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MK SR INDEX CASES REPRODUCTIVE CARE > Contraception > Flashcards

Contraception Flashcards

1
Q

Contraception – Why Bother?

A
  • Up to 50% of unintended pregnancies occur in women not using any contraception in the month they conceive
  • Despite many advances in contraception available abortion rates in MK have not improved. We are one of the higher areas in the UK with 20.2/1000 women of child bearing age seeking termination in 2016 (1085 women in total)
  • 4 in 10 women are using their method inconsistently/incorrectly and only 1 in 20 unintended pregnancies are attributable to method failure
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2
Q

Semen can live in a women’s vagina for

A

up to 7 days

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3
Q

When is conception window?

A

Therefore conception can occur from 7 days before up until 3 days after an egg is released, days 7-17 on a 28 day cycle

  • Semen can live in a women’s vagina for up to 7 days
  • The egg will last for up to 3 days
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4
Q

What do the UKMEC Eligibility Criteria grading mean?

A

1 = A condition for which there is no restriction for the use of the contraceptive method

2 = A condition where the advantages of using the method generally outweigh the theoretical or proven risks

3= A condition where the theoretical or proven risks usually outweigh the advantages of the method

4= A condition which represents an unacceptable health risk if the contraceptive method is used

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5
Q

Contraception Choices

A

PILLS
PATCHES, RINGS
IMPLANTS, INJECTIONS COILS
BARRIERS

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6
Q

Benefits of Combined Contraceptive Pill

A
  • Very reliable if taken correctly but reduced if missed pills, on other medications, absorption reduced due to vomiting or diarrhoea
  • Failure rate of all oral contraception in perfect use 0.1% but in typical use averages at 8%
  • Take for 3 week and then have no more than 7 day break during which time a withdrawal bleed is likely to occur. More recent guidance suggests move towards extended pill regimens
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7
Q

Limitations or downsides of Combined Contraceptive Pill

A
  • Side effects can include small amount of weight gain (average 2-3kg), headaches, mood swings, reduced libido, breast tenderness, nausea, irregular bleeding.
  • Usually minimal and get better after first 3 packets Possibly not suitable if overweight, high BP, migraine, family history blood clots, liver problems
  • Should not be given to smokers over 35 unless stop for over 1 year
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8
Q

Mechanism of Combined Contraceptive Pill

A
  • Works primarily by inhibiting ovulation via it’s action on the hypothalamo-pituitary axis, reducing LH and FSH
  • Additional effects on the endometrium and cervical mucus
  • First 7 pills of a packet inhibit ovulation, the rest maintain anovulation
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9
Q

Indications for Patches and Vaginal Rings as contraception

A

For those who are suitable for the combined pill but have problems remembering to take it, or who get gastric side effects such as nausea

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10
Q

Examples of Patches and Vaginal Rings as contraception

A

Evra = Patches put on skin and changed once a week for 3 weeks and then 1 week off

Nuvaring = vaginal ring, inserted and left for 3 weeks and then removed for 1 week

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11
Q

Indication for Progesterone Only Pills for contraception

A

For those who are not suitable for combined pills due to side effects or other medical problems the progesterone only pill may be a good alternative

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12
Q

Describe the Depo Provera Injection

A

Progesterone only
Given every 12 weeks
Very reliable contraception - Failure rates if given regularly are <4 in 1000 over 2 years

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13
Q

Main preparation of Progesterone Only Pills for contraception

A

Desogestrel. Take every day with no pill free week

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14
Q

Counsel patient on bleeding with the Progesterone Only Pills for contraception

A

many will get amenorrhea after 6 months

A percentage of people have no periods but there is a risk of irregular bleeding or spotting in the beginning

Must counsel that they should try it for at least 6 months

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15
Q

Counsel on the Pros and cons of depo provera injections

A
  • Often stop periods completely in first year of use (not ideal for someone who wants to get pregnant in the next year)
  • This delay in periods can persist for up to 1 year after
    stopping the injections
  • most risk of weight gain and most hormonal and can’t cease treatment once IM injection given
  • Not the most suitable method for <18 years or over 40 years due to concerns about loss of bone mineral density
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16
Q

Mechanism of depo provera injections

A
  • Works primarily by inhibiting ovulation
  • Thickening of cervical mucus inhibiting sperm
    penetration into the upper reproductive tract
  • Also changes the endometrium making it unfavourable for implantation
17
Q

Most of action of Contraceptive Implant

A

Primary mode of action is inhibition of ovulation

Also alters cervical mucus to prevent sperm penetration and inhibits normal endometrial development

18
Q

What is the Contraceptive Implant?

A

Nexplanon - 3 year progesterone only releasing rod inserted just under the skin of the upper arm

VERY reliable method of contraception - Contains 68mg etonogestrel

19
Q

Side effects of Contraceptive Implant?

A
  • Minimal weight gain, breast tenderness and mood changes
  • Periods can be stopped all together, very infrequent, regular or irregular and frequent
  • Irregular bleeding most likely to occur in first 3-6 months and then often settles
  • Consider exchange after 2 years in patients with a high BMI
20
Q

Options for Intra Uterine Contraception

A

Two kinds of coil, hormonal and non-hormonal

  • Non Hormonal T-safe 380 Copper IUD lasts for 10
    years
  • Hormonal IUS Mirena and Kyleena licensed for 5 years and Jaydess for 3 years

Kyleena and Jaydess for nulliparous women

21
Q

What is Nexplanon?

A

Contraceptive implant

3 year progesterone only releasing rod inserted just under the skin of the upper arm

22
Q

How does Copper IUD work?

A

Copper is toxic to ovum and sperm and inhibits
sperm penetration. Works primarily by inhibiting fertilisation/ Endometrial inflammatory reaction which has an anti-implantation effect

23
Q

Counsel on pros and cons of copper IUD

A

 No hormones so no side effects, keep normal cycles but can be heavier and more painful
 1-2% failure rate
- risk of expulsion

24
Q

What is the mirena IUS?

A

 Mirena coil contains small amount of daily progesterone which is released directly into the uterus
 5 year contraception, as reliable as being sterilised
Initial irregular bleeding but then lighter periods with less period pain and less PMT

25
Q

Mechanism of Mirena IUS

A

 Effect mediated by progestogenic effect on the endometrium which prevents implantation
 Reduction in sperm motility and penetration through cervical mucus
 Can be of clinical benefit in patients with PMT, menorrhagia and endometriosis
 Can form part of a HRT regimen as progesterone arm (stops endometrial hyperplasia from estrogen)

26
Q

Counsel on Jaydess IUS

A
  • licenced for 3 years, lower daily hormone dose, targeted at nullips as thinner and shorter so easier to insert in a narrower canal
  • Likely to maintain a regular but lighter cycle similar to that of COCP after initial irregular phase has settled
  • Recent introduction of 5 year version Kyleena
27
Q

3 Current Emergency Contraception Options

A
  • Levonelle – oral hormonal method
  • Ella One – oral hormonal method
  • Copper IUD – Non hormonal longer lasting method
28
Q

Counsel a patient on Levonelle

A
  • Levonelle can be given up to 72 hours post UPSI. It can be given after this time but patients need to know it is unlikely to be effective
  • There is no limit to how many times a patient can have Levonelle in any one cycle. Does not prevent quick starting of a new contraceptive method and not affected by recently taken progesterone
  • New guidance suggesting the need for double the dose if weight over 70kg
29
Q

Counsel a patient on copper IUD for emergency contraception

A
  • Copper IUD can be inserted up to 5 days post UPSI, or 5 days after expected date of ovulation
  • Most reliable method of EC as working on preventing implantation rather than ovulation, so can be used effectively after ovulation has already occurred
  • Provides a good method of ongoing contraception after
  • Most patients decline due to invasiveness of procedure. Can be very uncomfortable on young girls who are nullips and mid cycle
30
Q

Three areas to cover in history taking for emergency contraception

A
  1. which emergency contraception - LMP, unprotected sex, current contraception.
  2. STI status - regular partner, last screening
  3. ongoing contraception plan
31
Q

What only contraception methods that don’t interact with enzyme inducing drugs

A
  • depo provera

- copper coil

32
Q

When is it safe to insert a copper IUD for emergency contraception?

A

up to 5 days post UPSI, or 5 days after expected date of ovulation

For 28 day cycle, days 1-19

OR within 5 day window of UPSI

Don’t put it in if implantation could have already occurred

33
Q

Family planning clinic counselling on Unwanted pregnancy

A
  • Patients requesting TOP are signposted to BPAS or other similar local organisations
  • Medical termination – Mifepristrone and Misoprostol usually up to 9 weeks
  • Only a RMP can prescribe the drugs and must follow the MTP act and regulations
  • Surgical termination – either vacuum aspiration up to 15 weeks or dilatation and evacuation from 15-24 weeks

MK SR INDEX CASES REPRODUCTIVE CARE (23 decks)

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