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Reproduction (Physiology 2) > Contraception > Flashcards

Contraception Flashcards

1
Q

What are the characteristics of the perfect contraceptive?

A 
100% Reliable
100% Safe
Non User Dependent
Unrelated to Coitus
Visible to the Woman
No ongoing Medical Input
Completely reversible within 24 hours
No Discomfort
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2
Q

What are some of the associated risks of contraceptive treatments?

A 
Cardiovascular
Neoplastic
Emotional
Infection related
Allergic
Iatrogenic
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3
Q

Outline the benefits of contraceptive treatment

A 
Non Contraceptive 
Psychosexual
Choice
Sexual Health
Cost savings
Female equality
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4
Q

What are the risks of having no contraceptive treatments available?

A

Childbirth related
Abortion related
Social costs
Economic costs

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5
Q

Describe any benefits of having no contraception?

A

Non interference
Population growth
Control of women

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6
Q

Describe the oestrogen content of the combined oral contraceptive pill (COCP)?

A

EthinylOestradiol - 20,30,35,50 micrograms

Oestrogens act on anterior pituitary & hypothalamus - Directly on the ovary (on the Endometrium)

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7
Q

Where do the progesterone content of the COCP produce its effects?

A

Progestogens act on anterior pituitary & hypothalamus- directly on the ovary (on the Endometrium, fallopian tubes and cervical mucus

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8
Q

Outline the COCP sites of action

A

COCP causes the inhibition of follicular development, ovulation, and as consequence, corpus luteum formation. Further, it is also involved in the alteration of the cervical mucus that inhibit sperm penetration

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9
Q

Explain the benefits of the combined oral contraceptive benefits

A 
Reliable
Safe
Unrelated to coitus
Woman in control
Rapidly reversible
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10
Q

Outline the risks of combined oral contraception risks

A

Cardiovascular - Arterial – Progestogen , HBP, smoking
- Venous – Oestrogen-VTE-clotting disorders (DVT, PE, Migraine)
Neoplastic - Breast, Cervix, Liver
Gastrointestinal - COH/insulin metabolism, Weight gain, Crohns disease
Hepatic - hormone metabolisms, congenital nonhemolytic jaundices, gall stones
Dermatological - Chloasma, acne, erythema multiforme
Psychological - Mood swings, depression, Libido

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11
Q

Outline the guidelines of taking COCP

A

Start 1st packet 1st day of a menstrual period
Take 21 pills and stop for 7 day break (PFI)
Restart each new packet on 8th day (same)
Do not start new packets late
If late or missed pills in 1st 7 days, condoms
If missed pills in last 7 days no PFI

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12
Q

What other drugs may interact with COCP

A
  1. Liver enzyme inducing drugs - see list/MIMS
    - Affect metabolising of both oestrogen and progestogen
    - Beware rifampicin and anti-epileptics
  2. Broad spectrum antibiotics
    - Affect enterohepatic circulation of oestrogen only (40%)
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13
Q

What is combined vaginal contraceptive?

A

Same as COCP except vaginal delivery (ring) for 21 days

Remove for 7 days

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14
Q

Evaluate combined vaginal contraceptive

A

Adv – don’t have to take every day

Disadv - don’t have to take every day!!

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15
Q

What are the default oestrogen only methods

A

Implants: Nexplanon
Norplant (LNG)

Hormone releasing IUCD:
                       Mirena IUS (LNG)
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16
Q

What are the user dependent oestrogen only methods

A

POPs

- Desogestrel (Cerelle)
- Norethisterone 
- Ethynodiol diacetate
- Levonorgestrel
- Norgestrel

Injectables

- Depo Provera (MPA) (12weekly)  
- Noristerat (NET)
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17
Q

Why is cerelle used over POPs?

A 
> cerelle is better than older POPs:
As effective as COCP
No oestrogen – CIs e.g. breastfeeding
Favourable side effect profile vs older POPS
Bleeding as predictable as COCP
12 hour window
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18
Q

What are IUCDs?

A

Copper bearing intrauterine contraceptive devices are inserted into the uterus by suitably trained practitioners and may be left in situ long term

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19
Q

How do IUCDs work?

A

Act by
1. Destroying spermatozoa
2. Preventing implantation – Inflammatory reaction and
prostaglandin secretion as well as a mechanical effect

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20
Q

Describe copper bearing IUCDs

A
  1. Copper bearing Ortho T 380 – 8 -12yr
    Multiload 375 – 5yr
    Multiload 250 – 5yr (Standard & Short)
    Nova T 380 – 5yr
    Nova T 200 – 5yr
    GyneFix (IUI) – 5yr
  2. Hormone bearing – Mirena (IUS) – 5yr
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21
Q

What are the benefits of IUCDs?

A 
Non user dependent
Immediately and retrospectively effective
Immediately reversible
Can be used long term
Extremely reliable
Unrelated to coitus
Free from serious medical dangers
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22
Q

Outline any disadvantages of IUCDs

A

Has to be fitted by trained medical personnel
Fitting may cause pain or discomfort
Periods may become heavier & painful
It does not offer protection against infection
Threads may be felt by the male

23
Q

What are the associated risks of getting IUCDs

A

Miscarriage if left in situ if a pregnancy
?ectopics
May be expelled
The uterus may be perforated

24
Q

What are the absolute contraindications of IUCDs

A

Current pelvic inflammatory disease
Suspected or known pregnancy
Unexplained vaginal bleeding
Abnormalities of the uterine cavity

25
Name some of the relative IUCD contraindications
``` Nulliparity Past history of pelvic inflammatory disease Not in mutually monogamous relationship Menorrhagia / Dysmenorrhoea Small uterine fibroids ```
26
What are the major risks of IUCDs
Miscarriage if left in situ if a pregnancy
27
What are the advantages of condoms for males
Man in control Protects against STIs No serious health risks Easily available (free at Family Planning clinics)
28
What are the female advantages of using condoms
Woman in control Protects against STIs Can be put in in advance and left inside after erection lost Not dependent on male erection to work
29
What are the disadvantages of condoms for males?
``` Last minute use Needs to be taught May cause allergies May cause psycho sexual difficulties Higher failure rate among some couples Oily preparations rot rubber ```
30
What are the disadvantages of using condoms for females
``` Obtrusive Expensive Messy Rustles during sex Uncertain failure rate ```
31
What are diaphragm caps?
Made of latex Fit across vagina Sizes 55 – 95mm in 5cm jumps Must be used with spermicide and left in at least 6 hours after sexual intercourse
32
What are the advantages of diaphragm caps
Woman in Control Can be put in in advance Offers protection against cervical dysplasias Perceived as “natural”
33
Outline the disadvantages of diaphragm caps
``` Needs to be taught Messy Higher failure rate than most other methods Higher UTI Higher Candiasis ```
34
What are suction cervical cap
Made of plastic Suction to cervix or vaginal vault Different sizes Must be used with spermicide and left in 6 hours or more.
35
List the advantages of suction caps
Suitable for women with poor pelvic muscles No problems with rubber allergies Very unobtrusive Woman in control
36
What are the disadvantages of using suction cervical caps
Needs an accessible and suitable cervix Higher failure rate than diaphragm Not easy to find experienced teacher
37
When is ovulation most likely to occur
Prediction of ovulation ? 14/7 before period
38
How long do unfertilised gametes survive?
Sperm can survive 5 days in female tract | Ova can survive 24 hours
39
Where does fertilisation most often take place?
Ova are fertilised in the fallopian tube and take 4 days to reach the uterus and implant Cervical mucus is receptive to sperm around the time of ovulation
40
How can you time intercourse for pregnancy
Use Periodic Abstinence/alternative contraception to avoid pregnancy Time intercourse to pre-ovulatory phase to conceive
41
What are the advantages of fertility awareness
Non medical Can be used in 3rd world Allowed by Catholic church Can result in closeness of understanding between partners
42
What are the disadvantages of planning fertility
``` Failure rate heavily user dependent Requires skilled teaching May require cooperation between partners May involve limiting sexual activity Can cause strain ```
43
What are the major factors of natural family planning
``` Temperature Rhythm Cervix position Cervical mucus Persona Lactational amenorrhoea (LAM) ```
44
What are the emergency contraception pills available
Postcoital Pills Up to 72 hours after unprotected sexual intercourse (UPSI) Schering PC4 – prevents 3 out of 4 pregnancies which would have occurred Levonelle – prevents 7 out of 8 pregnancies consists of 2 tablets each containing 750 micrograms of Levonorgestrel 1.5mg one dose ellaOne (ulipristal)– similar
45
What are the emergency IUCDs options
Copper bearing IUCDs Up to 5 days after presumed ovulation or 5 days after one single episode of UPSI at any time of the cycle Failure extremely rare
46
Describe the PC4 postcoital pills
Lower failure rate in 1st 24 hours. Causes nausea & vomiting in many women Contraindicated during focal Migraine attack
47
Describe the Levonelle 2 postcoital pills
Lower failure rate in 1st 24 hours Very little nausea Only contraindicated in women taking very potent liver enzyme medication (anti TB)
48
Outline features of ellaOne
ulipristal acetate New selective progestagen receptor modulator (SPeRM) Up to 120 hours RR 0.58 pregnancy vs Levonelle Possible slightly higher side effect profile – GI symptoms mainly
49
How effective is Levonelle 2?
Up to 24hrs – 95% 25 – 48 hrs - 85% 49 – 72 hrs- 58%
50
Outline the effectiveness of Schering PC4
Up to 24 hrs – 77% 25 – 48 hrs – 36% 49 – 72 hrs – 31%
51
How do PC4 and Levonelle 2 work as postcoital contraception?
Act by postponing ovulation in 1st part of the cycle – So beware! ??Act by preventing implantation in 2nd part of the cycle
52
How do IUCDs act as postcoital medication
Copper kills sperm in 1st part of the cycle | Device prevents implantation in 2nd part of the cycle
53
What increases the risk of any contraceptive?
If it involves user input error the risks of failure are much higher

Reproduction (Physiology 2) (12 decks)

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