Contraception Flashcards
What is meant by a ‘99%’ effectiveness with regards to contraception?
That an average person using this method of contraception properly with a regular partner for a single year would only have a 1% change of getting pregnant
What is UKMEC used for?
Outline the 4 levels of UKMEC
To assess the safety of different contraceptive methods based on individuals
UKMEC1 = no restriction in use UKMEC2 = advantages > disadvantages UKMEC3 = disadvantages > advantages UKMEC4 = unacceptable risk, contraindicated
What is the effectiveness of the COCP if taken properly?
> 99%
What is the main mechanism of action of the COCP as contraception?
State two other actions
Prevents ovulation
Thickens cervical mucus
Thins endometrium
What are the different ways to take the the COCP (different types)? (3)
Describe each one
Monophasic - identical pills taken every day for 21 days followed by 7 day gap
Phasic - one pill taken every day for 21 days followed by 7 day gap, but pills contain varying amounts of hormones (need to be taken in correct order)
Every day - pill taken everyday, 7 are inactive placebo pills
What are common side effects of the COCP?
Breakthrough bleeding/spotting Breast tenderness Headaches/migraines Changes in libido Acne
What are some risks associated with COCP use?
Stroke
DVT
HTN
Increased risk of breast cancer
What effect does COCP use have on cancer risk?
Increased risk - breast cancer
Reduced risk - endometrial, ovarian and colon cancer
What are some UKMEC 4 contraindications for COCP use?
Over 35 + smoker Pregnancy Previous thrombosis Previous stroke/heart disease Uncontrolled HTN FH thrombosis Migraine with aura Breast cancer
When should the COCP be started to offer immediate protection?
First day of the cycle (first day of menstrual period)
What is the missed pill rule for ONE missed pill?
Take missed pill as soon as possible, no extra protection required
If you start the COCP not on the first day of the cycle, what precautions should be taken?
Barrier contraception for 7 days
How should switching of combined pill types be done?
Once 21 days of first pill is over, start 21 days of new pill immediately
Name two types of COCP
Microgynon
Yasmine
How is the POP taken differently to the COCP?
POP is taken continuously
COCP is taken cyclically
How does the POP work as contraception? (2)
Thickens cervical mucus
Prevents ovulation
What is the effectiveness of the POP if taken perfectly?
> 99%
What time of the day should traditional POP be taken?
Within the same 6 hour window every day (3 hours +/- the same time from day before)
Name two types of POP
Norethisterone (traditional)
Levonorgestrel (traditional)
Desogestrel (new gen, 24 hr window)
What are some side effects of the POP?
Irregular bleeding Amenorrhoea Breast tenderness Headaches Change in libido Acne
What are the two types of IUD?
What is their effectiveness if inserted properly?
Copper coil
Mirena coil
> 99%
What is the mechanism of action of the copper coil?
When is it effective after insertion?
Reduces sperm motility and survival
Effective immediately
What is an alternative use for the copper coil other than traditional contraception?
Emergency contraception - inserted up to 5 days after unprotected intercourse
What are some of the side effects/complications associated with copper IUD?
Menorrhagia/IMB (improves over time)
Uterine perforation/PID on insertion
Increased risk of ectopic pregnancies
What is the mechanism of action of the Mirena coil?
Releases levonorgestrel (progestogen) to thicken the cervical mucus and reduce endometrial thickening
How can the Mirena coil affect bleeding?
Can make periods lighter or stop altogether
Can cause irregular bleeding
What are the side effects associated with the Mirena coil?
Spotting/irregular bleeding
PID/uterine perforation (more rare)
Increased risk of ectopic pregnancies
What is the alternative use of the Mirena coil other than for traditional contraception?
First line treatment for menorrhagia (where pregnancy not desired)
What does the Depo-provera injection contain?
How often is it taken?
Medroxyprogesterone acetate (progestogen)
3 monthly IM injection
How effective is a regular 3 monthly Depo provera injection as contraception?
> 99%
What is the mechanism of action of the Depo provera injection? (2)
Prevents ovulation
Thickens cervical mucus
How long can it take for fertility to return in women who take the Depo provera injection as contraception?
12 months
When should the Depo provera injection be given to provide immediate contraception?
What precaution should be taken if started at any other time?
First day of cycle (menstrual period)
7 day barrier contraception
What side effects are associated with the Depo provera injection?
Amenorrhoea Irregular bleeding WEIGHT GAIN Acne OSTEOPOROSIS
Which contraceptive method is the only one to have a proven association with weight gain?
Depo provera injection
What is the name of the implant used as contraception in the UK?
Which hormone does it release?
NEXPLANON
Progesterone
How long is the progesterone implant effective for?
3 years
What is the mechanism of the progesterone implant?
Same as POP
- Inhibits ovulation
- Thins endometrium
- Thickens cervical mucus
What side effects are associated with progesterone implant use?
Minor operation required to insert/remove
Acne
Bleeding changes
Reduced libido
For how long after giving birth, do all women not require contraception?
21 days after giving birth, no contraception required
What contraception is considered safe in breastfeeding? When can it be started?
POP
Any time
Can the COCP be used whilst breastfeeding?
Should be avoided
UKMEC4 before 6 weeks
UKMEC2 after 6 weeks
Is lactational amenorrhoea (full breastfeeding + no periods) effective as contraception? For how long?
98% effective as contraception for 6 months
What contraceptives are contraindicated if mother is not breastfeeding?
Any contraceptive is fine
What are three types of emergency contraception?
Levonorgestrel - POP
Ulipristal - progesterone receptor modulator
Copper IUD
How is female sterilisation performed?
Laparoscopically under GA
Blockage, tying, cutting or removal of Fallopian tubes
How is male sterilisation performed?
Vasectomy, quick procedure under LA
Cutting and tying of vas deferens to prevent sperm reaching semen
