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Contraception Flashcards

1
Q

What would make the ideal contraceptive?

A

100% reversible - all except sterilisation.
100% effective - None
100% unrelated to intercourse - all except condoms
110% free of adverse side effects- None
100% protective against STIs - None
Non-contraceptive benefits - Combined pill and IUS
Low maintenance, no ongoing medical input - Implant or IUT
Male and female options - only condoms/vasectomy for men.

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2
Q

What is the Pearl index?

A

The number of contraceptive failures per 100 women years of exposure. It looks at the total months or cycles of exposure from the initiation of the product to the end of the study.

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3
Q

What is life table analysis?

A

Provides the contraceptive failure rate over a specified time-frame and can provide a cumulative failure rate for any specific length of exposure.

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4
Q

What is a method failure?

A

Pregnancy despite correct use of method by user.

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5
Q

What is a user failure?

A

Pregnancy because method not used correctly by the user.

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6
Q

What can minimise user failure rates?

A

Long-Acting Reversible Contraception (LARC) minimises user input so subsequently minimises user failure rates.

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7
Q

When can sex cause pregnancy?

A

Likely to ovulate day 12-18 of cycle.
Egg survives 24hours
Most sperm survive less than 4 days

So highest chance of pregnancy is between day 8-19.

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8
Q

What are some characteristics of Combined Hormonal Contraception?

A

Can come in pill, patch or vaginal ring form.
Combination of 2 hormones - ethinyl estradiol and synthetic progesterone.
Stops ovulation and also effects cervical mucus and endometrium.
Standard regime is 21 days with a hormone free week.

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9
Q

How long does the CHC pill, patch and ring last respectively?

A

Pill taken daily
Patch changed weekly
Ring changed every 3 weeks (can take it out for 3/24hrs).

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10
Q

What are some non-contraceptive benefits of combined hormonal contraception?

A

Regulate and reduce heavy bleeding.
Stop ovulation - may help premenstrual syndrome.
Reduction in functional ovarian cysts.
50% reduction in ovarian and endometrial cancer.
Improve acne and hirsutism.
Reduction in benign breast disease, rhematoid arthritis, colon cancer and osteoporosis.

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11
Q

What are some side effects of Combined Hormonal Contraception?

A 
Breast tenderness
Nausea
Headache
Irregular bleeding for first 3 months. 
Mood?
Weight gain?
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12
Q

What are some serious risks associated with CHC use?

A

Increased risk of venous thrombosis - DVT, PE. Avoid if BMI > 34, previous Hx, 1st degree relative Hx under 45, thrombophilis.

Increased risk of arterial thrombosis - MI, ischaemic stroke. Avoid in smokers >35yrs, personal Hx arterial thrombosis, focal migraine, age >50, hypertension > 140/90.

Avoid if active gallbladder disease or previous liver tumour.

Increased risk of cervical cancer - data predates HPV vaccine.

Increased risk of breast cancer - back to normal after 10yrs off CHC.

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13
Q

What are some characteristics of the Progestogen-only pill (POP) ‘mini pill’?

A

Take at same time each day without a pill free interval.
Desogestrel pill - 12hr window period. Nearly all cycles are anovulant and it also affects cervical mucus.

Traditional LNG NET pills - 3hr window period, 1/3 anovulant, 2/3 rely on cervical mucus effect. 1/3 bleed free, 1/3 irregular, 1/3 regular periods.

Oestrogen free so very few contraindications.

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14
Q

What are some Progestogenic side effects?

A 
Appetite increase
Hair loss/gain
Mood change
Bloating or fluid retention
Headache
Ance
Avoid if current breast cancer or liver tumour past/present.
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15
Q

What are some characteristics of the injectable progestogen?

A

Aqueous solution of the progestogen depomedroxyprogesterone acetate Depoprovera.
150mg 1ml deep intramuscular injection not the upper outer quadrant of the buttock every 13 weeks.
Newer 0.6ml subcutaneous version for self administration, Sayana press.

Prevents ovulation
Alters cervical mucus making it hostile to sperm
Makes endometrium unsuitable for implantation.
Oestrogen free so few contraindications.

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16
Q

How long does the injectable progestogen last?

A

Needs updated 12 weeks.

70% women amenorrheic after 3 doses.

17
Q

What are some side effects to the injectable progestogen?

A

Delay in return to fertility - av. 9 months.
Reversible reduction in bone density .
Problematic bleeding especially first 2 doses.
Weight gain - 2/3 women gain 2-3kgs.

18
Q

What is the implant?

A

Small plastic rod measuring 4cm in length and 2mm cross sectional diameter. It contains 68mg of progestogen etonogestrel dispersed in a matrix of ethinylvinylacetate (EVA). The rod is also covered in a rate controlling membrane made from EVA.

19
Q

What are some characteristics of the implant?

A

Inhibition of ovulation and effect on cervical mucus.
Can last 3 years or be removed at any time.
No user input needed.
No causal effect on weight.

20
Q

What are some side effects of the implant?

A

60% are almost bleed free but 30% have prolonged, frequent bleeding.
May cause mood change more often than other progesterone only methods.

21
Q

What are some characteristics of intrauterine contraception?

A

Little user input after fitting - neither woman or partner should be aware of the device.
Can be fitted at any age or parity.
Effects/side effects are immediately reversed when removed.
Small infection risk within first 3 weeks - offer STI testing.
Fitting takes 10minutes - usually done by GP or at SH clinic.
If conceives then may be ectopic but method is so effective that ectopic risk is lower than that for condoms.

22
Q

How do Copper IUDs work and how long do they last?

A

Copper is toxic to sperm so prevents them from reaching egg and can sometimes prevent implantation of fertilised egg.
Hormone free
Can last 5-10years depending on type.
May make periods heavier/crampier.

23
Q

How do levonorgestrel IUS work and how long do they last for?

A

Affect cervical mucus and endometrium, most women still ovulate.
Stop fertilisation of the egg and may stop implantation.
Slow release progestogen on stem.
Lower levels of circulating progestogen compared with pill/implant/injection.
Reduce menstrual bleeding after up to 4months.
3years Jaydess and 5 years Mirena and Kyleena.

24
Q

What are some examples of emergency contraception?

A

Copper IUD (most effective)
Levonogestrel pill “levenelle”
Ulipristal pill “ellaone”

25
Q

When must the Copper IUD be fitted to work as an emergency contraception?

A

Fit within 120hrs or by day 19 of 28 day cycle.

26
Q

When must the Levonorgestrel pill be taken to work as emergency contraception?

A

Within 72hrs

27
Q

When must the Ulipristal pill be taken to work as emergency contraception?

A

Within 120hrs

28
Q

When should contraception be started?

A

Start in the first 5 days of cycle for immediate cover.
If outwith first 5 days then need to use condoms/abstain for next 7 days and do preg. test after 4 weeks.

Breast feeding is contraceptive only for first 6 months if feeding every 4 hrs and amenorrhoeic.

29
Q

How long after one pregnancy can you become pregnant again?

A

Can become pregnant from sex 21 days after delivery and 5 days after miscarriage or abortion.

30
Q

What are some barrier methods of contraception?

A

Male and female condoms

Diaphragm.

31
Q

What is female sterilisation?

A

Surgery to permanently prevent pregnancy. Usually Filshie clips applied across Fallopian tubes to block lumen. Irreversible. No affect on period or hormones.
Reduces ovarian cancer risk.

32
Q

What is vasectomy?

A

Vas deferens is divided and end cauterised with a small incision in the midline of the scrotum.
Can be performed under local anaesthetic.
Takes 4-5months to be effective.
Irreversible - anti-sperm antibodies even if vas deferens is reconnected.
No effects on testosterone or sexual function.
No increased risk of testicular or prostate cancer.

33
Q

What are a clinician’s rights and responsibilities regarding abortion?

A

Medical staff have the right to refuse participation in abortion because they have a conscientious objection to the procedure. This is enshrined in the 1967 abortion act.

They are obligated to ensure that the woman is still able to access abortion care.

They have the right to refuse participation as long as this does not affect any duty to participate in treatment which is necessary to save the life of or prevent grave permanent injury to the physical/ mental health of pregnant woman.

34
Q

What is involved in the process of surgical abortion?

A

Cervical priming using misoprostol 3hrs preop (helps dilation and reduces risk of haemorrhage and perforation).
General or local anaesthetic cervical block.
Transcervical 6-10mm suction catheter.

35
Q

What is involved in the process of medical abortion?

A

Mifepristone oral antiprogestogen tablet.
36-48hrs later Misoprostol initiates uterine contraction which opens cervix and expels pregnancy.
Av. 4-6hrs to pass pregnancy under 12 weeks.
Mifepristone helps Misoprostol work better.

36
Q

What are the long term effects of Abortion?

A

No effect on the future fertility or pregnancy or delivery.
No effect on cancer risks.
Emotional effects depends on individual, pre-existing mental health and reasons for aborting.

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