Contraception Flashcards
How does contraception preventing ovulation work?
By suppressing FSH and LH
How does conctraception preventing fertilisation work?
Creates a mechanical or surgical barrier or direct toxicity
How does contraception preventing implantation work?
Creates a hostile endometrium or direct toxicity
Which methods of contraception prevent ovulation?
Most hormonal methods
Which methods of contraception prevent fertilisation?
Condoms, diaphragm + spermicide, female and male sterilisation, intrauterine devices, hormonal methods- cervical mucous
Which methods of contraception prevent implantation?
intrauterine devices, hormonal methods
What must a diaphragm be used with?
Spermicide
List some benefits of hormonal contraception
Reduced;
- period pain
- menstrual bleeding
- irregular PV bleeding
- ovulation pain
- PMS
- Breast tenderness
- ovarian cysts
- endometriosis
- ovarian cancer
- acne
- hirsutism
Which forms of contraception will reduce PV bleeding?
Combined hormonal contraception
Intrauterine system
DMPA
Which women cannot use IUS or IUD?
Women with submucosal fibroids
How long can the IUD last?
10 years
What are the downsides of the IUD?
Makes periods heavier, longer and more painful. especially during the 3/12 post insertion
Which women may benefit from the IUD?
Women after breast cancer
Which form of contraception is more effective than the IUD?
The IUS
What are the 4 main IUS devices ?
Mirena
Levosert
Kyleena
Jaydess
What is the mirena licensed for?
Heavy periods, can be part of HRT
Often useful in endometriosis or hyperplasia
What is common after insertion of the IUS?
Spotting in the first few months
What percentage of women have amenorrhoea on mirena at 6 months?
50%
What is nexplanon?
Subdermal contraceptive implant
What is the most effective of all contraceptive methods?
Nexplanon
How long does the nexplanon last?
3 years
Which hormone/s is/are contained in the nexplanon?
Progestogen only
What is the main side effect of nexplanon?
Prolonged PV bleeding
What may be used to help bleeding on nexplanon?
Addition of the CHC
What does UKMEC 1 mean?
Always useable, no increased risk(s) due to condition/characteristic
What does UKMEC 2 mean?
Broadly useable, advantage(s) of method > risk(s) due to condition/characteristic- consider follow up
What does UKMEC 3 mean?
Counsel/caution; risk(s) due to condition/characteristics > advantage(s) of method- expert opinion or specialist referral required
What does UKMEC 4 mean?
Do not use, method contraindicated due to condition/characteristic; do not prescribe
How should the COC be taken?
Start in the first 5 days of period
OR
At any time in cycle when reasonably sure not pregnant, plus condoms for 7 days
What should be done if there is spotting during the COC?
Stop for 4 days and then restart
What might impair the COC?
Impaired absorption; -GI conditions Increased metabolism; -liver enzyme induction, drug interaction Forgetting
What are the risks of the COC?
Venous thrombosis Arterial thrombosis Adverse effects on some cancers Systemic hypertension Arterial disease
How often should BP be checked on the COC?
Every 3 months
What other risk factor may increase the risk of MI in COC users?
Smoking
What BP indicates a higher risk of MI and stroke in COC users than hypertensive non-COC users?
Systolic >= 160mmHg
Diastolic <= 95mmHg
What is migraine with aura?
A change occurring 5-20 minutes before the onset of headache
What may an aura be?
Visual, scotoma, altered sensation, smell or taste, hemiparesis
What is the risk of migraine with aura?
Increases the risk of ischaemic stroke- don’t give COC
Which age automatically puts you in the UKMEC 2 category
> 35yrs
What are the unwanted effects of the COC?
Breast cancer, 1.24 increased relative risk
Cervical cancer- small increased risk
How long does breast cancer risk take to reduce to background after stopping COC use?
10 years
How long does cervical cancer risk take to reduce to background after stopping COC use?
10 years
What are the positive effects of COC?
Protection against ovarian (20% reduction for every 5 years of use to a maximum 50% reduction after 15 years use) and endometrial cancer (20-50% reduction)
What are the benefits of combined hormonal contraceptives?
- Beneficial effect on acne- antiandrogen/ progestogen/ antiglucocorticoid
- less bleeding
- fewer functional ovarian cysts
- pre-menstrual syndrom
- PCOS
How should the POP be started?
Day 1-5 of period
OR
anytime if reasonably sure not pregnant plus condoms 2 days
How does depo provera/sayana press work?
Lowers oestradiol
Supresses FSH
How effective is the diaphragm?
71-88% effective with typical use
How is vasectomy done?
Local or general anaesthetic
No-scalpel technique
What are the complications of vasectomy?
- Anaesthetic
- Pain
- Infection
- Bleeding/haematoma
- failure
- non-motile sperm at 7 months
What is the failure rate of female sterilisation?
2-3/1000
Which method of female sterilisation is used in tayside?
Clip
How effective is natural family planning?
76% effective with typical use
