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