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Repro > Contraception > Flashcards

Contraception Flashcards

1
Q

What is the perfect contraceptive?

A
  • 100% reliable
  • 100% safe
  • Non-user dependent
  • Unrelated to coitus
  • Visible to the woman
  • No ongoing medical input
  • Completely reversible
  • No discomfort
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2
Q

Contraceptive methods that require ongoing action by the individual?

A
  • oral contraception
  • barrier methods
  • fertility awareness
  • coitus interruptus
  • oral emergency contraception
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3
Q

Contraceptive methods that prevent contraception by default?

A
  • progesterone implants
  • progesterone injections
  • sterilisation
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4
Q

What are the risks and benefits of contraceptive treatment?

A

BENEFITS:

  • non-contraceptive
  • psychosexual
  • choice
  • sexual health
  • cost saving
  • female equality

RISKS:

  • cardiovascular
  • neoplastic
  • emotional
  • infection-related
  • allergic
  • iatrogenic
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5
Q

What are the risks and benefits of no contraceptive treatment?

A

BENEFITS:

  • non-interference
  • population growth
  • control of women

RISKS:

  • childbirth-related
  • abortion-related
  • social costs
  • economic costs
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6
Q

What does the combined oral contraceptive comprise of?

A

combination of (synthetic) oestrogen and progesterone (which is actually progestogens, a group of compounds which resembles progesterone)

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7
Q

What do oestrogens act upon in COCP?

A
  • on the anterior pituitary and hypothalamus
  • directly on the ovary
  • on the endometrium
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8
Q

What do progestogens act upon in COCP?

A
  • on the anterior pituitary and hypothalamus
  • directly on the ovary
  • on the endometrium
  • on the fallopian tubes
  • on the cervical mucus
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9
Q

What are the benefits of the COCP?

A
  1. CONTRACEPTIVE BENEFITS:
    - reliable
    - safe
    - unrelated to coitus
    - woman in control
    - rapidly reversible
  2. NON-CONTRACEPTIVE BENEFITS:
    - halves risk of ovarian cancer (long-term)
    - halves risk of endometrium cancer (long-term)
    - helps endometriosis, menorrhagia, dysmenorrhea
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10
Q

What are the risks of COCP?

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 nonhaemolytic jaundices, gall stones

DERMATOLOGICAL:
chloasma, acne, erythma multiforme

PSYCHOLOGICAL:
mood swings, depression, Libido

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11
Q

What is some medication that can interact with COCP?

A
  1. Liver enzyme-inducing drugs:
    Affect the metabolism of both oestrogen and progestogen
    Beware rifampicin and anti-epileptics
  2. Broad-spectrum antibiotics
    Affect enterohepatic circulation of oestrogen (40%)
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12
Q

Describe the vaginal contraceptive method

A

Same as COCP but there is vaginal delivery for 21 days, which you then remove for 7 days

Advantages: you don’t have to take it every day (easier on user)

Disadvantages: you don’t have to take it every day (may forget)

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13
Q

List some progestogen-only methods

A

The default methods are:
IMPLANTS:
- nexoplanon
- norplant (LNG)

HORMONE- RELEASING IUCD:
- mirena IUS (LNG)

The user-dependent methods are:
POPs
- Desogestrelle (Cerelle)
- norethisterone
- ethynodiol diacetate
- levonorgestrel
- norgestrel

INJECTIBLES:

  • depo provera (MPA) (12-weekly)
  • noristerat (NET)
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14
Q

Why is Cerelle better than older POPs?

A
  • it’s as effective as COCP
  • no oestrogen - (breastfeeding)
  • favourable side effect profile vs older POPs
  • bleeding is as predictable as COCP
  • you have a 12-hour window if missed (compared to 3-hour window)
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15
Q

Describe IUDs as a contraceptive method

A

The copper-bearing intrauterine contraceptive devices are inserted into the uterus by suitably trained practitioners and may be left in situ long-term and act by:

  1. destroying spermatozoa
  2. preventing implantation: an inflammatory reaction and prostaglandin secretion, as well as a mechanical effect

ALL IUCDs can be left in situ for 5 years. Any device inserted after a woman’s 40th birthday could be left in until after menopause, if the woman wishes, without being replaced.

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16
Q

Advantages and disadvantages of IUCDs?

A

ADVANTAGES:

  • non-user dependant
  • immediately and restrospectively effective
  • immediately reversible
  • can be used long-term
  • extremely reliable
  • unrelated to coitus
  • free from serious medical dangers

DISADVANTAGES:

  • has to be fitted by trained medical personnel
  • fitting may cause pain or discomfort
  • periods may become heavier and painful
  • doesn’t offer protection against infection
  • threads may be felt by the male
17
Q

Risks of IUCDs?

A

miscarriage can occur if left in situ during a pregnancy

  • protects less well against ectopic pregnancies
  • may be expelled
  • the uterus may be perforated
18
Q

What are some absolute contraindications with IUCDs?

A
  • current pelvic inflammatory disease
  • suspected or known pregnancy
  • unexplained vaginal bleeding
  • abnormalities of the uterine cavity

Some relative contraindications:

  • nulliparity (a woman never having given birth)
  • past history of pelvic inflammatory disease
  • not in mutually monogamous relationship
  • menorrhagia/ dysmenorrhea
  • small uterine fibroids
19
Q

What are some advantages of using condoms?

A

MALE:

  • man in control
  • protects against STIs
  • no serious health risks
  • easily available (free at family planning clinics)

FEMALE:

  • woman in control
  • protects against STIs
  • can be put in in advance and left inside after erection lost
  • not dependant on male erection to work
20
Q

What are some disadvantages of using condoms?

A

MALE:

  • last minute use
  • needs to be taught
  • may cause allergies
  • may cause psycho-sexual difficulties
  • higher failure rates among some couples
  • oily preparations rot rubber

FEMALE:

  • obtrusive
  • expensive
  • messy
  • rustles during sex
  • uncertain failure rate
21
Q

Describe caps as a contraceptive method?

A

DIAPHRAGM CAPS:

  • made of latex
  • fit across vagina
  • sizes 55-95mm in 5mm jumps
  • must be used with spermacide and left in at least 6 hours after sexual intercourse

SUCTION (CERVICAL) CUPS:

  • made of plastic
  • suction to cervix or vaginal vault
  • different sizes
  • must be used with spermicide and elft in 6 hours or more
22
Q

What are some advantages of using caps as a contraceptive method?

A

DIAPHRAGM CAPS:

  • woman in control
  • can be put in in advance
  • offers protection against cervical dysplasias
  • percieved as ‘natural’

SUCTION CAPS:

  • suitable for women with poor pelvic floor muscles
  • no problems with rubber allergies
  • very unobtrusive
  • woman in control
23
Q

What are some disadvantages of using caps as a contraceptive method?

A

DIAPHRAGM CAPS:

  • needs to be taught
  • messy
  • higher failure rate than most other methods
  • higher UTI chance
  • higher candiasis chance

SUCTION CAPS:

  • needs an accessible and suitable cervix
  • higher failure rate than the diaphragm cap
  • not easy to find experienced teacher
24
Q

Describe fertility awareness as a contraceptive method

A

It uses the prediction of ovulation, and several facts surrounding fertilisation:

  • sperm can survive 5 days in the female tract
  • the ova can survive 24 hours
  • 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

They use priodic abstinence/alternative contraception to avoid pregnancy. They also time intercourse to the pre-ovulatory phase to concieve.

25
Q

What does natural family planning take into consideration?

A
  • temperature
  • rhythm
  • cervix position
  • cervical mucus
  • persona
  • lectational amenorrhoes (LAM)
26
Q

What are some advantages and disadvantages of using fertility awareness as a contraceptive method?

A

ADVANTAGES:

  • non-medical
  • can be used in 3rd world countries
  • allowed by Catholic church
  • can result in closeness of understanding between partners
DISADVANTAGES:
failure rate is heavily user dependant
- requires skilled teaching
- my require cooperation between partners
- may involve limiting sexual activity
- can cause strain
27
Q

Describe some methods of emergency contraception

A

POSTCOITAL PILLS:

  • can work up to 72 hours after unprotected sexual intercourse (UPSI)
  • schering PC4 - prevents 3 out of 4 pregnancies which would have occured

COPPER-CEARING IUCDs:

  • up to 5 days after presumed ovulation OR 5 days after one single episode of UPSI at any time of the cycle
  • failure rate is extremely rare
28
Q

Compare PC4 and Levonelle 2 as postcoital pills

A

PC4:

  • lower failure rate in the first 24 hours
  • causes nausea and comiting in many women
  • contraindicated during a focal migraine attack

LEVONELLE 2:

  • higher failure rate in the first 24 hours
  • very little nausea
  • only contraindicated in women taking very potent liver enzyme medication (eg. anti-TB)
29
Q

Describe ellaOne as a postcoital pill

A
  • it’s a new selective progesteragen receptor modulator (SPeRM)
  • up to 120 hours
  • RR 0.58 pregnancy vs. Levonelle
  • possibly slightly higher side effect profile - GI symptoms mostly

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