo-Provera - 3 month, Noristeral and Sayana Press) - these can all be given during breast-feeding, 6 weeks post-partum.
Depot (Nexplanon - 3 years)
IUD
What are the types of emergency contraception and when can they be used?
Levonelle - up to 24 hours after unprotected sexual intercourse is most effective, but can be up to 72 hours.
Ulipristal (EllaOne) - up to 120 hours (5 days) after unprotected sexual intercourse.
Copper IUD - up to 5 days after unprotected intercourse or up to 5 days after earliest expected ovulation. E.g. if unprotected sexual intercourse happened 2 days before ovulation, the copper IUD could be inserted up to 7 days after the unprotected sex.
When can you start contraception after the emergency contraception?
Levonelle - straight away
Ulipristal (EllaOne) - start/continue 5 days after
IUD - contraceptive instantly
What are the forms of barrier contraception?
Male condoms
Female condoms
Cervical cap
Diaphragms
What is given at the same time as the IUD in emergency contraception?
Prophylactic antibiotics
What are the different types of IUD?
Copper IUD - prevents fertilisation as copper is toxic to sperm.
Progesterone IUD - Mirena (5 years) and Jaydess/Levosert (3 years).
What is the contraceptive efficacy and advantages of IUD?
Not user dependent
<0.5/100 women-years failure rate
What scale is used for contraceptive efficacy?
Pearl Index (PI)
How long after pregnancy can an IUD be inserted?
6 weeks
What are the complications and risk factors of IUD?
Painful insertion
Uterine perforation at time of insertion (<0.5%) or after
Expulsion/migration into walls
Increased risk of PID if there is an asymptomatic STI in the cervix
If pregnancy does occur, it is more likely to be ectopic
What are the absolute contraindications to the IUD?
Pregnancy Endometrial or cervical cancer Undiagnosed vaginal bleeding Active/recurrent pelvic infection Current breast cancer (progesterone IUD)
What are the types of female sterilisation?
Filshie clips - applied to the fallopian tubes laparoscopically to completely occlude the lumen.
At caesarian section, a portion of each tube can be excised.
Hysteroscopic placement of microinserts into the proximal part of each tubal lumen. These inserts expand and cause fibrosis, occluding the lumen.
Can you reverse some female sterilisation?
Pretty irreversible, especially with microinserts, but IVF is possible after. Reversible surgery is not available on the NHS.
What is male sterilisation? What does it involve? What is its efficacy?
Vasectomy.
Ligation of the vas deferens, preventing sperm release (checked by 2 negative semen analyses).
1 in 2000 (better than female sterilisation).
What are the natural methods of contraception?
Rhythm method
Lactation
Withdrawal
