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Reproductive System > Contraception > Flashcards

Contraception Flashcards

1
Q

What are the most common forms of contraception?

A

Of women using contraception:

  • 25% Combined OCP
  • 28% sterilised
  • Implants only make 3% and coil 6%
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2
Q

How do we determine the effectiveness of a contraceptive method?

A

Life Table Analysis or Pearl Index

Pearl index: % of women using a the method who get pregnant anyway.

Life table analysis: contraceptive failure rate over a specific period of time.

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3
Q

Whats in the Combined OCP?

A

Ethinyl Oestradial (EE) and Synthetic Progesterone (Progestogen)

3rd gen pills contain Gestogene (GSD) and Desogestrel (DSG)

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4
Q

Dose for cOCP?

A

20-35microgram but 50 if on liver enzyme inducers

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5
Q

How often is the cOCP taken?

A

Every day for 21 days then 7 days off (takes 7 days to become effective when you start it)

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6
Q

How does the cOCP work?

A

Prevents the FSH/LH surge by -ve feedback on the GnRH produced by hypothalamus –> stops ovulation

Also prevents implantation by providing an inadeqaute endometrium. Alters cervical mucous to Inhibit sperm penetration.

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7
Q

What are the non contraceptive benefits of the cOCP?

A
  • Regulate/reduce bleeding - help heavy or painful natural periods
  • Stop ovulation- may help premenstrual syndrome
  • Reduction in functional ovarian cysts
  • 50% reduction in ovarian and endometrial cancer
  • Improve acne / hirsutism
  • Reduction in benign breast disease, rheumatoid arthritis, colon cancer and osteoporosis
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8
Q

What are the major risks of cOCP?

A
  • Increased risk of VTE (DVT, PE)
  • Increased risk of Ischaemic stroke
  • Risk of breast and cervical cancer
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9
Q

The cOCP is often blamed for VTEs, how risky is it really?

A

The pill triples risk from 5 to 15 per 100,000

However thats still less likely than being in an RTA and 1/4 of the risk of a VTE were you to get pregnant

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10
Q

What groups might we actually worry about VTEs in if we give them the cOCP?

A
  • BMI >34
  • Previous VTE
  • 1st degree relative VTE under 45
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11
Q

How does Depoprovera work (injectable progestogen ‘the jag’)?

A
  • Prevents Ovulation by -ve feedback
  • Alters cervical mucous preventing sperm penetration
  • Renders endometrium unsuitable, preventing implantation
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12
Q

What is the medical term for the coil?

A

Long Acting Reversible Contraception (LARC)

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13
Q

What are the best forms of Emergency Contraception?

A

CU-IUD (copper coil)

Levonorgestrel pill/ Levonelle

Ulipristal pill ‘Ellaone’

All less effective than ongoing contraception

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14
Q

How long after sex can you use emergency contraception?

A

Copper coil up to 5 days (120hrs) post sex or by day 19 of 28day cycle

Levonorgestrel within 72 hours

Ella One within 120 hours

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15
Q

What is the main form of female sterilisation?

A

Laparascopic tubal ligation with filshie clips (to block tube lumen)

May do salpingectomy at planned C section if baby seems well and discussed in advanced.

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16
Q

How is a vasectomy done?

A

Permanent division of vas deferens under local anaesthetic

Then they have to come back for semen analysis before they start having unprotected sex (take 4-5 months)

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17
Q

Can you get pain from vasectomy? Testicular cancer?

A

Can get pain due to a sperm granuloma (degenerating spermatozoa surrounded by macrophages)

No risk of testicular or prostate cancer

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18
Q

Is vasectomy reversible?

A

Low success rate for reversals

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19
Q

When is a termination best performed?

A

<9wks as it reduces complications if its early

20
Q

AT what point do we stop doing terminations?

A

20wks. then we refer to england who do it till 24wks

21
Q

Why would you terminate a pregnancy?

A

IF the continuation of it would cause greater physical/mental harm to the women or existing children than terminating

  • Maternal health
  • Social reasons
  • Fetal Anomaly
22
Q

What do we do during a clinic consultation on termination?

A
  • Scan for gestation and viability
  • Medical history
  • Risk VTE/bleeding/ from GA/ contraceptive eligibility
  • Circumstances – reasons for considering abortion
  • Language line - check no coercion or gender-based violence
  • Discuss methods of abortion
  • What to expect and when to seek medical advice
  • Contraception for afterwards
  • FBC/Rhesus Group
  • Vaginal swab for Chlamydia and gonorrhoea
  • STI bloods offered
  • Scan for gestation and viability
  • Medical history
    • Risk VTE/bleeding/ from GA/ contraceptive eligibility
  • Circumstances – reasons for considering abortion
  • Language line - check no coercion or gender-based violence
  • Discuss methods of abortion
  • What to expect and when to seek medical advice
  • Contraception for afterwards
  • FBC/Rhesus Group
  • Vaginal swab for Chlamydia and gonorrhoea
  • STI bloods offered
23
Q

Most terminations in Grampian are medical, how are they done?

A

Mifepristone (oral anti-progestogen tablet):

Swtiches off pregnancy hormones –> 48 hours later prostaglandins (Misoprostol) initiate uterine contraction –> opens cervix and expels pregnancy

24
Q

What are the risks of Medical TOP?

A
  • Haemorrhage
  • Uterine perforation
  • Cervical trauma
  • Failure
  • Infection
  • Retained products of conception (RPOC)
  • Damage to future fertility
  • Psychological problems
25
Q

Whats the alternative to the combined OCP?

A

Progestogen only pill (POP)

26
Q

How often do you have to take the POP?

A

Take the desogestrel pill every day within the same 12 hr window (traditional PoPs have only a 3hr window)

27
Q

How does the POP work?

A

Renders cervical mucus impenetrable to sperm

Also has some effect inhibititing ovulation

28
Q

Which days of the cycle are the highest risk of getting pregnant?

A

Day 8-19 20-30%

29
Q

How long are sperm and the egg most likely to survive?

A

Egg: 24h

Sperm: 4 DAYS

30
Q

How does the ring work?

A

Ring Nuvaring TM

  • Changed every 3 weeks
  • Can take out for 3 hrs in 24 so may prefer to take out for sex
  • Latex free
31
Q

What are potential side effects of combined hormonal therapy?

A
  • Breast tenderness
  • Nausea
  • Headache
  • Irregular bleeding first 3 months
  • Mood ? Causal or other life events
  • Weight gain - not causal
32
Q

What is the regime for POP?

A

Take at the same time every day without a pill-free interval

33
Q

Types of PoP pills?

A
  1. Desogestrel pill – 12 hour window period o
  • Nearly all cycles anovulant - also effect mucus.
  • Most bleed free.
  1. Traditional LNG NET pills
  • 3 hour window period
  • 1/3 anovulant
  • 2/3 rely on cervical mucus effect: 1/3 bleed free, 1/3 irregular, 1/3 regular periods
34
Q

Side effects for POP?

A
  • Appetite increase
  • Hair loss/gain
  • Mood change
  • Bloating or fluid retention
  • Headache
  • Acne
  • No increase risk of venous or arterial thrombosis
35
Q

When to avoid a POP?

A
  • No increased risk venous or arterial thrombosis with contraceptive dose progestogens
  • Still avoid if current breast cancer or liver tumour past/present
36
Q

What is injectable progesterone?

A

Aqueous solution of the progestogen depomedroxyprogesterone acetate DepoproveraTM

Every 13 weeks

37
Q

Benefits of injectable progesterone?

A
  • Only need to remember every 12 weeks
  • 70% women amenorrhoeic after 3 doses
  • Estrogen-free so few contraindications
38
Q

Side effects of injectable progesterone?

A
  • Delay in return to fertility – average 9 months
  • Reversible reduction in bone density- discuss her other risks for osteoporosis
  • Problematic bleeding especially first 2 doses
  • Weight gain 2/3 women gain 2-3 kg

This is the only contraceptive method with a causal effect on weight gain, delayed return of fertility and bone density

39
Q

What is the ROD?

A

Subdermal progesterone implant

  • Implanon is a small plastic rod measuring 4cm in length and 2mm in diameter
  • Contains 68mg of the progestogen etonogestrel dispersed in a matrix of ethinylvinylacetate (EVA).
40
Q

Benefits of the ROD?

A
  • Inhibition of ovulation + effect on cervical mucus
  • Can last 3 years- or be removed at any time
  • No user input needed
  • No causal effect on weight
41
Q

Side effects of the ROD?

A
  • 60% are almost bleed free but 30% have prolonged / frequent bleeding
  • May cause mood change more often than other progestogen only methods
42
Q

How does the copper coil work?

A
  • Affect cervical mucus and endometrium most women still ovulate
  • Stop fertilisation of egg - may prevent implantation fertilised egg
  • Slow release progestogen on stem
43
Q

What people should avoid combined hormonal contraception due to serious risk of arterial thrombosis (MI/stroke)?

A
  • Avoid in smokers >35
  • Personal history arterial thrombosis, focal migraine
  • Age>50
  • Hypertension >140/90
  • Avoid if active gall bladder disease or previous liver tumour
44
Q

What are the side effects of female fertilisation?

A
  • Risks of GA and laparoscopy
  • Irreversible - risk regret
  • Failure rate 1 in 200 lifetime risk – could be ectopic
  • No effect on periods / hormones
  • Reduces ovarian cancer risk ( ? Even more reduction if salpingectomy but more complex surgery)
45
Q

What is the action of the copper IUD?

A

Usual mode of action: Toxic to sperm –> stop sperm reaching egg

  • May sometimes prevent implantation of fertilised egg
  • Hormone free
  • May make periods heavier/crampier
  • Can last 5-10 years depending on type
46
Q

What is the action of levonorgestrel IUS?

A

Affect cervical mucus and endometrium most women still ovulate –> Stop fertilisation of egg

  • May prevent implantation fertilised egg
  • Slow release progestogen on stem
  • Low circulating progestogen levels compared with pill/implant/injection
  • Reduce menstrual bleeding after up to 4 months initial irregular bleeding
47
Q

What are the differences between mirene and kyleena IUS?

A

Mirena

  • 85% bleed free by 1 year
  • Licensed to treat heavy menstrual bleeding and as progestogenic part of HRT

Kyleena

  • Less hormone
  • Less likely to be bleed free
  • Less chance of side effects

Reproductive System (26 decks)

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