Contraception Flashcards
List some forms of combined hormonal contraception?
Pills
Patch
Vaginal Ring
List some progestogen only methods of contraception?
Pill
Injectable
Implant
What are the features of an ideal contraceptive?
- Reversible
- 100% effective
- Unrelated to intercourse
- Free of adverse side effects
- 100% Protective against STIs
- Non-contraceptive benefits
- Low maintenance, no ongoing medical input
- Male and female options
What is the term for the number of contraceptive failures per 100 women-years of exposure?
The pearl index
What is the advantage of Long-Acting Reversible Contraception?
Minimises user input - minimises user failure rates
In what days of the cycle does ovulation normally take place?
Day 12-18
What days are the highest chance of pregnancy?
Day 8-19
What two hormones are used in combined hormonal contraception?
Ethinyl estradiol (EE) Synthetic progesterone (prostestogen)
What do combined hormonal contraceptions do to the ovulation cycle?
Stop ovulation through negative feedback
Affects cervical mucus and endometrium
What are some non-contraceptive benefits of combined hormonal contraceptions?
- Regulate/reduce bleeding
- Stop ovulation
- Reduction in functional ovarian cysts
- 50% reduction in ovarian and endometrial cancer
- Improve acne/hirsutism
- Reduction in benign breast disease, RA, colon cancer and osteoporosis
List some side effects of combined hormonal contraceptions?
Breast tenderness
Nausea
Headache
Irregular bleeding first 3 months
Serious effects
- DVT/PE Risk
- Arterial thrombosis risk/MI/Stroke
- Avoid in active gallbladder disease
- Increased risk of cervical/breast cancer
List side effects to progesterone contraceptions?
- Appetite increase
- Hair loss/gain
- Mood change
- Bloating/fluid retention
- Headache
- Acne
What type of contraception has a causal effect on weight gain, delayed return of fertility and bone density?
Injectable progestogen
How does injectable progesterone affect chances of fertilisation?
- Prevents ovulation
- Alters cervical mucus making it hostile to sperm
- Makes endometrium unsuitable for implantation
What is the mode of action of the copper IUD?
Toxic to sperm - stop sperm reaching egg, sometimes prevent implantation of fertilised egg
What are the three types of emergency contraception?
- Copper IUD - most effective
- Levonorgestrel pill - ‘Levonelle’
- Ulipristal pill - ‘Ellaone’
What is the usual method of female sterilisation?
Laparoscopic - filshie clips applied across tube to block tube lumen
(Can also do salpingectomy at planned cesarean if discussed in advance)
What are potential downsides to female sterilisation?
- Risks of GA and laparoscopy
- Irreversible - risks regret
- Failure rate - 1 in 200 lifetime risk - could be ectopic
What is involved in a vasectomy?
Vas deferens divided and ends cauterised - small incision midline scrotum
What are potential downsides to male sterilisation?
- 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
What fraction of UK women will have an abortion in their lifetime?
1/3
What is involved in a consultation for termination?
- Scan for gestation and viability
- Medical history
- Circumstances - reasons for seeking abortion (check no coercion)
- Discuss methods of abortion, what to expect
- Contraception for afterwards
- FBC/Rhesus Groups
- Vaginal swabs/Bloods for STIs offered
What is involved in surgical termination of pregnancy?
- Cervical priming (misoprostol) 3 hrs preop
- GA/LA cervical block
- Transcervical suction catheter
Complications - perforation/risks from GA
What is involved in medical termination of pregnancy?
- Mifepristone (antiprogesterone tablet)
- 36-48hr later Misoprostol initiates uterine contraction
Complications - may need surgery if incomplete abortion
Infection
<1/1000 need blood transfusion
What is the standard regime for combined hormonal contraception?
21 days, with a hormone free week
How often does the combined hormonal contraception patch need changed?
Weekly
What are some side effects of injectable progesterone?
- Delayed return to fertility
- Reversible reduction in bone density
- Problematic bleeding
- Weight gain
What are some side effects of progestogen implant?
- Most are almost bleed free, but some have prolonged/frequent bleeding
- May cause mood change more often
How long can the progestogen implant last?
3 years
How long can intrauterine contraception ‘Coils’ be used?
5-10 years
What are some side effects to intrauterine contraception?
- Very small infection risk
- Small perforation risk
- Expulsion risk (Threads should be checked after each period
- May increase risk of ectopic pregnancy if conception does occur
- May make periods heavier/crampier
What is the right of the clinician in termination of pregnancy?
To refuse participation - conscientious objection.
However, they are obligated to ensure the woman is still able to access abortion care
When is termination of pregnancy legal?
- Continuing pregnancy has grave risk to life of pregnant woman
- Termination is necessary to prevent permanent injury to physical/mental health of pregnant woman
- <24 weeks and continuing pregnancy involves greater risk to physical/mental health of pregnant woman/existing children
- Substantial risk of physical or mental abnormalities
What two medications are used in the medical termination of pregnancy?
Mifepristone
Misoprostol
What medication can be given for self administration if a home abortion?
Misoprostol
(Mifepristone still needs to be taken in clinic/hospital).
List some barrier methods of contraception
Male condoms
Female condoms
Diaphragm/cap
