CONTRACEPTION Flashcards
Solutions for Unwanted pregnancy (3)
- keep it
- terminate
- adoption
What percent is unplanned in the UK?
40%
Mechanisms of Actions of Contraception
- Prevention of ovulation (most HORMONAL methods (emergency contrac.)
- Prevention of Fertilization (by toxicity/ mechanical/ surgical barrier)
- Prevention of Implantation (hostile endometrium or direct toxicity)
How to thicken cervical mucus
ius, DMPA, POP, SDI
Form of female sterlization
- Tubal Occlusion
How to classify contraception
- Permanent/ Reversible
- Hormonal vs non hormonal
- Combined vs progesterone only
- iNTRAUTERINE METHOD
- emergency methods
- LARC
Spermicides can be only be used with _____
diaphragm
Family Planning vs Contraception
- avg age to have a child 27-28 years
vs avg. age at which people have sex 16 y.o
When does life truly start according to some Gynaecological organisation?
- at implantation!
Factors that may influence choice of contraceptive method.
PERSONAL PREFERENCE 1. : good for STI prevention, 2. cost: 3. forgetful 4. mental capacity 5. freq of sex and type of sex 6. previous experience with contraceptive method 7. future preg plans (short and long term) 8. relationship status 9. child protection age
Major Complication of Hormonal pills
MIGRAINES
Noncontraceptive benefits of Hormonal Contraception
- acne/hirstuism (decr. TESTOSTERONE)
- endometriosis (heavy, painful periods)
- PMS
- Ovarian cysts/ Ovarian cancer
Method vs User failure
Method- goes wrong (1 in 5 condom failing)
User failure- incorrect use or poor compliance to methos
Reasons for User failure
poor compliance wrog lube wrong storage diaphgram removed too early no replacement
CHC, POP, DMPA: late injection, wrong use, wrong storage
Iatrogenic user failure
- wrong instructions
- poor support
2 types of IUD
- Mirena —HAS PROGESTOGEN ( makes endometrium thick; thickens mucus; abstain for 7 days)
- Copper IUD (can continue with sex right after; EMERGENCY contraception! )
How long do the IUDs last?,
mirena: 5 years
Copper IUD: 5-10 years
What are COMPLICATIONS of IUD?
- risk of INFECTION ( after a couple of months
- perforation of the womb
- ectopic pregnancy
- does not protect against STI
- can fall out
What is UKMEC?
—READ UP and on FPA
- used for CONTRACEPTION only
- more prochoice than BNF and MIMS
- less relevant for therapeutic use …use clinical judgement
What are the big themes of UKMEC?
VTE risks
CVD risks
Liver problems
Hormone Dependent Tumor
What is LARC stand for?
Long-Acting Reversible Contraception
What is lactational amenorrhea?
- 3 criteria:
1. Exclusively breast feeding
2. Less than 6 months post natally
3. Amenorrhoeic
Name 3 types of IUS; diff. based on doses.
Mirena (52mg) —lasts 5 years
These last 3 years
Kyleena (19.5mg)
Jaydess (13.5mg)
How does CHC act?
- contains estrogen and progesterone
- —INHIBITS ovulation
- effect on cervical MUCUS and ENDOMETRIUM
Mode of axn of POP?
Newer POP: Inhibits ovulation/ effect on cervical mucus, fallopian tube transport, endometrium
Older POP: effect on cervical mucus, fallopian tube transport, endometrium
What is the pearl index?
the no. of contraceptive failure per 100 women
The pearl index of POP and CHC?
CHC: 0.2
POP: 0.3%
What should be considered when prescribing CHC and POP?
- absorption
- Metabolism
What is the mode of axn of an implant and failure rate ?
- inhibition of ovulation (+ effect on endometrium and cervical mucus)
- 0.05%
What is the mode of action of depo injection?
- inhibits ovulation
- axn on cervical mucus and endometrium
Is depo injection considered to be a LARC?
- yes
- it lasts 14 weeks; given every 13 weeks
What is pearl index for depo injection?
- 0.2%
Name the most effective contraceptive.And state why.
Subdermal Implants
- SAFE for most women (esp. because its progesterone only)
- less hormonal effects
- lasts 3 years
What is the main s.e of SDI?
PV bleeding- controlled with CHC
What is main mode of action of IUS?
- effects IMPLANTATION (effect on cervical mucus and endometrium)
What is suggested if Mirena is inserted after the age of 45?
-can be kept in place until after Menopause (when it is no longer needed)
How do the IUS affects periods?
- Mirena and Levosert: periods become lighter, shorter and less painful
- —-MAY happen with Jaydess
How painful is the insertion of an IUD or IUS?
QUICK but painful with insertion
- 5/10 for Nulliparous
- 3/10 for multiparous
What is the mode of action of IUD?
- prevention of fertilisation (by making it hard for the sperm to survive)
- INFLAMMATORY response in endometrium
What medical conditions is C/I with IUD use ?
PID unexplained vaginal bleeding cervical cancer persistently high hCG levels endometrial cancer STI symptoms
How does IUD affect periods?
- makes it HEAVIER, longer and PAINFUL
esp. first 3 months
Which contraceptive might be the only acceptable contraceptive after Breast Cancer?
- Copper IUD
Which LARC can be used as emergency contraceptive, post-coital?
- Copper IUD (no need to abstain)
- IUS (need to abstain from sex for 7 days)
How long does IUD last and what is its pearl index?
- 5-10 years
- 0.6%
Methods of female sterlization?
- filshie clips
- essure
- blocks fallopian tubes
- —-SHOULD ensure no risk of being pregnant when performed
Least effective contraception
- female diaphragm
What does it mean to quick start contraception?
- starting contraception when patient comes to the clinic for the first time
Which contraceptives can be given on the first occasion?
- some CHC
- POP
- IMPLANT
- DEPO
What is bridging contraception?
- when the preferred method can’t be started
(as pregnancy cannot be excluded) - interim method is used
IN what situations may emergency contraception be needed?
- when more than one COC is missed
- ring has been out for more than 48 hrs
- patch has been OFF for more than 48 hrs
- up to 5 days AFTER UPSI or within 5 days of predicted date of ovulation
What is the importance for the implant to be fitted within the first 5 days of your menstrual cycle?
- if put on any other of your menstrual cycle —need to use additional contraception (condoms) for 7 DAYS
Name the 3 methods for emergency contraception.
- Copper IUD
- ORAL ( LNG- EC: up to 72 hrs post UPSI…96hrs off licence)
(UPA-EC: up to 120 hrs post upsi =5days)
What is 10x more effective oral EC?
- copper IUD
- —-toxic to sperm, anti-implantation
When can copper IUD be inserted?
- 120 hrs post UPSI
OR - up to 5 days AFTER earliest expected date of ovulation
What should the pt be screened for prior to insertion of Cu IUD?
- STI and she should be treated for ti
Why is there a specific time in which a Cu-IUD can be inserted (within 5 days of UPSI) ?
a pregnancy does NOT implant in first 5 days
—84% IMPLANT at 8-10 days POST fertilization; earliest 6 days
Wht is the diff. btw UPA- EC and LNG-EC? And their similarity?
UPA-EC: Anti-progesterone
LNG-EC: high dose progesterone
—-both delay ovluation (not abortive)
When is the ORAL EC most effective?
LNG-EC just before LH surge
UPA-ECcan work durign LH not after peak
—–BOTH ineffective after ovulation
When is UPA c.i?
- if pt has severe acute asthma (uncontrolled by oral steroid)
- if wishing to QUICK start hormonal contraception
- must delay ongoign contraception for 5 days
- —-if hormonal contraception has been sued in past 7 days
