Contraception Flashcards
What is contraception
Methods that prevent conception
What are the methods of contraception
•Hormonal methods: introduce synthetic hormones into the woman to prevent ovulation, thicken cervical mucus, or prevent a fertilized egg implantation
/non hormonal methods:
block the meeting of egg and sperm physically
Behavioural methods:
Barrier
surgical
What are the 5 types of hormonal contraceptives
1) Oral contraceptives (pills)
2) Vaginal ring (Nova Ring)
3) Transdermal patch (Evra)
4) Injected hormones (Depo-Provera)
5. Implants (Norplant, Implanon) ??
5) Hormonal IUDs (Mirena)
General overview of oral contraceptive pills
1)combined oral contraceptive (COC)
Oral, Short-acting, reversible
containing estrogen and progestin
Indications :
-Hyperandrogenism (e.g., acne, hirsutism)
-Menstrual cycle disorders (menorrhagia, dysmenorrhea)
-Symptom control in endometriosis, leiomyomas
2)Progestin-only contraceptive pills (minipill)
Short-acting, reversible oral
containing low doses of norethindrone
Indications:
-Contraception when estrogen-containing contraceptives are contraindicated
Types of oral contraceptives
Monophasic/ constant dose :
25 micro grams / day
Same dose of estrogen and progestin in each pill.
Multiphasic
- biphasic: one hormone fixed and other fluctuates
- triphasic: both hormones fluctuate w/in 21 day cycle
Protesting only :For women CI for estrogen —breastfeeding
high b.p
risk for blood clots
smokers
Antiprogestin: inhibits or delays ovulation by inhibiting the progesterone receptor
How do oral contraceptives work/ MOA
Estrogen
- ↓ LH → inhibits ovulation secondary to reduces FSH and inhibited folliculorgenesis
- ↓ FSH→ prevents folliculogenesis( no Graafian follicle)
Progestin
-↓ release of GnRH
-Suppresses LH surge in secretory phase
→ suppresses ovulation
-Inhibits endometrial proliferation when withdrawn but maintains it when present
-↓ volume and ↑ viscosity of cervical mucus
-impairs fallopian tube peristalsis → inhibition of sperm ascension and egg implantation
Inhibits follicular maturation
Antiprogestin: inhibits or delays ovulation by inhibiting the progesterone receptor
Side effects of contraceptives
Estrogen: 3xHHH, MnV
-Venous thrombo embolism
d/2 estrogen-mediated coagulopathy
-Cardiovascular events
-Hypertension :
d/2 sim of RAS esp w/
history of HTN during pregnancy or fam history of HTN
- Headaches: early, common cause of discontinuation!!
- Hepatic adenoma development
- Mastopathy and mastodynia( breast pain)
- Nausea
Progestin:
- Breakthrough bleeding ( most common cause of discontinuation )
- Follicular cysts( prevent ovulation so corpus luteum degeneration is affected)
- Weight gain is not a side effect of hormonal contraceptive
benefits of oral contraceptive
- Regulation of menses
- relieves menstrual cramps
- postpartum contraception to allow body to recover from pregnancy
- prevents pregnancy
Non contraceptive benefits/ indication
- reduces risk of gynaecological diseases
1) endometriosis
2) myomas
3) endometrial and ovarian carcinoma
4) acne
By what mech does OCP reduce risk of gynaecological diseases
Inhibits ovulation- reduces trauma, inflammation and repeated division associated w/ cancer formation
Reduced inflammation and ovulation therefore reduce
pathological process
1) aromatase reduced: reduced risk of oestrogen mediated disease ( endometriosis, menstrual sx, acne)
2) reduced COX2; reduced inflammation mediated diseases:
What are the types of contraindications of oral contraceptives
Relative CI
ABSOLUTE CI
Relative CI OF OC
CARDIOVASCULAR
- Superficial venous thrombosis
- Thrombophlebitis
- Severe varicosis
METABOLIC
- Hypercholesterinemia ( increases risk of CDI events)
- Morbid obesity
- Diabetes mellitus
OTHER Leiyomyomas! Smoking Ulcers & ulcerative colitis Age over 40
Absolute CI of OCP
CDV Thromboembolism !! Coagulopathy, antiphospholipid ab’s Coronary heart disease Stroke Arterial hypertension (> 160/95 mm Hg)
MET
Metabolic liver disorders
ONCOLOGICAL
Hepatic tumors
Estrogen-dependent tumors
OTHER
Over 35 y/o smokers
Pregnancy
Principles of taking oral contraceptive
•Once a day at the same time everyday
-if you miss one take it ASAP & continue next day at normal time
•Use condoms for first month
•Use condoms when on antibiotics
•Use condoms for 1 week if you miss a pill or take one late
•The pill offers no protection from STD’s
Take it on the first day of the period
Signs that oral contraceptive pills should be discontinued
ACHES
Abdominal pain
Chest pain: sharp pain, SON
Headache:aura, one side, dizziness
Eye problems: blurred vision
Severe leg pain: Pte in calf/ thigh
What is Evra contraception
transdermal patch providing sustained low doses of estrogen and progestin
Short-acting, reversible contraceptive as effective as COC pills
Only require application to the skin on arm/ abdomen once a week
Similar indications as for COC
What is the NUVARING
Flexible vaginal ring that contains estrogen and progesterone
Short-acting, reversible flexible
Similar indications as for COC
What is depo poreva / DMPA
Injectable progestin
Depot medroxyprogesterone acetate
IM •150 mg administered deep intramuscular
Sub cut •104 mg subcutaneous
once ever 3 weeks- 3months
Long term reversible use
Pros: effective in obese pt , little compliance
Side effects: Bleeding irregularities •Delayed return of fertility •Weight gain •Decrease in bone mineral density
What is implanon etonestgtrel
Sub dermal implant
subcutaneously in the forearm
Lasted 3 years
Side effects: weight gain, acne, altered bleeding
CI:
Anitphospohlipod ab’s In SLE
Intrauterine devices
Hormonal
Progestin
Levonestrel
Less than 1% failure
Long term and reversible
Changed every 3-5 years
Non hormonal
Copper
T-shaped device wrapped in copper wire that is inserted into the uterus to prevent pregnancy
Approved for 10 years of continuous use; may be effective for longer
increases tubal motility causing the fertilized egg to be transported to the uterus before the endometrium is receptive for implantation.
Ci Uterine abnormalities (i.e. bleeding, malignancy, anomalies, infection) Suspected pregnancy Menorrhagia Dysmenorrhea Copper hypersensitivity
Comp Menorrhagia Dysmenorrhea Uterine perforation Ectopic pregnancy Pelvic inflammatory disease
What are the barrier methods of contraception
Male & female condom
spermicide:Foams, suppositories, jellies,creams
Diaphragm w/ spermicidal jelly or cream
Cervical cap with spermicidal jelly or cream
Lea’s Shield and FemCap
The sponge
Condoms
Male 98% effective
Female 95% effective
Protection against some STD’s
Contraindication: latex allergy for latex condoms
Diaphragm
- 95% effective
- Placed into the anterior and posterior fornix of the vagina prior to sexual intercourse Prevents passage of semen into the cervix
- Leave in place 6 hours after intercourse
- Use with contraceptive jelly/ cream
Contraindications: cervical anomalies or abnormalities (e.g., infection, malignancy), spermicide or latex allergy
Complication: toxic shock syndrome
Cervical cap
Cup shaped latex, metal, or plastic device that holds spermicide
Prevents passage of semen into the cervical canal
Placed over the base of the cervix;
inserted up to ∼ 8 hours before sexual intercourse
must be removed after 48 hours
Contraindications: cervical anomalies or abnormalities, spermicide or latex allergy
Complication: toxic shock syndrome, cervical erosion (resulting in spotting)
Foam
- 80-85% effective
- Works immediately
- Effective for an hour
- No douching for 6 hours after intercourse
- 20% have burning (reaction
Sponge
Foam disk containing spermicidal fluid; moistening the disc with tap water and gently squeezing before inserting into the vagina activates the disk
Inserted up to 24 hours before intercourse; no less never than 30 hours after
Prevents entry of semen into the cervix and has spermicidal effects
Contraindications: similar to diaphragm
Complication: vaginal irrigation, toxic shock syndrome (rare)
Behavioural methods of contraception
Withdrawal: (pull out 100% effective so far) removing the penis from the vagina just before ejaculation
- Abstinence (never worked ever)
- Fertility awareness
- Cervical mucus method
- Body temperature method
- Calendar method
Emergency contraception
•Emergency contraception pills (ECPs) -taken within 3 days post I ntercourse to prevent fertilization or implantation.
1)morning after
after unprotected intercourse but before a
woman misses her period
Contains anti progesterone
2Postinor Duo
progestin-only pill taken as soon as possible after unprotected intercourse.
A second pill follows 12 hours later
Surgical methods of contraception
Sterilisation
-Female
•Tubal ligation: seals the Fallopian tubes to block sperm.
•Hysterectomy: removal of the uterus.
-Male
Vasectomy: cutting and tying off of both vasa deferentia.
More effective and safer than female procedures
Surgical abortion
•Vacuum aspiration
•Dilation and evacuation (D&E)
•Dilation and curettage (D&C)
List the behaviour contraceptives (4)
Abstinence
Coitus interruptus
Fertility-awareness based methods
- Calendar method
- Cervical mucus method:
- Basal body temperature method
- Symptothermal method
Vaginal douche
Lactational amenorrhea
Coitus interruptus
known as the withdrawal method
Method: The penis is withdrawn from the vagina before ejaculation
Failure rate : 22%
Pros: Reversible Inexpensive Readily available No side effects
Com
High risk for human error
No protection from sexually transmitted infections
Semen may enter vagina before ejaculation
How is the effectiveness of contraceptives measured
Failure rate with typical use
-number out of every 100 women who become pregnant within the first year of typical use of the method of contraception.
Pearl index
-unintended pregnancies in 100 women per year with perfect use of the method of contraception.
What are fertility awareness methods
24% typical failure use
avoiding sexual intercourse during the ovulation period
Calendar
Cervical mucus
Basal body temp
Symptothermal method
Pros Reversible Inexpensive Readily available No side effects
Cons
High risk for human error
Requires regular periods
No protection from sexually transmitted infections
Explain the Calendar method
Principles
i) an egg can be fertilized for ∼ 24 hours after ovulation; (ii) the lifespan of sperm is 48 hours following ejaculation; and (iii) ovulation occurs 12–16 days before onset of the next menses.
Fertilization can occur anytime from 3 days before to 1-3 day after ovulation.
Determining time of ovulation based on first day of men’s then avoiding coitus around those days
Cervical mucus method
fertility period is estimated by evaluating the abundance and consistency of cervical mucus throughout the cycle
Conception is more probable up to 4 days after cervical mucus reaches its maximum abundance and elasticity;
CI:
Post partum breast feeding women before 6 wks
Post partum non breast feeding before 4 weeks
Irregular menses
Basal body temperature method
body temperature is measured throughout the cycle. Ovulation triggers an increase in basal body temperature, thus indicating the fertility period.
Temperature is taken in the morning after waking up (oral, vaginal and rectal; inner ear and axillary are inaccurate). Basal temperature decreases before ovulation and then increases by 0.2–0.5°C (32.4–32.9°C) due to the release of hormones.
The temperature decreases at the beginning of the menstrual cycle.
Fertilization is unlikely from the third day following the increase in basal body temperature(ovum lasts 2 days max)/
Vaginal douche
The vagina is flushed with water or other products immediately after male ejaculation during intercourse in an attempt to theoretically flush semen out
Not recommended and unsafe
Lactational amenorrhea
Amenorrhea is induced by exclusively breastfeeding within the first 6 months postpartum
Lactation → ↑ prolactin and ↓ gonadotropin-releasing hormone → suppression of ovulation
Also inhibits follicular maturation (↓ luteinizing hormone)
Why does estrogen increase coagulation
Estrogen increases levels of factors II, VII, VIII, and X and fibrinogen, and decreases levels of antithrombin and protein S, and increases resistance to protein C
