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Block 5 > Contraception > Flashcards

Contraception Flashcards

1
Q

What are the advantages of contraception?

A

Choice/control for personal/medical reasons
Pregnancy spacing (health)
Cost sometimes
Saves lives globally

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2
Q

What are the disadvantages of contraception?

A

Changes in sexual habits
Increased promiscuity
Medical complications
Cost sometimes

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3
Q

What must be considered in a contraceptive consultation?

A 
Health
Age
Desire for fertility
Social/religious/ethical
Education
Compliance
Cost
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4
Q

What are the 4 different types of contraceptive methods from least to most reliable?

A
  1. Natural/physiological
  2. Barrier
  3. Hormonal
  4. Surgical
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5
Q

What natural/physiological contraceptive methods exist?

A
  1. Calendar rhythm method: prevent sperm/egg interaction
  2. Coitus interruptus: prevent sperm/egg interaction
  3. Lactation: prevents ovulation but only with exclusive regular feeding
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6
Q

What is the mechanism of action of the calendar rhythm method?

A

In rhythm with woman’s natural fertility as the ovum has a limited period of fertilised so intercourse should be avoided in fertility window, 4-5 days prior and 1-2 days after predicted ovulation

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7
Q

When does ovulation normally take place? What is a tell-tale sign?

A

~ day 14

Spinbarkeit (spinnability) of vaginal mucus or higher body temperature

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8
Q

What are the advantages and disadvantages for the calendar rhythm method and coitus interruptus?

A

Adv: cheap/no side effects, no medical contraindication and no religious/ethical problems

Disadv: limits sexual activity, education (3-6mths), failure rate higher and no STI protection

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9
Q

What is the mechanism of action of lactation?

A

Regular and exclusive (i.e. no bottle feeds) breastfeeding for ~6 months will induce production of prolactin which inhibits secretion of FSH, suppressing HPO axis so no ovulation takes place but failure rate is an issue

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10
Q

What is coitus interruptus?

A

Penile withdrawal before ejaculation

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11
Q

What 4 barrier contraceptive methods exist?

A
  1. Condom
  2. Diaphragm
  3. Cervical cap
  4. Plus - spermicide
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12
Q

What is the main mechanism of action of barrier contraceptive methods?

A

Prevent sperm/egg interaction

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13
Q

How does the diaphragm and cap work?

A

Inserted in the vagina with spermicide in it just before sex, left in for 6 hours after sex and then can be taken out so patients need to be educated on its use

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14
Q

What are the advantages and disadvantages of condoms?

A

Adv: cheap/readily available and STI protection

Disadv: latex allergy, some sensation loss/interruption/accidents, education (beware of body oil and Vaseline w/ latex) and female condom even less popular

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15
Q

What is the mechanism of action of long acting reversible contraception (LARC)?

A

Copper IUD releases copper which is a spermicide and mechanically prevents implantation

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16
Q

What are the advantages of long acting reversible contraception (LARC)?

A 
Long-term
Doesn't limit/interrupt sexual activity
IUCD copper has no artificial hormones
Amenorrhea
Decreased dysmenorrhea
Partner unaware (sometimes string can be felt in IUCD)
17
Q

What are the disadvantages of long acting reversible contraception (LARC)?

A 
Decreased libido
Irregular bleeding
Amenorrhea may be beneficial
Cost
Invasive
No STI protection
18
Q

When should the intra-uterine contraceptive device (IUCD) be used?

A

Long-lasting for 1-12 years so good for women who are older/parous, if compliance is a problem and can be used as emergency contraception is implanted within 5 days of unprotected sex

19
Q

What are the complications of the intra-uterine contraceptive device (IUCD)?

A

Expulsion
Perforation
Infection (PID) as string provides a route up to uterus
Ectopic

20
Q

What are the side effects of the cooper/inert intra-uterine contraceptive device (IUCD)?

A

Bleeding
Cramping
Usually good or bad

21
Q

What is a termination (TOP)?

A

Often called an abortion - legal to 24/40 weeks gestation in UK which can be:

  1. Medical (up to 9/40): Mifepristone/Misoprostol
  2. Surgical: vacuum aspiration (15/40) or dilation and curettage (>15/40)
22
Q

What is surgical sterilisation?

A

Irreversible method of preventing sperm/egg interaction via surgical interruption:

  • Male = vasectomy
  • Female = tubal ligation
23
Q

What are the problems with surgical sterilisation?

A

Requires counselling
Costly
Invasive
Failures still exist

24
Q

What are oral hormonal contraceptives?

A

Synthetic steroid hormones that mimic the function of oestrogens and progesterone:

  • Combined inc. oestrogen and progesterone
  • Progesterone-only version
25
Q

What is the mechanism of action of oral hormonal contraceptives?

A

Act upon oestrogen and progesterone IC TFs by diffusing across cell membranes:

  • ER1⍺ and ERβ for oestrogen
  • PR-A and PR-B for progesterone

Binding of hormone drives receptor activation via dissociation from HSP90 so active receptor dimers then form, move into nucleus and influence gene expression influencing tissue growth, regeneration and secretion of hormones

26
Q

What are the primary outcomes of oral contraceptives?

A

SUPPRESSION OF OVULATION:

  • Combined: must be taken at right time to disrupt critical endocrine events required for ovulation
  • Progesterone only: taken asynchronously and exerts additional effects that disrupt fertilization and implantation (makes body think you are already pregnant)
27
Q

What drives ovulation?

A

Endocrine dynamics and relative TIMING of hormone secretion and activity - LH surge essential for this

28
Q

What happens to the corpus luteum if implantation occurs or does not occur?

A

Progesterone is produced by the corpus luteum during the menstrual cycle and with +ve embryo implantation, it is sustained and progesterone levels remain high promoting pregnancy but if there is no embryo implantation, it disintegrates so progesterone levels fall contributing to menses and the cycle resumes

29
Q

What usually happens to progesterone levels throughout the menstrual cycle?

A

LOW in follicular phase

HIGH in luteal phase

30
Q

What is the problem with progesterone-only contraceptive pills?

A

High doses are required to suppress ovulation which can cause sig. nausea and this is still not 100% effective whereas combined pill is >99.8% effective so the progesterone-only pill is only used for emergency contraception or in situations when oestrogen-derived complications/risks occur

31
Q

What are the effects of progesterone?`

A
  1. Negative feedback to hypothalamus + anterior pit. to reduce FSH/LH synthesis inhibiting ovulation
  2. Inhibits endometrial gland development making implantation less favourable as sufficient nutrients would not be available
  3. Thickens cervical mucus so inhibits sperm motility
32
Q

What can progesterone intra-uterine systems (IUS) be used for?

A

E.G. Mirena can incorporate a progesterone-releasing polymer component that lasts up to 5 years which is a very effective contraceptive system BUT can also treatment conditions such as menorrhagia

33
Q

What are the common adverse effects of oral contraceptives?

A

Breakthrough bleeding
Nausea
Depression
Increased risk of CVD complications with oestrogen-containing pills (e.g. thromboembolism, stroke, IHD, raised BP)
Slight increase in breast cancer risk in long-term use

34
Q

What other benefits to contraceptives offer?

A

Relief of symptoms of endometriosis, dysmenorrhoea, menorrhagia and acne in women

Progesterone reduces risk of endometrial cancer too

Block 5 (29 decks)

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