Contraception Flashcards
What factors would the ideal contraception have?
100% effective 100% safe 100% reversible No side effects Cheap/free Free from medical intervention Acceptable to all cultures and religions Prevents STIs
What is used to measure the efficacy of contraception?
The Pearl Index: the risk of pregnancy per 100 woman years of using the given contraception
What are special patient groups when looking at contraception?
Adolescents; Women with IBD; Breastfeeding women; Contraception in later life; women in developing countries
What should be considered when thinking about contraception in adolescents?
Non-adherence with the pill. Reduction in bone density with the injection.
What should be considered when thinking about contraception in women with IBD?
Small bowel disease and associated malabsorption can lead to decreased efficacy of oral contraception. Women with IBD are at increased risk of osteoporosis so the injection should be last resort.
What should be considered when thinking about contraception in breastfeeding women?
The combined pill affects breast milk volume and is avoided before 6 weeks postpartum and is relatively contraindicated between 6 weeks and 6 months postpartum. Progestogen only methods have no effect on milk production and can be used in the first 6 weeks postpartum and thereafter. The IUD can be inserted from 4 weeks postpartum.
What are the hormonal contraception options?
POP; depo injection; COC; transdermal patch; vaginal ring
What does the COC pill work?
Exerting negative feedback on gonadotrophin release and thereby inhibiting ovulation. They also thin the endometrium and thicken cervical mucus.
How is the COC taken?
A single tablet taken every day for 3 weeks and then stopped for 1 week. Vaginal bleeding occurs at the end of the pill packet.
What are the common side effects of progestogen?
Depression; postmenstrual tension-like symptoms; bleeding; amenorrhoea; acne; breast discomfort; weight gain; reduced libido
What are the common side effects of oestrogen?
Nausea; headaches; increased mucus; fluid retention and weight gain; occasionally HTN; breast tenderness and fullness; bleeding
What are the uses of the COC other than contraception?
Menstrual cycle control, menorrhagia, pre-menstrual symptoms, dysmenorrhoea, acne/hirsutism and prevention of recurrent simple ovarian cysts
What can reduce absorption of the COC pill?
Diarrhoea, vomiting (take another pill) or if taking some oral antibiotics (use condoms at the same time)
What are the associations between the COC pill and surgery?
The pill is normally stopped 4 weeks before major surgery because of its prothrombotic risks.
What are the side effects of the COC pill?
Serious: venous thrombosis (and embolism) and MI (esp. with extra risk factors). Slight increased risk of stroke, focal migraine, HTN, jaundice and liver, cervical and breast carcinoma
Minor: nausea, headaches and breast tenderness, breakthrough bleeding common in first few months
What are the advantages of the COC pill?
Very effective contraception. More regular, less painful and lighter menstruation. Protects against simple ovarian cysts, benign breast cysts, fibroids and endometriosis. reduction in the incidence of ovarian, endometrial and bowel cancer
What are the absolute contraindications to the combined hormonal contraception?
- More than 35 years old and smoking more than 15 cigarettes/day
- Migraine with aura
- History of thromboembolic disease or thrombogenic mutation
- History of stroke or ischaemic heart disease
- Breast feeding < 6 weeks post-partum
- Uncontrolled hypertension
- Current breast cancer
- Major surgery with prolonged immobilisation
What are the relative contraindications to the combined hormonal contraception?
- More than 35 years old and smoking less than 15 cigarettes/day
- BMI > 35 kg/m^2*
- Family history of thromboembolic disease in first degree relatives < 45 years
- Controlled hypertension
- Immobility e.g. wheel chair use
- Carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
- Current gallbladder disease
How do you use the combined transdermal patch?
A new patch is applied weekly for 3 weeks then followed by a patch-free week. Efficacy, side effects and contraindications are similar to COC
How is the combined vaginal ring used?
The ring is easily inserted into the vagina by the patient and worn for 3 weeks. It is then removed to allow for a 7 day ring-free break and a withdrawal bleed.
What type of women can take the POP?
Any, they need to be well motivated
Is the COC or POP more effective?
The COC
How does the POP work?
It makes the cervical mucus more hostile and can sometimes inhibit ovulation
How is the POP used?
Continuous, every day at the same time (if taken not within 3 hours of the usual time, use condoms for 2 days)
What are the side effects of the POP?
Vaginal spotting, other progestognenic effects such as weight gain, mastalgia and pre-menstrual like symptoms
What are the benefits of the POP?
Few contradictions so can be used in lactating mothers
How does the depot injection work?
Progestogens are slowly released, bypassing the portal circulation. Similar to the mini-pill, increase cervical mucus hostility and usually prevents ovulation
What are the benefits of the depot injection?
Protect against functional ovarian cysts and ectopic pregnancy. Not user-dependent and have high efficacy rates. More cost-effective than the COC
What are the advantages of the implant?
It will last 3 years and female satisfaction is high. No drop in bone density, removal is easy and there is a rapid resumption on fertility.
What are the side effects of the implant?
Progestognenic symptoms: particularly irregular bleeding in the first year.
How long must diaphragms and caps stay in after intercourse?
They must remain in situ for at least 6h afterwards
What are the types of IUD?
Copper-containing devices and hormone-containing devices
How do copper IUDs work?
They prevent fertilisation, the copper ion being toxic to sperm. They also act to block implantation. The copper is either would around an inert frame which sits within the uterine cavity or threads which are attached to the fundus.
What do hormone-containing IUDs (IUS) work?
Progestogen is slowly released locally over 5 years. They change the cervical mucus and uterotubal fluid which impair sperm migration, backed by endometrial changes impeding implantation.
What are the advantages of the IUS?
It can reduce menstrual loss and pain. The blood levels of progestogen are less than other forms of contraception so systemic side effects are low. return of fertility after removal is rapid and complete
What are the side effects of the IUS?
Irregular light bleeding
When is the coil inserted?
Normally during the first half of the cycle, but can be used straight after termination of pregnancy or in the puerperium.
What are the complications of the coil?
Pain or cervical shock; perforation of the uterine wall; heavier or more painful menstruation; infection; ectopic pregnancy
When would perforation occur?
Perforation of the uterine wall can occur at insertion or the device can migrate through the wall afterwards
What are some absolute contraindications to the IUD?
Endometrial or cervical cancer Undiagnosed vaginal bleeding Active/recent pelvic infection Current breast cancer (for IUS) Pregnancy
What are some relative contraindications to the IUD?
Previous ectopic pregnancy Excessive menstrual loss Multiple sexual partners Young/nulliparous Immunocompromised, including HIV
What are some advantages of the IUD?
It is very safe; the woman does not need to remember to use other contraception. The IUD can be used as emergency contraception if inserted within 5 days of ovulation
What are the ways that female sterilisation can take place?
Clips and transcervical sterilisation.
How do clips cause female sterilisation?
They are applied to the tubes laparoscopically, completely occluding the lumen.
How does transcervical sterilisation cause female sterilisation?
It involves the hysteroscopic placement of microinserts into the proximal part of each tubal lumen. The inserts expand and cause fibrosis and occlusion of the lumen is confirmed, 3 months later, with a hysterosalpingogram.
What are the complications of female sterilisation?
Perioperative: risks of laparoscopy (primarily visceral damage) and inadequate access to the tubes.
Postoperative: pain that can be reduced using local anaesthetic on the tubes and in the skin incisions.
What does male sterilisation involve?
Ligation and removal of a small segment of the vas deferens, thereby preventing release of sperm.
What are the complications of male sterilisation?
Failure, postoperative haemotomas and infection and chronic pain.
