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human development > contraception > Flashcards

contraception Flashcards

1
Q

what are the reasons for using contraception?

A
  • Preventing pregnancy-related health risks in women
  • Reducing infant mortality
  • Helps to prevent HIV/AIDS
  • Empowering people and enhancing education
  • Reducing adolescent pregnancies
  • Slowing population growth
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2
Q

what are the sites of action of contraception?

A

ovary
endometrium
Cervix

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3
Q

what drugs target the ovary?

A

Combined hormonal contraception, Progesterone-only pill, Injection, Implant

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4
Q

what drugs target the endometrium?

A

IUS

IUD

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5
Q

what drugs target the cervix?

A

IUS, Progesterone-only pill, CHC

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6
Q

what hormones are involved in the female menstruation cycle?

A

FSH
oestrogen
LH
Progesterone

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7
Q

what does FSH do in the female menstrual cycle?

A

Ovarian follicular development, Oestrogen levels rise

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8
Q

what does oestrogen do in the menstrual cycle?

A

Endometrial proliferation, LH surge

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9
Q

what does LH do in the menstrual cycle?

A

Ovulation, Corpus luteum formation, Oestrogen and progesterone rise

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10
Q

what does progesterone do?

A

endometrial thickening

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11
Q

what is the combined hormonal contraception?

A

Combination of oestrogen and progesterone

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12
Q

what is the mode of action of CHC?

A

o Inhibits LH and FSH –> prevents ovulation
o Thickens cervical mucus –> natural sperm barrier
o Thins endometrium –> prevents implantation

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13
Q

what is the failure rate of CHC?

A

o If used perfectly 0.3 per 100 woman years

o If used typically 9 per 100 woman years

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14
Q

what are the types of CHC?

A

Birth control pills, Vaginal ring, Birth control patch

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15
Q

what are the advantages of CHC?

A

o Reduce menorrhagia / dysmenorrhoea / PMS
o Reduce risk of PID
o Reduce risk of benign ovarian tumours / colorectal cancer / ovarian cancer
o Improve acne
o May reduce risk of fibroids, ovarian cysts and non-cancerous breast disease

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16
Q

what are the disadvantages of CHC?

A

o Higher risk of VTE / stroke / CV disease
o Increased risk of breast cancer (returns to normal 10 years after stopping)
o Small increased risk of cervical cancer
o Depression / low mood
o Temporary side effects include headache, nausea, breast tenderness, mood changes
o Breakthrough bleeding

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17
Q

what are the contraindications of CHC?

A

o VTE / CV disease (inc atrial fibrillation) / stroke – either personal or close family history
o Hypertension
o Any thrombophilic condition
o Oestrogen-dependent cancers (usually breast or cervical)
o Migraine with aura
o Liver disease
o Combination of risk factors for cardiovascular disease, e.g. hypertension/diabetes
o Over 35 years and a smoker
o BMI > 35
o < 6 weeks postpartum if breastfeeding
o <3 weeks postpartum if non-breastfeeding

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18
Q

what is progesterone only contraception?

A

various different forms of synthetic progesterone

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19
Q

what is the mode of action of progesterone only contraception?

A

o Thickens cervical mucus  natural sperm barrier
o Thins endometrium  prevents implantation
o Inhibits ovulation (97% desogestrel, 60% others)

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20
Q

what is the failure rate of progesterone only contraception?

A

oIf used perfectly 0.3 per 100 woman years

o If used typically 9 per 100 woman years

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21
Q

what are the types of progesterone only contraception? how long do they last?

A

o POP
o Injection (Depo-Provera) - lasts 3 months
o Implant (Nexplanon/Implanon) - lasts 3 years
o Intrauterine system (IUS) - lasts 5 years

22
Q

what are the advantages of progesterone only contraception?

A

o Reduces menorrhagia / dysmenorrhoea / PMS; Amenorrhoea; Reduce risk of endometrial cancer; Can be used when breastfeeding; Fewer adverse effects compared to CHC

23
Q

what are the disadvantages of the progesterone only contraception?

A

o Irregular spotting
o Acne
o Headaches, nausea, mood swings, bloating, breast tenderness, weight gain
o Ovarian cysts
o All above usually settle after 6 months
o IUS only – uterine perforation, expulsion, ectopic pregnancy, PID

24
Q

what are the contraindications of progesterone only pill?

A 
o	Unexplained vaginal bleeding
o	If VTE / stroke / IHD occur during use
o	Breast cancer
o	Severe liver disease
o	IUS only – PID, >48h - <4w postpartum
25
Q

what is the mode of action of the intrauterine device?

A

o Copper is spermicidal
o Thickens cervical mucus  natural sperm barrier
o May act as physical barrier to implantation

26
Q

what is the failure rate of the intrauterine device?

A

0.6-0.8 per 100 women

27
Q

what are the advantages of the IUD?

A

Long-acting (5-10 years), No hormones

28
Q

what are the disadvantages of the IUD?

A

Uterine perforation, Expulsion, Ectopic pregnancy, PID, Menorrhagia (IUD only)

29
Q

what are the contraindications of the IUD?

A

o Unexplained vaginal bleeding; PID / untreated STI; Cancers (cervical, endometrial); Puerperal sepsis; > 48 hours - <4 weeks post-partum
o Distorted uterine cavity (may be appropriate under imaging guidance after discussion)

30
Q

what is the success rate of the male condom?

A

o If used perfectly failure rate 2 per 100 woman years

o if used typically failure rate 18 per 100 woman years

31
Q

what is the success rate of the diaphragm/cap?

A

o If used perfectly, failure rate 6 per 100 woman years

o If used typically, failure rate 12 per 100 woman years

32
Q

what are the advantages of the barrier methods?

A

only contraception to protect against STIs

33
Q

what does natural planning involve?

A

education and charting of various indicators of female fertility including: Temperature, Consistency of cervical mucus, Position of cervix, Day of cycle

34
Q

what is the failure rate of natural planning?

A

o If used perfectly failure rate is 0.5 per 100 woman years

o If used typically failure rate is 24 per 100 woman years

35
Q

what are the advantages of family planning?

A

o Does not involve using any chemicals or physical devices
o No physical side effects
o Can help person to recognise normal and abnormal vaginal secretions
o Can help with communication around fertility and sexuality
o Acceptable to all faiths and cultures

36
Q

what are disadvantages of natural planning?

A

o Takes 3-6 menstrual cycles to learn effectively
o Have to keep daily records
o Some events - e.g. illness, lifestyle, stress, travel – may make fertility indicators harder to interpret
o Need to avoid sex or use barrier methods during fertile time
o Does not protect against STIs

37
Q

what is the mode of action of the withdrawal method?

A

Male partner pulls penis out of vagina before he ejaculates so that sperm cannot reach uterus

38
Q

what is the failure rate of the withdrawal method?

A

22 per 100 women

39
Q

what is the mode of action of female sterilisation?

A

Typically laparoscopic bilateral tubal occlusion with clips/ligation/rings/diathermy

can be done under local or general anaesthetic

40
Q

what is the failure rate of female sterilisation?

A

lifetime failure rate 1 in 200

41
Q

what is the mode of action of male sterilisation?

A

o Ligation/diathermy/excision of vas deferens bilaterally

o Done under local anaesthetic

42
Q

what is the failure rate of male sterilisation?

A

Lifetime failure rate 1 in 2000

43
Q

what is the female risk of sterilisation?

A

pain, heavier periods <30 years, ectopic pregnancy, injury to internal organs, regret

44
Q

what is the risk of male sterilisation?

A

pain, swelling, infection, retrograde ejaculation, regret

45
Q

what is the mode of action of oral emergency contraception?

A

delayed ovulation

46
Q

name common oral emergency contraceptions?

A

levonelle

ellaone

47
Q

what is levonelle?

A

Levonorgestrel 1.5mg single dose. Licensed up to 72 hours post-UPSI. Pregnancy rate 0.6 – 2.6%

48
Q

what is ellaone?

A

Ullipristal acetate 30mg single dose. Licensed up to 120 hours post-UPSI. Pregnancy rate 1 – 2%

49
Q

what is the mode of action of IUD emergency contraception?

A

Inhibits fertilisation by direct toxicity

Affects implantation by causing endometrial inflammation

50
Q

what is the overall pregnancy rate?

A

Licensed up to 5 days after UPSI / earliest possible ovulation

human development (20 decks)

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