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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
Q

Name some of the relative IUCD contraindications

A 
Nulliparity
Past history of pelvic inflammatory disease
Not in mutually monogamous relationship
Menorrhagia / Dysmenorrhoea
Small uterine fibroids
26
Q

What are the major risks of IUCDs

A

Miscarriage if left in situ if a pregnancy

27
Q

What are the advantages of condoms for males

A

Man in control
Protects against STIs
No serious health risks
Easily available (free at Family Planning clinics)

28
Q

What are the female advantages of using condoms

A

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
Q

What are the disadvantages of condoms for males?

A 
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
Q

What are the disadvantages of using condoms for females

A 
Obtrusive
Expensive
Messy
Rustles during sex
Uncertain failure rate
31
Q

What are diaphragm caps?

A

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
Q

What are the advantages of diaphragm caps

A

Woman in Control
Can be put in in advance
Offers protection against cervical dysplasias
Perceived as “natural”

33
Q

Outline the disadvantages of diaphragm caps

A 
Needs to be taught
Messy
Higher failure rate than most other methods
Higher UTI
Higher Candiasis
34
Q

What are suction cervical cap

A

Made of plastic
Suction to cervix or vaginal vault
Different sizes
Must be used with spermicide and left in 6 hours or more.

35
Q

List the advantages of suction caps

A

Suitable for women with poor pelvic muscles
No problems with rubber allergies
Very unobtrusive
Woman in control

36
Q

What are the disadvantages of using suction cervical caps

A

Needs an accessible and suitable cervix
Higher failure rate than diaphragm
Not easy to find experienced teacher

37
Q

When is ovulation most likely to occur

A

Prediction of ovulation ? 14/7 before period

38
Q

How long do unfertilised gametes survive?

A

Sperm can survive 5 days in female tract

Ova can survive 24 hours

39
Q

Where does fertilisation most often take place?

A

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
Q

How can you time intercourse for pregnancy

A

Use Periodic Abstinence/alternative contraception to avoid pregnancy
Time intercourse to pre-ovulatory phase to conceive

41
Q

What are the advantages of fertility awareness

A

Non medical
Can be used in 3rd world
Allowed by Catholic church
Can result in closeness of understanding between partners

42
Q

What are the disadvantages of planning fertility

A 
Failure rate heavily user dependent
Requires skilled teaching
May require cooperation between partners
May involve limiting sexual activity
Can cause strain
43
Q

What are the major factors of natural family planning

A 
Temperature
Rhythm
Cervix position
Cervical mucus
Persona
Lactational amenorrhoea (LAM)
44
Q

What are the emergency contraception pills available

A

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
Q

What are the emergency IUCDs options

A

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
Q

Describe the PC4 postcoital pills

A

Lower failure rate in 1st 24 hours.
Causes nausea & vomiting in many women
Contraindicated during focal Migraine attack

47
Q

Describe the Levonelle 2 postcoital pills

A

Lower failure rate in 1st 24 hours
Very little nausea
Only contraindicated in women taking very potent liver enzyme medication (anti TB)

48
Q

Outline features of ellaOne

A

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
Q

How effective is Levonelle 2?

A

Up to 24hrs – 95%
25 – 48 hrs - 85%
49 – 72 hrs- 58%

50
Q

Outline the effectiveness of Schering PC4

A

Up to 24 hrs – 77%
25 – 48 hrs – 36%
49 – 72 hrs – 31%

51
Q

How do PC4 and Levonelle 2 work as postcoital contraception?

A

Act by postponing ovulation in 1st part of the cycle – So beware!
??Act by preventing implantation in 2nd part of the cycle

52
Q

How do IUCDs act as postcoital medication

A

Copper kills sperm in 1st part of the cycle

Device prevents implantation in 2nd part of the cycle

53
Q

What increases the risk of any contraceptive?

A

If it involves user input error the risks of failure are much higher

Reproduction (Physiology 2) (12 decks)

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