Contraception Flashcards
What are the most common forms of contraception?
Of women using contraception:
- 25% Combined OCP
- 28% sterilized
Implants only mkae 3% and Coil 6%
How do we determine the effectiveness of a contraceptive method?
Life Table Analysis or Pearl Index
Pearl index: % of women using a the method who get pregnant anyway.
Life table analysis: contraceptive failure rate over a specific period of time.
Whats in the Combined OCP?
Ethinyl Oestradial (EE) Synthetic Progesterone (Progestogen)
3rd gen pills contain Gestogene (GSD) and Desogestrel (DSG)
Dose for cOCP?
20-35microgram but 50 if on liver enzyme inducers
How often is the cOCP taken?
Every day for 21 days then 7 days off
takes 7 days to become effective when you start it
How does the cOCP work?
Prevents the FSH/LH surge by -ve feedback on the GnRH producing hypothalamus
Also prevents implantation by providing an inadeqaute endometrium.
Alters cervical mucous to Inhibit sperm penetration
What are the non contraceptive benefits of the cOCP?
Regulate/reduce bleeding- help heavy or painful natural periods
Stop ovulation- may help premenstrual syndrome
Reduction in functional ovarian cysts
50% reduction in ovarian and endometrial cancer
Improve acne / hirsutism
What are the major risks of cOCP?
- .Very small increased risk of VTE
- Very small increased risk of Ischaemic stroke
- Small risk of breast cancer
- Doubles Cervical cancer risk if used for 10yrs
the cOCP is often blamed for VTEs, how risky is it really?
.The pill triples risk from 5 to 15 per 100,000.
However thats still less likely than being in an RTA and 1/4 of the risk of a VTE were you to get pregnant
It just sounds scary if you don’t actually know the numbers
What groups might we actually worry about VTEs in if we give them the cOCP?
- BMI >34
- previous VTE
- 1st degree relative VTE under 45
- Avoid in smokers >35
- personal history arterial thrombosis
- focal migraine
- Age>50
- Hypertension>140/90
- Avoid if active gall bladder disease
- Avoid if previous liver tumour
How does Depoprovera work?
- Prevents Ovulation by -ve feedback
- Alters cervical mucous preventing sperm penetration
- Renders endometrium unsuitable, preventing implantation
What do we properly call the coil?
Long Acting Reversible Contraception (LARC)
What are the best forms of Emergency Contraception?
CU-IUD (copper coil)
Levonorgestrel pill/ Levonelle
Ella One pill
All less effective than ongoing contraception
How long after sex can you use emergency contraception?
Copper coil up to 5 days post sex of post cycle
Levonorgestrel - 72 hours
Ella One - 120 hours
What is the main form of female sterilization?
Laparascopic Tubal Ligation with Filshie clips
How is Vasectomy done?
Permanent division of vas deferens under local anaesthetic
Then they have to come back for semen analysis before they start having unprotected sex
Can you get pain from vasectomy? Testicular cancer?
Can get pain due to a sperm granuloma (Degenerating spermatozoa surrounded by macrophages)
No risk of cancer
Is vasectomy reversible?
.Low success rate for reversals
When is a termination best performed?
<9wks as it reduces complications if its early
AT what point do we stop doing terminations?
20wks. then we refer to england who do it till 24wks
Why would you terminate a pregnancy?
IF the continuation of it would cause greater physical/mental harm to the women or existing children than terminating
- Maternal health
- Social reasons
- Fetal Anomaly
What do we do during a clinic consultation on termination?
- Talk about methods
- Advise they may have prolonged bleeding post-TOP
- Offer counselling post-TOP
- Contraception advice
- FBC, Rubella & STI checks
- Certificate A signed
Most terminations in Grampian are medical, how are they done?
Mifepristone:
Swtiches off pregnancy hormones –> 48 hours later prostaglandins (Misoprostol) initiate uterine contraction –> opens cervix & expels pregnancy
What are the risks of Medical TOP?
,Haemorrhage Uterine Perforation Cervical Trauma Failure Infection RPOC Damage to future fertility Psychological problems
Whats the alternative to the Combined OCP?
Progestogen Only Pill (POP)
How often do you have to take the POP?
Take the desogestrel pill every day within the same 12 hr window
(Traditional PoPs have only a 3hr window)
How does the POP work?
Renders Cervical mucus impenetrable to sperm
Also has some effect inhibititing ovulation
When is one most likely to get pregnant? and likelihood of getting pregnant during one of these days?
Day 8-19
20-30%
How long are sperm and the egg most likely to survive?
Egg: 24h
Sperm: 4 DAYS
How does the patch work?
changed weekly
< 5% have skin reaction
How does the ring work?
Ring Nuvaring TM
changed every 3 weeks
can take out for 3 hrs in 24 so may prefer to take out for sex
Latex free
What are potential side effects of combined hormonal therapy?
Breast tenderness Nausea Headache Irregular bleeding first 3 months Mood- THOUGH COULD BE RELATED TO OTHER LIFE EVENTS Weight gain- not causal
How does POP work?
Take at the same time every day without a pill-free interval
Types of PoP pills
- Desogestrel pill – 12 hour window period
o Nearly all cycles anovulant- also effect mucus.
o Most bleed free. - Traditional LNG NET pills
o 3 hour window period
o 1/3 anovulant
o 2/3 rely on cervical mucus effect: 1/3 bleed free, 1/3 irregular, 1/3 regular periods
Side effects for POP
Appetite increase Hair loss/gain Mood change Bloating or fluid retention Headache Acne
When to avoid a POP
No increased risk venous or arterial thrombosis with contraceptive dose progestogens
Still avoid if current breast cancer or liver tumour past/present
What is injectable progesterone?
Aqueous solution of the progestogen depomedroxyprogesterone acetate DepoproveraTM
Every 13 weeks
Benefits of injectable progesterone?
Only need to remember every 12 weeks
70% women amenorrhoeic after 3 doses
Estrogen-free so few contraindications
Side effects of injectable progesterone?
Delay in return to fertility – average 9 months
Reversible reduction in bone density- discuss her other risks for osteoporosis
Problematic bleeding especially first 2 doses
Weight gain 2/3 women gain 2-3 kg
what is the ROD?
Subdermal progesterone
Implanon is a small plastic rod measuring 4cm in length and 2mm in cross sectional diameter.
The rod contains 68mg of the progestogen etonogestrel dispersed in a matrix of ethinylvinylacetate (EVA).
Benefits of the ROD?
Inhibition of ovulation + effect on cervical mucus
Can last 3 years- or be removed at any time
No user input needed
No causal effect on weight
Side effects of the ROD
60% are almost bleed free but 30% have prolonged / frequent bleeding
May cause mood change more often than other progestogen only methods
How does the copper coil work?
Affect cervical mucus and endometrium most women still ovulate Stop fertilisation of egg- may prevent implantation fertilised egg
Slow release progestogen on stem
