Contraception Flashcards
What is the pearl index?
The number of contraceptive failures per 100 women years of exposure from the initiation of the product to the end of the study
What is method failure with regards to contraception?
Pregnancy despite the correct use of method by the user
What is user failure with regard to contraception?
Pregnancy because the method was not used correctly by the user
Why does long acting reversible contraception minimise user failure rates?
It minimises user input and therefore minimises failure rate
On which days of the menstrual cycle are pregnancy most likely?
Days 8-19
Name the three types of combined hormonal contraception
Pill
Patch (EVRA)
Vaginal ring (Nuvaring)
Which hormones are in the combined hormonal contraception
Ethinyl estradiol and synthetic progesterone
How are the different types of combined hormone contraception taken and what are the contraindications?
Pill - taken daily (not good if frequent GI upset)
Patch - changed weekly (<5% skin reaction)
Ring - changed every 3 weeks
What are the non-contraceptive benefits of the combined hormone methods?
- Regulates/reduces bleeding (helps heavy/painful bleeding)
- Stops ovulation (helps premenstrual syndrome)
- Reduction in functional ovarian cysts
- 50% reduction in ovarian and endometrial cancer
- Improves acne/hirsutism
- Reduction in benign breast disease, rheumatoid arthritis, colon cancer and osteoporosis
What are the side effects of the combined hormone contraceptive?
Breast tenderness, nausea, headache, irregular bleeding in the 1st 3 months, mood changes and weight gain
What are the serious risks of combined hormonal contraception use?
Increased risk of venous thrombosis (DVT/PE), increased risk of arterial thrombosis (MI/ischaemic stroke), increased risk of cervical cancer and increased risk of breast cancer
What are the types of progesteron only (mini) pill and what are the contraindications?
- Desogestrel: 2hr window
- LNG NET: 3hr window (affect on periods varies)
- Contraindications: personal history of breast or liver cancer
What are the side effects of progesterone only pills?
Appetite increase, hair loss/gain, mood change, bloating/fluid retention, headache and acne
How does the depo injection work?
- IM injection into the buttocks every 13 weeks
- Prevents ovulation, alters cervical mucus making it hostile to sperm and makes the endometrium unsuitable for implantation
What are the disadvantages to the depo injection
Delay in return to fertility, reversible reduction in bone density, problematic bleeding (esp. 1st 2 doses) and weight gain
How does the subdermal progestogen implant (rod) work?
Inhibition of ovulation and effects cervical mucus - works for up to 3yrs
What are the disadvantages of the implant?
30% have prolonged, frequent bleeding and it can cause mood change
How does the copper IUD work?
- Toxic to sperm and may prevent implantation of the fertilised egg
- Hormone free
How does the levonorgestrel IUS work?
- Affects cervical mucus and endometrium (most women still ovulate)
- Stops fertilisation of egg
- Slow release progestogen
What are the options for emergency contraception?
- Copper IUD (within 120hrs or by day 19)
- Levonorgestrel/levonelle (within 72hrs)
- Ulipristal/ellaone (within 120hrs)
What are the contraindications of the ellaone pill?
Breast feeding, enzyme inducing drugs and acid reducing drugs
What effect does pregnancy/ termination/ miscarriage/ breastfeeding have on the chances of becoming pregnant
- Pregnancy: can become pregnant 21 days after pregnancy
- Miscarriage/termination: can become pregnant 5 days after
- Breast feeding: only contraceptive for six months, if feeding every four hours and only if amenorrhoeic
Name the two medicines used for a medical termination of pregnancy
Mifepristone (antiprogestogen) and misoprostol (uterine contraction)
