Contraception Flashcards
what contraception acts at the ovary
Combined hormonal contraception
Progesterone-only pill
Injection
Implant
what contraception acts at the endometrium
IUS
IUD
what contraception acts at the cervix
IUS
Progesterone-only pill
CHC
what is the mode of action of the combined hormonal contraction
Inhibits LH and FSH this prevents ovulation
Thickens cervical mucus this acts as a natural sperm barrier
Thins endometrium this prevents implantation
what is the failure rate of the combined hormonal contraception
- If used perfectly 0.3 per 100 woman years
- If used typically 9 per 100 woman years
what are the time of the combined hormonal contraception
- birth control pill
- vaginal ring
- brith control patch
what are the advantages and disadvantage of the combined contraceptive pill
advantages
- Reduce menorrhagia / dysmenorrhoea / PMS
- Reduce risk of PID
- Reduce risk of benign ovarian tumours / colorectal cancer / ovarian cancer
- Improve acne
- May reduce risk of fibroids, ovarian cysts and non-cancerous breast disease
disadvantages
- Higher risk of VTE / stroke / CV disease
- Increased risk of breast cancer (returns to normal 10 years after stopping)
- Small increased risk of cervical cancer
- Depression / low mood
- Temporary side effects include headache, nausea, breast tenderness, mood changes
- Breakthrough bleeding
what publishes the UKMEC guidelines
FSRH
what does a UKMEC 1 condition mean
- a UKMEC 1 condition means it is fine to take that form of contraception with the disease
what does an UKMEC 4 mean
this means that you should not take the contraception with that condition
what are the UKMEC 4 conditions for the combined contraception pill
- VTE / CV disease (inc atrial fibrillation) / stroke – either personal or close family history
- Hypertension
- Any thrombophilic condition
- Oestrogen-dependent cancers (usually breast or cervical)
- Migraine with aura – slightly higher risk of stroke with hormonal contraception
- Liver disease
- Combination of risk factors for cardiovascular disease, e.g. hypertension/diabetes
- Over 35 years and a smoker
- BMI > 35
- < 6 weeks postpartum if breastfeeding – it can mess with postpartum hormone regulation
- <3 weeks postpartum if non-breastfeeding
what is the mode of action of progesterone
- Thickens cervical mucus this act as a natural sperm barrier
- Thins endometrium prevents implantation
- Inhibits ovulation (97% desogestrel, 60% others
what is the failure rate of progesterone only contraception
If used perfectly 0.3 per 100 woman years
If used typically 9 per 100 woman years
what are the types of progesterone only contraception
POP Injection (Depo-Provera) - lasts 3 months Implant (Nexplanon/Implanon) - lasts 3 years Intrauterine system (IUS) - lasts 5 years
what is the advantages and disadvantages of the progesterone
Advantages
- Reduces menorrhagia / dysmenorrhoea / PMS
- Amenorrhoea
- Reduce risk of endometrial cancer
- Can be used when breastfeeding
- Fewer adverse effects compared to CHC
disadvantages
- Irregular spotting
- Acne
- Headaches, nausea, mood swings, bloating, breast tenderness, weight gain
- Ovarian cysts
- All above usually settle after 6 months
- IUS only – uterine perforation, expulsion, ectopic pregnancy, PID
what are the UKMEC 4 diseases for progesterone pill only
- Unexplained vaginal bleeding
- If VTE / stroke / IHD occur during use
- Breast cancer
- Severe liver disease
- IUS only – PID, >48h - <4w postpartum
what is the mode of action of intrauterine device
Copper is spermicidal
Thickens cervical mucus this acts as a natural sperm barrier
May act as physical barrier to implantation
what is the failure rate for the IUD
0.6-0.8 per 100 woman years
what are the advantages and disadvantages to the IUD
Advantages
- Long-acting (5-10 years)
- No hormones
Disadvantages
- Uterine perforation
- Expulsion
- Ectopic pregnancy
- PID
- Menorrhagia (IUD only) – more painful periods
what is the contraindications of the IUD
- Unexplained vaginal bleeding
- PID / untreated STI
- Cancers (cervical, endometrial)
- Puerperal sepsis – it would come out as soon as you put it in
- > 48 hours - <4 weeks post-partum
- Distorted uterine cavity (may be appropriate under imaging guidance after discussion)
what are the two types of barrier methods
male codon
diaphragm cap
what is the failure rate of the male codon
If used perfectly failure rate 2 per 100 woman years
if used typically failure rate 18 per 100 woman years
what is the filature rate of the diaphragm and cap
If used perfectly, failure rate 6 per 100 woman years
If used typically, failure rate 12 per 100 woman years
what contraceptions protect against STIs
barrier method - male codon, diaphragm/cap
how do you do natural family planning
Involves education and charting of various indicators of female fertility including:
- Temperature
- Consistency of cervical
- mucus
- Position of cervix
- Day of cycle
what is the failure rate for natural family planning
If used perfectly failure rate is 0.5 per 100 woman years
If used typically failure rate is 24 per 100 woman years
what are the advantages and disadvantages of natural family planning
Advantages
- Does not involve using any chemicals or physical devices
- No physical side effects
- Can help person to recognise normal and abnormal vaginal secretions
- Can help with communication around fertility and sexuality
- Acceptable to all faiths and cultures
disadvantages
- Takes 3-6 menstrual cycles to learn effectively
- Have to keep daily records
- Some events - e.g. illness, lifestyle, stress, travel – may make fertility indicators harder to interpret
- Need to avoid sex or use barrier methods during fertile time
- Does not protect against STIs
what is coitus interruptus
- the withdrawn method
what is the mode of action of coitus interruptus
Male partner pulls penis out of vagina before he ejaculates so that sperm cannot reach uterus
what is the failure rate of coitus interrupts
With typical use, rate is 22 per 100 woman years
what is the mode of action of female sterilisation
Typically laparoscopic bilateral tubal occlusion with clips/ligation/rings/diathermy
Can be done under local or general anaesthetic
what is the failure rate of female sterilisation
Lifetime failure rate 1 in 200
what is the mode of action of male sterilisation
Ligation/diathermy/excision of vas deferens bilaterally
Done under local anaesthetic
what is the filature rate of male sterilisation
Lifetime failure rate 1 in 2000
what is the risk of sterilisation for females
Female Pain Heavier periods if <30 years Ectopic pregnancy Injury to internal organs Regret
what is the risk of sterilisation for males
Male Pain Swelling Infection Retrograde ejaculation Regret
what are the two types of emergency contraception
oral
IUD
what is the mode of action of emergency contraception oral
Delay ovulation
what are the two emergency contraception for oral
Levonelle. Levonorgestrel 1.5mg single dose. Licensed up to 72 hours post-UPSI. Pregnancy rate 0.6 – 2.6%
EllaOne. Ullipristal acetate 30mg single dose. Licensed up to 120 hours post-UPSI. Pregnancy rate 1 – 2%
what is the emergency contraction IUD mode of action
Inhibits fertilisation by direct toxicity
Affects implantation by causing endometrial inflammation
Overall pregnancy rate <0.1%
Licensed up to 5 days after UPSI / earliest possible ovulation
