Contraception Flashcards
- List the common methods of contraception and describe the mechanism of action of each
- Describe the side-effects associated with the common methods of contraception
- Describe the methods of male and female sterilisation along with their indications and failure rates
- To be aware of the issues involved during counselling of a couple prior to sterilisation
- Describe the Abortion Act + the common medical and surgical methods of termination of pregnancy
.
List the 3 combined hormonal methods of contraception (all contain ethinyl estradiol (EE) and synthetic progesterone (progestogen)); just in different forms of use)
Combined pill
Patch
Vaginal ring
List the 4 progestogen only methods of contraception
Progestogen-only pill (mini pill)
Implant
Injection
IUS (intra-uterine system)
Name the long term non-hormonal contraceptive that females use
Copper IUD
Mechanism of action of combined hormonal contraceptives (ethinyl estradiol (EE) and synthetic progesterone (progestogen))
Stop ovulation (due to the negative feedback effect of the oestrogen and progesterone) AND thicken cervical mucus on the cervix to slow the sperm
Non-contraceptive benefits of combined hormonal contraceptives
Regulate/reduce bleeding
Reduces functional ovarian cysts and risk of ovarian or endometrial cancer
Improve acne/hirsutism (excessive hair growth)
Side effects of combined hormonal contraceptives (pill/patch/ring)
Breast tenderness
Nausea
Headache
Irregular bleeding first 3 months
Serious risks with use of combined hormonal contraceptives (pill/patch/ring)
Increased risk of
- DVT
- arterial thrombosis –> MI/stroke
- cervical/breast cancer
Contra-indications of combined hormonal contraceptives
BMI >35
Breast feeding
Smoking >35
Hypertension
History of or family history of venous thromboembolisms
Prolonged immobility due to surgery or disability
History of migraines with aura
Mechanism of action of progestogen-only contraceptives (pill/implant/injection/IUS)
Inhibit ovulation AND thicken cervical mucus to prevent passage of sperm
Side effects of progestogen-only contraceptives (pill/implant/injection/IUS)
Irregular cycles Appetite increase Hair loss/gain Mood change Headache Acne
Contra-indications of progestogen-only contraceptives (pill/implant/injection/IUS)
Current or past history of breast cancer
Liver cirrhosis or tumours
Disadvantages of injectable progestogen
Not rapidly reversible – can take up to a year to return to normal fertility
Loss of bone mineral density with long term use
Increase in body weight, up to 2-3kg over a year
Altered bleeding patterns
(the only contraceptive with a causal effect on weight gain, delayed return of fertility and bone density)
Which progestogen only method has the best success rates
Implant
What non-hormonal contraceptives are there (4)
Male condoms
Female condoms
Diaphragm
IUD
Mechanism of action of IUDs
Releases copper which is toxic to sperm and may induce a sterile inflammatory response within the uterus that makes implantation impossible
Side effects of IUDs
Small risk of infection after fitted in
Small risk of expulsion of the IUD
Heavier bleeding during first few weeks
Mechanism of action of the IUS
Same as the progestogen only methods
-thins the endometrium (preventing implantation) and thickens cervical mucus
What are the 3 options of emergency contraceptives
IUD - most effective
Levonorgestrel (Levonelle)*
Ulipristal acetate (EllaOne)*
*morning after pill
When should you ideally start combined hormonal contraceptives if you want immediate cover from pregnancy without needing additional contraception
Within first 5 days, ideally first day
But if you have a short cycle like 23 days then you should also use condoms within the first week to be safe
Describe the procedure for female sterilisation
Permanently preventing pregnancy by blocking/sealing the fallopian tubes to by prevent eggs travelling down the fallopian tubes to meet sperm coming up from the cervix
Indications for female/male sterilisation
If you do not want any more children or do not want children at all
Females should only be considered if their male partner are unable or unwilling or does not have a permanent partner
Describe the procedure for male sterilisation
Vasectomy (cutting and sealing or tying the vas deferens which carries sperm from the testes to the penis)
Failure rates of
- female sterilisation
- male sterilisation
1 in 200
1 in 2000
What issues should you be aware of during counselling of a couple prior to sterilisation
If they definitely are done with children
Other forms of long-acting contraception
Permanent and reversal is not routinely funded
Describe the basis of the abortion act 1967
A person shall not be guilty of an offence under the law relating to abortion when a pregnancy is terminated by a registered medical practitioner if two registered medical practitioners are of the opinion, formed in good faith
Criteria for abortion under abortion act 1967
That the pregnancy has not exceeded its 24th week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family
OR
That the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
OR
That the continuance of the pregnancy would involve risk to the life of the pregnant woman, greater than if the pregnancy were terminated (acceptable past 24 weeks)
OR
That there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped (acceptable past 24 weeks)
Medical abortion
Mifepristone (inhibits progesterone) first then misoprostol (induces uterine contraction to expel pregnancy) 24-48 hrs later
Will happen within 4-6 hrs of taking misoprostol
Surgical abortion
Vacuum or suction aspiration (up to 15 wks gestation)
Dilation & evacuation (beyond 15 wks)
-forceps to remove it
