Contraception Flashcards
What is Contraception?
- Intentional prevention of pregnancy by artificial or natural means
What are the Reasons for Contraception?
- Gives women the ability and choice on when to start a family
- Cost-effective health-care interventions
- Population control
What are the Factors Influencing Contraceptive Choice?
- Cultural, religious and personal beliefs
- Side effects/contraindications
- Previous experience/use
- Access to health care
- Understanding of effectiveness
- Need for STI prevention
- Cost associated
- Preference for permanent or temporary contraception
List 3 Barrier Methods
- Male condoms
- Female (internal) condoms
- Diaphragm
What is the role of Male Condoms?
- Prevent the transfer of genital fluids between partners and reduce risk of STI
What are the Benefits of Male Condoms?
- Good efficacy
- Readily available, no prescription
- Reduce risk of STIs
- Available in formulations suitable for latex allergies
- Can be used with water based lubricants
What are the Disadvantages of Male Condoms?
- Condoms can break/tear or slip off
- Oil based lubricants can damage latex and cause a tear
- Compliance
What are Female (Internal) Condoms?
- Inserted into the vagina before sex
- Reduces STI risk
- Female required to practice insertion before use and insert 6 hours prior
- Not readily available
What is a Diaphragm?
- Inserted into the vagina and covers the cervix
What does the COCP contain?
Contain an estrogen and progestogen in various formulations and strengths
COCP: What is the role of Estrogen Component?
- Estrogens suppress the FSH release from the pituitary
- Prevents follicle development
COCP: What is the role of Progesterone Component?
- Can inhibit ovulation by blocking LH surge
- Increase the thickness of cervical mucus
COCP: What is the role of the combination of Estrogen and Progesterone?
- Alter endometrium to discourage implantation
What is the goal of the COCP?
- The goal is to use the lowest dose of estrogen and progestogen whilst achieving:
- Effective contraception
- Cycle control
- Minimal adverse effects
- Non-contraceptive benefits e.g. acne
What is Monophasic?
- Same amount of estrogen and progestogen in each active pill
What is Multiphasic?
Slow increase in estrogen and potentially progestogen – aim is to mimic the natural cycle
What are the three types of synthetic estrogens available in the COCP?
- Ethinylestradiol
- Estradiol
- Mestranol
What type of Progesterone is used in the COCP?
- Rapidly metabolised in the liver
- Synthetic progestogens are used in the COCP to ensure efficacy
- Newer generations of progesterone have fewer side effects as they bind more selectively to the progesterone receptor
What is Extended Cycling?
- Women continue to take the active pill
- Bicycling and tricycling
- Avoid withdrawal bleed
- Can improve compliance
- It’s recommended that a withdrawal bleed occurs at least every 3-4 months
What are the Benefits of COCP other than contraception?
- Reduce the chance of endometrium, ovarian and bowel cancers
- Be used as a treatment for pre-menstrual syndrome (PMS)
- Improve acne and hirsutism
- Regulation of menstrual bleeds in regards to timing and reduced volume
- Can time withdrawal bleed
- Easily reversible and has no effect on future fertility
What are Contraindications of COCP?
- Cardiovascular:
- Hx of cerebrovascular event or coronary artery disease, VTE or thrombogenic mutations
- All CV risk factors need to be assessed prior to COCP being prescribed
- Breast cancer
- Migraine with aura