Contraception Flashcards
What clinical assessments must you make before giving someone contraception?
- Age (<50 )
- menstrual hx
- previous contraception method
- Previous pregnancies
- Previous/current STIs
- contraceptive needs
- medical problems
- FH of heart disease, VTE and breast cancer
- migraine without aura
- breast feeding
- smoking
- drug hx
- herbal medicines e.g st johns wart
What examinations should be done and what are the parameters?
BP - >140-159 systolic and or >90-95 diastolic
BMI
Cervical smear if over 25 yrs
STI screen
What is the fraser criteria
contraception can be prescribed to a girl under 16 yrs of
- the girl can understand what the dr is advising
- The doctor has tried to persuade her to tell her parents or allow him to
- She will begin or continue having intercourse without contraception
- Her physical or mental health is likely to suffer if she does not receive contraceptive advice
- Her best interests require the prescriber to give contraceptive advice +/- treatment without parental consent
Methods of contraception: user failure ones
- COCP
- Contraceptive patch
- progesterone only pill
- barrier methods (male/female condom/diagphragm/cap/spermacides)
- natural family planning
- lactational amenorrhoea method
Methods of contraception: non user failure ones
- contraceptive injection (depo-provera
- intrauterine device (IUD)
- intrauterine system (IUS)
- Male/female sterilisation
How does the COCP work
Advantages?
Disadvantages?
- oestrogen and progesterone
- alters cervical mucus and thins endometrium
Advantages? Reversible, reliable, 12hr window Regular predictable cycle menorrhagia, dysmenorrhoea May help with acne risk of PID (due to thickened Cx mucous) May help reduce PMS Protective against ovarian, endometrial & colorectal cancer
Disadvantages
P) drug interactions (eg anti-epileptics, antibiotics, barbiturates, herbals)
Doesn’t protect against STI’s
efficacy if taken late or after D&V
Possible small risk of breast cancer
Possible small risk of cervical cancer
Risk of thromboembolic disease (x2)
How does the POP work?
+VE
-VEs
- progesterone only
- thickens cervical mucus
- thinks endometrium
- can stop ovulation
Advantages
Can be used to prevent oestrogenic side effects (e.g. breast tenderness, headache, nausea)
Suitable smokers > 35yrs
Can be used in grossly obese
Used with medical problems (e.g. migraine, BP)
Disadvantages
- less effective than COC
- 3 HR window
- increased ectopic risk
- disrupts menstrual pattern
- functional ovarian cysts possible
advantages of male condom
disadvantages
- protects agains STI + prevent pregnancy
- fat soluble lubricants can damage
female condom advanages and disadvantages?
- protects from STIs
Inserted any time before intercourse
Not affected by oils, no restriction with choice of lubricant
Non latex
Disadvantages Failure rate higher than male condoms Needs careful insertion Easy for penis to miss it! Can be noisy and intrusive Do not use with male condom as they can stick together causing slippage or displacement
Diaphragm/caps
Failure rate 2 – 5% dependent on user
If weight changes by > 3kg different size needed
Requires good pelvic muscle tone
Fitted in advance of SI to allow spontaneity
Fertility awareness method?
Can be used to plan pregnancy as well as prevent
Need 3-12 months of cycles to predict fertile time
Requires daily charting of temperature and vaginal secretions to predict onset and end of fertile time
Periods of abstinence / barrier methods
Predictor kits (e.g. Persona)
How does lactational ameorrhoea work?
For how long is it effective
what can impact it
When should they stop using this method
- based on pospartum infertility when women amenorrhoeic if fully breastfeeding
- effective at < 6 months post partum
- once mensas start (2 sequential days of bleeding/spotting)
Injectable
Depo-provera
How does it work
Advantages
Disadvantages/
- IM injection of progesterone
- 12 week intervals
- inhibits ovulation by ihbiting LH and FSH
+
- effective
- reversible
- can help pMS and painful heavy periods
-
- irregular prolongeed bleeding
- amenorrhoea
- weight gain
- delay in return to feritlity
IUD
method
+
-
copper in plastic frame \+ Long term (5-10 yrs), reliable and reversible Effective immediately Effective as emergency contraception
-
May cause menstrual irregularities, spotting & IMB
May cause menorrhagia & dysmenorrhoea
risk of PID first 20 days of insertion (screen for STD’s)
Risk of ectopic pregnancy
Perforation at insertion
Risk of expulsion
Progesterone implant
+ and -
Low dose, long acting (3 yrs), reversible
No oestrogenic side effects
Minimal medical intervention (insertion and removal)
dysmenorrhoea & menstrual blood loss
- Irregular bleeding Requires minor op for insertion and removal Occasional discomfort Rarely infection at site
