Contraception Flashcards
What are the general advantages of contraception?
Choice Control (personal or medical reasons) Family planning Saves lives globally Cost (pharmacological contraception free in UK)
What are the general disadvantages of contraception?
Changes in sexual habits
Medical complications
Cost?
What needs to be considered in a contraceptive consultation?
Health Age Desire for fertility Social/ religious/ ethical Education Compliance Cost
What are the types of contraception?
Natural/ physiological
Barrier
Hormonal
Surgical
What natural/ physiological methods can be used as contraception?
Rhythm method (keeping in rhythm with natural fertility, avoiding fertility window) Coitus interruptus (penile withdrawal before ejaculation) Lactation (regular and exclusive breastfeeding)
What are the advantages and disadvantages of the rhythm method of contraception?
Advantages: cheap; no side effects; no medical contraindications; no religious or ethical conflicts
Disadvantages: limits sexual activity; requires education; high failure rate; no STI protection
Why does lactation act as a contraception?
Prolactin inhibits secretion of FSH which suppresses the HPO axis to prevent ovulation
What barrier methods are available as contraception?
Condom
Diaphragm
Cervical cap
+/- Spermicide
MoA: prevents sperm-egg interaction
What are the advantages and disadvantages of condoms as a form of contraception?
Advantages: cheap; protection against (most) STIs
Disadvantages: latex allergies; some loss of sensation/ interruptions etc.; can rip; requires education (e.g. not using body oil etc.)
What are the advantages and disadvantages of using a diaphragm as a form of contraception?
Advantages: professional fitting; can be used with spermicides; reusable
Disadvantages: requires education; must remain in situ for 6 hours; interruptions
What is long acting reversible contraception (LARC)?
Intra-uterine device - non-hormonal IUD is made of copper which is a spermicide and mechanically prevents implantation
What are the advantages or disadvantages of IUCDs?
Advantages: long term, don’t interrupt sexual activity/ partner can be unaware, copper IUD so no artificial hormones; amenorrhea/ decrease dysmenorrhea. can be used as emergency contraception (within 5 days of unprotected sex)
Disadvantages: decreased libido, irregular bleeding, cost, invasive, side effects (e.g. cramping)
What are the possible complications if an IUCD?
Expulsion
Perforation
Infection (e.g. pelvic inflammatory disease)
?Ectopic
To what stage of gestation is termination legal to in the UK?
24 weeks (medical before 9 weeks, surgery after)
What forms of surgical contraception are possible?
Females: tubal ligation
Males: vasectomy
What are the advantages or disadvantages of surgical methods of contraception?
Irreversible - advantage and disadvantage? Can be psychologically damaging Cost Invasive Failure rate (0.5% female, 0.05% male)
What is the MoA of the combined oral contraceptive pill?
Oestrogen + Progestogen (synthetic hormone mimicking actions of Progesterone)
Act on intracellular transcription factors (ER alpha and ER beta for Oestrogen and PR-A and PR-B for Progesterone)
Hormones diffuse across membrane and bind with receptors to initiate dissociation of HSP90 from the receptor complex - active receptor dimers then form and influence extensive gene expression
Why can synthetic steroid hormones easily diffuse across cellular membrane?
Lipid-based molecules so are hydrophobic
What is the primary outcome of oral contraceptives?
Suppression of ovulation
[Nb. ovulation is driven by endocrine dynamics and timing of hormone secretion and activity so oral contraceptives taken at appropriate time disrupt critical endocrine events required for ovulation]
How does Progesterone act to suppress ovulation?
Inhibits activity of hypothalamus and anterior pituitary by negative feedback, thus suppressing secretion of FSH and LH (and preventing development of follicle cell)
What effects does high levels of Progesterone have on the endometrium?
Inhibits endometrial gland development making implantation less favourable and thickens cervical mucus inhibiting sperm motility
What are some common adverse effects of oral contraception?
Breakthrough bleeding, nausea, depression
Increased of CV complications (e.g. thromboembolism, stroke, ischaemic heart disease and hypertension) - oestrogen containing contraceptions
Slight increase in breast cancer risk in long term use
What benefits can oral contraception have, outside of for the purpose of contraception?
Endometriosis symptom relief
Dysmenorrhea and menorrhagia
Acne in women (oestrogen containing contraceptions)
Reduced risk of endometrial cancer (progesterone)
