Contraception Flashcards
If a child is under the age of 16 how will it be assessed whether they are suitable for contraception?
Using Fraser Competence guidelines (from age 13, 12 is statutory rape)
UPSIS (unprotected sex is silly)
- Understand - risks and benefits of contraception
- Parents - encouraged but not forced to tell
- Sexual intercourse - will continue anyway
- Suffer-physical or mental health will suffer without
- Interest-contraception within best issues
What age is not suitable for contraception?
UNDER THE AGE OF 13 - they are unable to consent to sexual intercourse. Any sex in people of this age group is considered criminal
How can we categorise someone’s suitability for specific contraceptive methods?
UKMEC CRITERIA UKMEC 1 = Always usable UKMEC 2 = Benefit outweigh risks UKMEC 3 = Risks outweigh benefits UKMEC 4 = Do NOT use
Name some Short acting and long acting contraceptions
Short acting reversible methods:
- The pills, patches, rings and barrier contraception
Long acting reversible contraceptions (LARC):
- Coils, IUDs, IUSs, Implants and injectable contraceptives
Irreversible methods
- Male and female sterilisation
How effective is the COCP and POP at preventing pregnancy?
PERFECT USE = 0.3% of women become pregnant
TYPICAL USE = 9% of women become pregnant
How effective is the LNG IUS at preventing pregnancy?
PERFECT USE = 0.2% women become pregnant
TYPICAL USE = 0.2% women become pregnant
How effective are condoms at preventing pregnancy?
TYPICAL USE = 18% pregnancy rate
PERFECT USE = 2% pregnancy rate
What is the most effective method of contraception at preventing pregnancy?
Implant is most effective! (progesterone) (0.05% perfect and typical use)
What is the main benefit of barrier contraceptives and when should they be encouraged?
They are the only contraceptive method that prevents against STIs (also no hormonal effect)
- Bad at preventing against pregnancy so advise use with other contraceptive method
(they also are poorly used, interrupt sex and are very user dependent)
When is it deemed to be an ‘established pregnancy’ under UK law?
-When it has IMPLANTED in the uterine wall
(this can happen any time between 6-12 days after you ovulate and usually day 9 s used)
- Therefore preventing pregnancy before this point is not legally deemed an abortion (hence 0-5 days for emergency contraception)
What are the three options for emergency contraception the UK? (and when are they licensed?)
LEVONORGESTREL LNG
-licenced <72 hours
- ULIPRISTAL ACETATE
- lisenced up to <120 hours/5 days after UPSE
- used if copper coil cant be used/not accepted
- COPPER IUD (gold standard)
-lisenced up to <120 hours/5 days after UPSE
OR
5 days after ovulation (not implanted yet)
What do you need to know from the woman before you can decide which method of EC is most suitable?
- Date of LMP
- When the episode of UPSI was (and any other UPSI episodes)
- Where she is in her cycle
How do the two oral methods of EC work (LNG and UA)?
When can you NOT use them?
They work by preventing ovulation and so technically won’t work after day 14. (if they have ovulated>give copper coil)
When is EC indicated?
after pregnancy and TOP
ANY DAY of natural menstrual cycle
From day 21 after childbirth
From day 5 after abortion, miscarriage or ectopic
When regular contraception has been compromised or used incorrectly
When should EC be offered if a woman has missed pills?
COCP
- missed 2 or more pills (>24 hours) during week 1 of her packet (with UPSI)
POP
-1 missed pill (>12 hours) and UPSI since
How does LNG EC work and how long is it effective for?
- Progesterone basest, works by inhibiting/delaying ovulation
- Licensed for 72hours (3 days)
- NOT EFFECTIVE IF WOMAN HAS ALREADY OVULATED
When do doses of LEVONORGESTREL need repeating?
If woman vomits in 2 hours post ingestion then consider another dose
Can LEVONORGESTREL EC be given more than once in the same cycle?
Yes but off licence - senior decision
Who need doubles doses of LEVONORGESTREL EC?
- Women taking enzyme inducers (HIV, TB and epilepsy medication)
- Women BMI26+ or 70kg
How does ulipristal acetate work and how effective is it compared to LNG EC?
Any cons compared to LNG?
How long is it effective for?
Ulipristal acetate
-Binds to progesterone receptor and inhibits/delays ovulation
-It is MORE EFFECTIVE than levonorgestrel (however is effected by the progesterone pill (7 days prior, 5 days after)
Lisenced for within first 120 hours (5 days)
For how long after UPSI is EC effective?
Why is EC not a form of abortion?
120 hours (5 days) - there is little reduction in its efficacy over this time
Fertilisation happens day 6-12 after ovulation (therefore pre day 6 is stopping implantation, NOT abortion)
When should a repeat dose of UPA EC be given?
- If the woman vomits within 3 hours of taking
- BMI 26+ or >70kg
What extra advice do you need to give to women taking UPA EC about its effects? (think about interactions)
- Cannot breastfeed within 1 week of taking
- Reduce effectivness of progesterone pill taken in the 7 days prior or 5 DAYS AFTER (COCP or Prog pill)
What is the gold standard of emergency contraception?
The copper IUD. It should be offered to any woman seeking EC (although uptake is poor)