Contraception Flashcards
1
Q
Combined hormonal pill
A
- Combination of 2 hormones
- ethinyl estradiol (EE)
- synthetic progesterone (progestogen)
- Stop ovulation, also affect cervical mucus and endometrium
- Standard regime - 21 days with a hormone free week
2
Q
Types of combined hormonal contraception.
A
- Pill - taken daily, not good if frequent GI upset
- Patch EVRA TM - changed weekly - < 5% have skin reaction
- 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
3
Q
Non-contraceptive benefits of combined methods.
A
- Regulate/reduce bleeding- help heavy or painful natural periods
- Stop ovulation- may help premenstrual syndrome
- Improve acne / hirsutism
- Reduction in functional ovarian cysts
- 50% reduction in ovarian and endometrial cancer
- Reduction in benign breast disease, rheumatoid arthritis, colon cancer and osteoporosis
4
Q
Side effects of combined hormonal methods.
A
- Breast tenderness
- Nausea
- Headache
- Irregular bleeding first 3 months
5
Q
Serious Risks associated with Combined hormonal contraceptive use
A
- Increased risk venous thrombosis - DVT, PE
- Increased risk arterial thrombosis - MI / ischaemic stroke
- Increased risk cervical cancer- data predates HPV vaccine
- Increased risk breast cancer- back to normal after 10 years off Rx
- NB family history of breast cancer not a contraindication (unless BRCA positive)
6
Q
Contraindications for combined hormonal contraceptive use.
A
- Increased risk venous thrombosis - DVT, PE
- avoid if BMI >34
- previous VTE (venous thrombotic events)
- 1st degree relative VTE under 45
- thrombophilis eg systemic lupus erythematosus, reduced mobility
- Increased risk arterial thrombosis - MI / ischaemic stroke
- Avoid in smokers >35
- age>50
- personal history arterial thrombosis
- focal migraine
- hypertension >140/90
- avoid if active gall bladder disease or previous liver tumour
7
Q
Progestogen-only pill (POP) ‘mini-pill’
A
- Take at the same time every day without a pill-free interval
- Not good choice if frequent GI upset
8
Q
Progestogen-only pill contraindications
A
- Oestrogen free - so very few contraindications
- Personal Hx Breast cancer / liver tumour
9
Q
Progestogenic side effects
A
- Appetite increase
- Hair loss/gain
- Mood change
- Bloating or fluid retention
- Headache
- Acne
- No increased risk of venous or arterial thrombosis with contraceptive dose progestogens
10
Q
How does injectable progesterone work?
A
1 - prevents ovulation
2 - It alters cervical mucus making it hostile to sperm
3 - Makes endometrium unsuitable for implantation
11
Q
Injectable progesterone regime
A
- injection every 12 weeks
- 70% women amenorrhoeic after 3 doses
- oestrogen-free so few contraindications
12
Q
Side effects of progesterone injection
A
- Delay in return to fertility - average 9 months
- Reversible reduction in bone density- discuss her other risks for osteoporosis
- Weight gain - 2/3 women gain 2-3 kg
- Problematic bleeding especially first 2 doses
13
Q
Progestogen implant
A
- 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
14
Q
Progestogen implant side effects
A
- 60% are almost bleed free but 30% have prolonged / frequent bleeding
- May cause mood change more often than other progestogen only methods
15
Q
Copper IUD usual mode of action
A
- Toxic to sperm -stops sperm reaching egg, may sometimes prevent implantation of fertilised egg
- Hormone free
- May make periods heavier/crampier
- Can last 5-10 years depending on type
16
Q
Levonorgestrel IUS
A
- Slow release progestogen on stem
- Low circulating progestogen levels compared with pill/implant/injection
- Affects cervical mucus and endometrium, most women still ovulate
- Stops fertilisation of egg -may prevent implantation of fertilised egg
- Reduce menstrual bleeding after up to 4 months of irregular bleeding initially
17
Q
Emergency contraception
A
- Copper IUD
- Levonelle
- Ellaone
18
Q
When to start contraception?
A
- can start in first 5 days of cycle -immediate cover
- can start other times cycle if no risk of pregnancy -need condoms / abstain for next 7 days and do pregnancy test after 4 weeks
19
Q
How quickly can a women become pregnant after previous pregnancy?
A
- Can get pregnant from sex 21 days after delivery, 5 days after miscarriage or abortion
- Breast feeding is contraceptive only for first 6 months, if feeding every 4 hours, and amenorrhoeic
20
Q
Female Sterilisation
A
- Laparoscopic Sterilisation
- Usually Filshie clips applied across tube to block tube lumen
- May do salpingectomy at planned caesarean section if baby seems well and discussed in advance
21
Q
Female sterilisation risks
A
- Risks of GA and laparoscopy
- Irreversible
- Failure rate 1 in 200 lifetime risk - could be ectopic
- No effect on periods / hormones
- Reduces ovarian cancer risk (Even more reduction if salpingectomy but more complex surgery)
22
Q
Vasectomy
A
- Vas deferens divided and ends cauterised, small incision midline scrotum
- Local anaesthetic - most done in primary care
- Takes 4-5 months to be effective - 2 sperm samples sent in by post after 4 and 5 months
- Failure rates - 2 in 100 do not get clear samples
23
Q
Vasectomy risks and benefits
A
- Failure rate after x 2 clear samples 1 in 2000 lifetime
- Irreversibility - Anti-sperm antibodies even if vas reconnected
- < 1:100 risk long term testicular pain
- No effects on testosterone or sexual function
24
Q
Copper IUD as emergency contraception
A
- Copper IUD most effective option - must be fit before implantation ie within 120 hrs of UPSI or by day 19 of 28 day cycle
- If 100 women use emergency IUD there will be < 1 pregnancy
- Can keep IUD long term if they like the method
25
Q
Levonelle
A
- Levonorgestrel pill - take within 72 hrs
- If 100 women use there will be 2-3 pregnancies
26
Q
Ellaone
A
- Ulipristal pill - take within 120 hrs
- If 100 women use will be 1-2 pregnancies
- More contraindications eg breast feeding/enzyme inducing drugs/ acid reducing drugs
27
Q
Clinic consultation for abortion
A
- Scan for gestation and viability
- Medical history- risk VTE/bleeding/ from GA/contraceptive eligibility
- Circumstances - reasons for considering abortion- see alone, use language line, check no coercion or gender based violence
- Contraception for afterwards
28
Q
Tests carried out before abortion
A
- FBC/Rhesus Group
- Vaginal swab for Chlamydia and gonorrhoea
- STI bloods offered
29
Q
Surgical termination of pregnancy (STOP)
A
- Procedure -5-12 weeks
- Cervical priming- misoprostol 3 hrs preop helps dilation and reduces risk perforation/ haemorrhage
- GA or LA cervical block
- Transcervical - 6-10mm suction catheter
30
Q
STOP complications
A
- 1-4 :1000 perforation
- < 1:100 cervical injury
- infection
- risks from GA
31
Q
Medical termination of pregnancy (MTOP)
A
- Mifepristone oral antiprogestogen tablet
- 36-48 hours later Misoprostol initiates uterine contraction which opens cervix and expels pregnancy
- Average 4-6 hours to pass pregnancy under 12 weeks
- Mifepristone helps Misoprostol work better
32
Q
MTOP complications
A
- Failure 1 in 100 <8 weeks, 8 in 100 >12 weeks need surgery for incomplete abortion
- Infection – test and prophylactic antibiotics
- < 1 in 1000 need blood transfusion
